胸大肌前置两阶段假体乳房重建术联合与不联合脱细胞真皮基质：我们能看出区别吗？
Prepectoral Two-Stage Implant-Based Breast Reconstruction with and without Acellular Dermal Matrix: Do We See a Difference?
机构信息
From the Division of Plastic Surgery, Mayo Clinic; the Department of Plastic and Reconstructive Surgery, China Medical University Hospital; the Department of Plastic Surgery, National Cancer Institute of Peru; the Department of Plastic and Burn Surgery, Arzobispo Loayza National Hospital; and the Departamento De Cirugía Plástica y Reconstructiva, Hospital Militar Central, Universidad Militar "Nueva Granada."
出版信息
Plast Reconstr Surg. 2020 Feb;145(2):263e-272e. doi: 10.1097/PRS.0000000000006442.
BACKGROUND
Prepectoral implant-based breast reconstruction has gained popularity because of advantages over the subpectoral technique. Acellular dermal matrix use with implant-based breast reconstruction has become common because of its perceived superior aesthetic outcome. Matrices are expensive, however, and recent evidence has pointed to several potential complications. This article reports a series of prepectoral implant-based breast reconstructions with and without acellular dermal matrix and compared their outcomes.
METHODS
This is a single-surgeon retrospective review of patients who underwent staged prepectoral implant-based breast reconstruction following nipple-sparing mastectomy over two periods. Patients with well-perfused mastectomy skin flaps with a homogeneous thickness underwent reconstruction with acellular dermal matrix initially. On evolution of the practice, it was not used. Patient demographics, operative data, and complications were analyzed. Aesthetic outcome was measured by the BREAST-Q survey and the Aesthetic Item Scale. A cost analysis was also performed.
RESULTS
Forty patients were included (acellular dermal matrix group, n = 19; non-acellular dermal matrix group, n = 21). The nonmatrix group had one case (5 percent) of seroma and one case (5 percent) with hematoma; there were none in the acellular dermal matrix group. Average BREAST-Q and Aesthetic Item Scale scores were 82.3 versus 81.6 (p = 0.954) and 20.98 versus 20.43 (p = 0.640) for the matrix and nonmatrix groups, respectively. The direct cost savings for the authors' institution over 1 year if matrix was not used in all cases of implant-based breast reconstruction would be estimated at $3,105,960 to $6,211,920 for unilateral and bilateral cases, respectively, for Medicare reimbursement.
CONCLUSIONS
With adequate patient selection, acellular dermal matrix is not always required during two-stage prepectoral implant-based breast reconstruction for good aesthetic outcomes. The economic burden on patients and the health care system could be lessened with selective matrix use.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
由于相对于胸肌下技术的优势， 假体乳房重建的前胸部植入已越来越受欢迎。 由于其认为具有更好的美学效果， 因此在假体乳房重建中使用脱细胞真皮基质已变得很普遍。 然而， 基质昂贵， 最近的证据指出了几种潜在的并发症。 本文报告了一系列使用和不使用脱细胞真皮基质的假体乳房重建的前胸部植入， 并比较了它们的结果。
方法
这是一位外科医生对接受过乳头保留乳房切除术的患者进行的单阶段回顾性研究， 这些患者在两个时期接受了分期前胸部假体乳房重建。 具有良好灌注的乳房皮瓣和均匀厚度的患者最初接受了脱细胞真皮基质重建。 在实践的发展过程中， 不再使用该基质。 分析了患者的人口统计学， 手术数据和并发症。 通过 BREAST-Q 调查和美学项目量表来衡量美学结果。 还进行了成本分析。
结果
共有 40 例患者入选（脱细胞真皮基质组， n = 19；非脱细胞真皮基质组， n = 21）。 非基质组有 1 例（5％）血清肿和 1 例（5％）血肿；基质组无任何病例。 基质组和非基质组的平均 BREAST-Q 和美学项目量表评分分别为 82.3 和 81.6（p = 0.954）和 20.98 和 20.43（p = 0.640）。 如果在所有假体乳房重建中都不使用基质，则作者所在机构的直接成本节省估计为每年单侧和双侧病例分别为 3105960 美元至 6211920 美元， 适用于医疗保险报销。
结论
在适当的患者选择下， 在两阶段前胸部假体乳房重建中， 不一定需要脱细胞真皮基质即可获得良好的美学效果。 选择性使用基质可以减轻患者和医疗保健系统的经济负担。
临床问题/证据水平： 治疗性， III 级。
Zotero 插件