Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK.
Department of Breast Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK.
BJS Open. 2020 Feb;4(1):71-77. doi: 10.1002/bjs5.50236. Epub 2019 Dec 19.
Single-stage reconstruction is used widely after mastectomy. Prepectoral implant placement is a relatively new technique. This multicentre audit examined surgical outcomes following prepectoral reconstruction using acellular dermal matrix (ADM).
All patients who had a mastectomy with prepectoral breast reconstruction and ADM in the participating centres between January 2015 and December 2017 were included. Demographic and treatment details, and short- and long-term operative outcomes were recorded. Factors affecting complications and implant loss were analysed: age, BMI, smoking status, diabetes, vascular disease, laterality of surgery, previous ipsilateral breast surgery or radiotherapy, indication for surgery (invasive versus in situ carcinoma, or risk reduction), type of mastectomy, axillary clearance, breast volume, implant volume, and neoadjuvant and adjuvant chemotherapy.
A total of 406 reconstructions were performed across 18 centres. Median follow-up was 9·65 months. Median hospital stay was 1 day. The 90-day unplanned readmission rate was 15·7 per cent, and the return-to-theatre rate 16·7 per cent. Some 15·3 per cent of patients had a major complication, with a 90-day implant loss rate of 4·9 per cent. A further six patients had delayed implant loss. In multivariable analysis, no factor was significantly associated with complications or implant loss.
Prepectoral breast reconstruction with ADM has satisfactory surgical outcomes. The duration of follow-up needs to be extended to examine outcomes in patients who received adjuvant radiotherapy.
乳房切除术后广泛采用单阶段重建。胸肌前置植入物放置是一种相对较新的技术。这项多中心审计研究检查了使用脱细胞真皮基质（ADM）进行胸肌前置重建后的手术结果。
所有在参与中心于 2015 年 1 月至 2017 年 12 月期间进行乳房切除术和胸肌前置乳房重建并使用 ADM 的患者均被纳入研究。记录人口统计学和治疗细节以及短期和长期手术结果。分析了影响并发症和植入物丢失的因素：年龄、BMI、吸烟状况、糖尿病、血管疾病、手术侧、同侧乳房手术或放疗史、手术指征（浸润性与原位癌，或降低风险）、乳房切除术类型、腋窝清扫、乳房体积、植入物体积、新辅助和辅助化疗。
在 18 个中心进行了总共 406 例重建。中位随访时间为 9.65 个月。中位住院时间为 1 天。90 天非计划性再入院率为 15.7%，重返手术室率为 16.7%。约 15.3%的患者发生严重并发症，90 天内植入物丢失率为 4.9%。另有 6 例患者发生延迟性植入物丢失。多变量分析显示，没有任何因素与并发症或植入物丢失显著相关。
ADM 胸肌前置乳房重建具有令人满意的手术结果。需要延长随访时间，以检查接受辅助放疗患者的结果。
