From the Departments of Plastic Surgery and Breast Services, Cleveland Clinic.
Plast Reconstr Surg. 2020 Aug;146(2):250-254. doi: 10.1097/PRS.0000000000006976.
The concept of sensate autologous breast reconstruction is not novel, and prior literature has focused mainly on sensate abdominally based breast reconstruction. The goal of this article is to present the authors' results with a novel technique performing sensate implant-based reconstruction. A database was prospectively maintained for patients who underwent implant-based sensate breast reconstruction. The anterior branch of the lateral fourth intercostal is identified and preserved during the mastectomy by the breast surgeon. A processed nerve allograft is used as an interpositional graft connecting the donor nerve to the targeted nipple-areola complex. The sensory recovery process was objectively monitored using a pressure-specified sensory device. Thirteen patients underwent the proposed technique. Eight patients with 15 breasts were monitored for sensory recovery. For sensory measurement, the nipple had a mean threshold of 67.33 ± 34.48 g/nm. The upper inner (29 ± 26.75 g/nm) and upper outer (46.82 ± 32.72 g/nm) nipple-areola complex quadrants demonstrated better scores during the moving test compared with the static test. Mean time between the test and surgery was 4.18 ± 2.3 months, and mean time between the second test and surgery was 10.59 ± 3.57 months. Threshold improvements were documented after the second test for all nipple-areola complex areas evaluated. This is the first study to report on early results obtained after performing sensate implant-based breast reconstruction. More studies are required to determine the long-term outcomes and impact on quality of life and to assess whether patient or breast characteristics impact the success of this procedure.
感觉自体乳房重建的概念并不新颖，先前的文献主要集中在基于腹部的感觉乳房重建上。本文的目的是介绍作者在新型可感知植入物乳房重建方面的结果。一个数据库被前瞻性地维护，用于接受基于植入物的可感知乳房重建的患者。乳房外科医生在乳房切除术期间识别并保留第四肋间外侧前支。使用处理过的神经同种异体移植物作为将供体神经连接到目标乳头乳晕复合体的中间移植物。使用压力特定的感觉装置客观监测感觉恢复过程。13 名患者接受了拟议的技术。8 名患者的 15 只乳房接受了感觉恢复监测。对于感觉测量，乳头的平均阈值为 67.33 ± 34.48 g/nm。在上内象限（29 ± 26.75 g/nm）和上外象限（46.82 ± 32.72 g/nm）乳头乳晕复合体象限中，在移动测试中比在静态测试中表现出更好的评分。测试和手术之间的平均时间为 4.18 ± 2.3 个月，第二次测试和手术之间的平均时间为 10.59 ± 3.57 个月。评估的所有乳头乳晕复合体区域在第二次测试后都记录到阈值提高。这是第一项报告关于进行基于可感知植入物的乳房重建后获得的早期结果的研究。需要更多的研究来确定长期结果以及对生活质量的影响，并评估患者或乳房特征是否会影响该手术的成功率。
