From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.
Plast Reconstr Surg. 2021 Mar 1;147(3):580-584. doi: 10.1097/PRS.0000000000007638.
Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
胸肌前置乳房重建术已将与基于肌肉下植入物的乳房重建相关的发病率和动态畸形降至最低。然而，在即刻植入物重建中，依赖脱细胞真皮基质进行植入物覆盖仍然受到高材料成本的限制。作者描述了一种技术，即将胸肌前置重建中的前侧植入物覆盖物分为脱细胞真皮基质的下外侧和合成的、可吸收的网片的上侧。使用脱细胞真皮基质的下侧提供覆盖并加强乳房下皱襞，而可吸收的网片则被修剪并以适当的张力缝合到脱细胞真皮基质上，以支撑植入物并减轻乳房切除术皮瓣的压力。对一家医疗机构中使用该技术进行的所有连续一期胸肌前置乳房重建的患者进行了回顾性分析。查询并分析了患者的人口统计学、乳房切除术和重建特征、重建结果以及支撑材料的成本。11 名患者（21 个乳房）接受了使用 Vicryl 和脱细胞真皮基质前侧覆盖的胸肌前置即刻植入物重建。平均乳房切除术重量为 775.8 克。所有病例均使用光滑、圆形的粘性植入物，平均植入物大小为 514.5 毫升。总的并发症发生率较低，包括一例轻微感染（4.8%）、一例轻微乳房切除术皮瓣坏死和部分乳头坏死各一例（4.8%）。单侧使用 Vicryl 和脱细胞真皮基质前侧覆盖的计算节省成本高达 3415 美元，双侧病例的节省成本高达 6830 美元。使用脱细胞真皮基质下侧和 Vicryl 网片上侧的胸肌前置乳房重建是一种安全的技术，可降低与支撑材料相关的材料成本，并使外科医生能够精确控制植入物口袋和位置。
临床问题/证据水平：治疗性，IV。
