Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
Eur J Surg Oncol. 2020 Apr;46(4 Pt A):511-515. doi: 10.1016/j.ejso.2019.10.042. Epub 2019 Nov 1.
Acellular dermal matrices (ADM) are increasingly used in implant-based breast reconstruction (IBR). Uncertainty remains with regard to their efficacy and complications. The aim of this study was to evaluate the outcomes and complication rates associated with the use of ADMs in IBR.
Retrospective cohort study of patients undergoing ADM-assisted IBR between 2008 and 2013. Cases were identified from a prospectively collected database. Simple descriptive statistics and logistic regression analysis were performed.
A total of 110 patients (175 mastectomies) were included in the analysis. The median age was 46 (19-75) years and the median BMI was 22.2 (16.2-41.5). Seventy nine mastectomies were performed for therapeutic purposes. The median mastectomy weight was 244 (185-335) gr. The majority of reconstructions were performed with fixed volume (n = 115, 66%) or permanent expandable implants (n = 53, 30%) as one-stage procedures. Forty mastectomies were associated with at least one complication. The infection rate was 2.3% (n = 4). Post-operative haematoma developed in 5 cases (2.9%), but only 2 required surgical interventions. Three mastectomies were complicated by nipple necrosis (3.6%), 3 with skin necrosis (1.7%) and 9 with wound dehiscence (5.1%). The capsule formation rate was 2.3% (n = 4). Reconstruction failure with implant loss occurred in 3 cases (1.7%).
The complication rates following ADM-assisted IBR can be very low with appropriate patient selection and meticulous surgical technique. This supports the safety of using ADM in carefully selected patients. Further research is warranted to assess the health economics of ADM use in IBR.
脱细胞真皮基质（ADM）越来越多地用于基于植入物的乳房重建（IBR）。其疗效和并发症仍存在不确定性。本研究旨在评估 ADM 在 IBR 中的应用相关的结果和并发症发生率。
回顾性队列研究，纳入 2008 年至 2013 年期间接受 ADM 辅助 IBR 的患者。从前瞻性收集的数据库中确定病例。采用简单描述性统计和逻辑回归分析。
共纳入 110 例（175 例乳房切除术）患者进行分析。患者的中位年龄为 46 岁（19-75 岁），中位 BMI 为 22.2（16.2-41.5）。79 例乳房切除术为治疗目的。中位乳房切除术的重量为 244 克（185-335 克）。大多数重建术采用固定容量（n=115，66%）或永久性可扩张植入物（n=53，30%）作为一期手术。40 例乳房切除术至少有 1 种并发症。感染率为 2.3%（n=4）。5 例（2.9%）出现术后血肿，但仅 2 例需要手术干预。3 例乳房切除术出现乳头坏死（3.6%），3 例出现皮肤坏死（1.7%），9 例出现伤口裂开（5.1%）。包膜形成率为 2.3%（n=4）。3 例（1.7%）发生植入物丢失的重建失败。
适当的患者选择和细致的手术技术可使 ADM 辅助 IBR 的并发症发生率非常低。这支持在精心挑选的患者中使用 ADM 的安全性。需要进一步研究来评估 ADM 在 IBR 中的使用对健康经济学的影响。
