Plastic Surgery Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale Regina Margherita 302, 00198, Rome, Italy.
Department of Plastic and Reconstructive Surgery, Ulss 9 General Hospital, Treviso, Italy.
Aesthetic Plast Surg. 2021 Feb;45(1):51-60. doi: 10.1007/s00266-020-01892-y. Epub 2020 Aug 28.
The use of conservative mastectomies has risen significantly during the last few years. The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques. The initial trend in Italian centers was to use dual-plane hybrid reconstruction. However, a high level of complications has been registered. From 2015 onward, in our centers, a pre-pectoral approach has been adopted. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates.
A multicenter retrospective clinical study was performed from January 2010 to June 2018. The enrolled patients were divided into two groups: Cases with an ADM-only coverage pre-pectoral reconstruction made up the first group (Group 1). Those with the retro-pectoral muscular position + ADM implant coverage comprised the second one (Group 2). Complications such as seroma, hematoma, wound dehiscence, surgical site infection, reconstruction failure, animation deformity and capsular contracture were recorded.
We performed 716 direct-to-implant reconstructions: 509 were partially sub-pectoral and 207 were pre-pectoral. Minimum follow-up was 1 year. Incidence of complications was higher in dual-plane reconstructions. There were statistical significant differences in the rates of seroma and hematoma.
Using the pre-pectoral approach, the authors have experienced favorable aesthetics and superior clinical and functional outcomes. Retro-pectoral muscular ADM implant coverage has to be considered only in specific complicated second-stage surgeries.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
近年来，保守性乳房切除术的应用显著增加。随着现代乳房切除术技术的发展，直接向植入物重建的重建选择变得更加可行。意大利中心的初始趋势是使用双平面混合重建。然而，已经登记了高水平的并发症。自 2015 年以来，我们的中心采用了前胸壁入路。作者试图描述意大利逐渐放弃使用假体下外侧极覆盖的胸肌下技术的趋势，使用 ADM 比较使用 ADM 无任何肌肉解剖的前胸壁入路，就并发症发生率而言。
进行了一项多中心回顾性临床研究，时间为 2010 年 1 月至 2018 年 6 月。入组患者分为两组：仅 ADM 覆盖前胸壁重建的病例构成第一组（组 1）。那些具有后胸肌位置+ADM 植入物覆盖的构成第二组（组 2）。记录了血清肿、血肿、伤口裂开、手术部位感染、重建失败、运动畸形和包膜挛缩等并发症。
我们进行了 716 例直接向植入物重建：509 例为部分胸肌下，207 例为前胸壁。最小随访时间为 1 年。双平面重建的并发症发生率较高。血清肿和血肿的发生率有统计学显著差异。
使用前胸壁入路，作者获得了良好的美学效果和更好的临床和功能结果。仅在后胸肌 ADM 植入物覆盖的情况下，应考虑进行特定的复杂二期手术。
证据水平 V：本杂志要求作者为每篇文章分配一个证据水平。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南 www.springer.com/00266 。
