Professor of Plastic Surgery, Virginia Commonwealth University - Inova Branch, McLean, VA.
Aesthet Surg J. 2020 Nov 17;40(Suppl 2):S29-S37. doi: 10.1093/asj/sjaa164.
Prepectoral placement of prosthetic devices is rapidly becoming the preferred method of breast reconstruction.
The objective of this study was to review long-term surgical and aesthetic outcomes following prepectoral prosthetic breast reconstruction.
The study included 90 patients (139 breasts). Follow-up for all patients ranged from at least 1 year up to a maximum of 4.3 years. Parameters analyzed included preoperative and postoperative breast symmetry, rippling, edge visibility, and capsular contracture, as well as secondary procedures such as fat grafting, implant exchange, contralateral procedures, and autologous flap conversion.
The incidence of breast symmetry, which was noted preoperatively in 84.4% of patients, gradually declined to 68.9% after 1 to 2 years and to 56.7% after 2 to 5 years. Rippling and edge visibility were noted in 19.4% and 12.9% of patients, respectively. Explantation without replacement of the device was performed in 12 breasts (8.6%). Secondary procedures included autologous fat grafting (23.7%), implant replacement (7.2%), conversion to an autologous flap (12.2%), and a contralateral breast procedure in 15 of 41 patients (36.6%). Capsular contracture (grade 3-4) was demonstrated in 14 of 139 breasts (10.1%).
Prepectoral breast reconstruction can provide good to excellent short-term (1-2 years) and longer-term (2-4.3 years) benefits; however, over time, the quality of prepectoral breast reconstruction as well as breast symmetry can change due to various factors.
假体在胸大肌前放置正在迅速成为乳房重建的首选方法。
本研究旨在回顾胸大肌前置假体乳房重建的长期手术和美学效果。
本研究纳入了 90 例患者（139 侧乳房）。所有患者的随访时间至少为 1 年，最长为 4.3 年。分析的参数包括术前和术后乳房对称性、波纹、边缘可见度和包膜挛缩，以及脂肪移植、假体置换、对侧手术和自体皮瓣转换等二次手术。
术前乳房对称性为 84.4%的患者，术后 1-2 年逐渐下降至 68.9%，2-5 年下降至 56.7%。19.4%和 12.9%的患者分别出现波纹和边缘可见度问题。12 例（8.6%）乳房进行了假体取出而未置换。二次手术包括自体脂肪移植（23.7%）、假体置换（7.2%）、自体皮瓣转换（12.2%）和 41 例患者中的 15 例（36.6%）对侧乳房手术。139 例乳房中有 14 例（10.1%）发生 3-4 级包膜挛缩。
胸大肌前置乳房重建可提供良好至极好的短期（1-2 年）和长期（2-4.3 年）效果；然而，随着时间的推移，由于各种因素，胸大肌前置乳房重建的质量和乳房对称性可能会发生变化。
