Kraenzlin Franca S, Darrach Halley, Chopra Karan, Rosson Gedge D, Broderick Kristen P, Sacks Justin M
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Md.
Plast Reconstr Surg Glob Open. 2020 May 27;8(5):e2850. doi: 10.1097/GOX.0000000000002850. eCollection 2020 May.
Roughly 80% of patients undergoing mastectomy in the United States opt for reconstruction with implants. The introduction of acellular dermal matrices has allowed for placement of breast prostheses in the prepectoral plane, while a new carbon dioxide tissue expander (TE) (AeroForm) allows for needle-free, patient-controlled expansion. These 2 novel technologies have ushered in a new patient-centered era of breast reconstruction, with the possibility of reducing patient morbidity for the first time in decades. We hypothesize that AeroForm expanders placed in the prepectoral plane reduce time to second-stage reconstruction, reduce the number of clinic visits, and have lower complications than traditional saline TEs.
This is a retrospective review of all patients undergoing breast mastectomy and TE placement in the prepectoral plane over a 21-month period (169 patients, 267 breasts), comparing AeroForm expanders to TEs.
The AeroForm group (n = 57) had a shorter period to second-stage reconstruction than the TE group (n = 210) (135.4 versus 181.7 days; = 0.01) and required fewer clinic visits (5.1 versus 6.9; < 0.01). Partial thickness (25.6% versus 12.3%, = 0.03) and full thickness (8.7% versus 0.0%, = 0.02) necrosis were more common in the saline cohort. The rates of infection, hematoma, and seroma requiring drainage were not statistically significant between the 2 groups.
Two-staged breast reconstruction with the use of AeroForm expanders in the prepectoral space marks progress in improving care for breast cancer patients by demonstrating a reduction in some adverse events, the number of clinic visits, and the time to second-stage reconstruction.
在美国，接受乳房切除术的患者中约80%选择植入物重建。脱细胞真皮基质的引入使得乳房假体能够放置在胸肌前平面，而一种新型二氧化碳组织扩张器（AeroForm）实现了无针、患者自控扩张。这两项新技术开创了以患者为中心的乳房重建新时代，有可能数十年来首次降低患者的发病率。我们假设，置于胸肌前平面的AeroForm扩张器可缩短二期重建时间，减少门诊就诊次数，且并发症低于传统盐水扩张器。
这是一项对在21个月期间接受乳房切除术并在胸肌前平面放置扩张器的所有患者（169例患者，267侧乳房）进行的回顾性研究，将AeroForm扩张器与传统扩张器进行比较。
AeroForm组（n = 57）二期重建时间短于传统扩张器组（n = 210）（135.4天对181.7天；P = 0.01），且门诊就诊次数更少（5.1次对6.9次；P < 0.01）。盐水扩张器组部分厚度坏死（25.6%对12.3%，P = 0.03）和全层坏死（8.7%对0.0%，P = 0.02）更为常见。两组间感染、血肿及需要引流的血清肿发生率无统计学差异。
在胸肌前间隙使用AeroForm扩张器进行两阶段乳房重建，通过减少一些不良事件、门诊就诊次数和二期重建时间，标志着在改善乳腺癌患者护理方面取得了进展。
