Albright William B, Hawkes Patrick J
Aesthet Surg J Open Forum. 2019 Oct 23;2(1):ojz031. doi: 10.1093/asjof/ojz031. eCollection 2020 Jan.
As immediate direct to permanent implant-based breast reconstruction (IBBR) continues to gain in popularity, surgeons seek to apply these techniques to patients with large or ptotic breasts. A new bell pattern skin excision is described and limits major complications in this high-risk population.
The authors describe a novel skin excision pattern for patients with large or ptotic breasts who desire IBBR and assess its safety. The authors also evaluated the ability of the pattern to account for intraoperative developments.
This retrospective analysis of a single surgeon's experience included 17 consecutive patients (31 breasts) with large or ptotic breasts undergoing skin-reducing mastectomy with attempted utilization of the bell pattern approach and IBBR with acellular dermal matrix.
Mean age was 50 years, mean body mass index was 27.4 kg/m, and mean breast specimen weight was 683 g. A bell pattern excision was planned for all breasts preoperatively. Three breasts (10%) required an alternative closure pattern due to intraoperative ischemia ( = 1), or additional oncologic resection ( = 2). The pattern successfully accommodated flap ischemia in 8 (26%) other breasts. After a median follow-up of 5.1 months, the number of bell pattern breasts with major and minor complications was 0 (0%) and 9 (32%), respectively. The most common minor complication was seroma ( = 5, 18%), and minor incision wound ( = 3, 11%). There were no reconstruction failures utilizing the bell pattern.
The bell pattern approach is a safe and adaptable alternative to traditional skin-reducing mastectomy in patients with large or ptotic breasts.
随着基于即刻直接至永久植入物的乳房重建术（IBBR）越来越受欢迎，外科医生试图将这些技术应用于乳房较大或下垂的患者。本文描述了一种新的钟形皮肤切除术式，该术式可减少这一高风险人群的主要并发症。
作者描述了一种适用于希望接受IBBR的乳房较大或下垂患者的新型皮肤切除模式，并评估其安全性。作者还评估了该模式应对术中情况变化的能力。
这项对单一外科医生经验的回顾性分析纳入了17例连续患者（31侧乳房），这些患者乳房较大或下垂，接受了缩乳乳房切除术，并尝试采用钟形模式和带脱细胞真皮基质的IBBR。
平均年龄为50岁，平均体重指数为27.4kg/m，平均乳房标本重量为683g。术前所有乳房均计划采用钟形切除术式。3侧乳房（10%）因术中缺血（1侧）或额外的肿瘤切除（2侧）需要采用替代闭合模式。该模式在另外8侧乳房（26%）中成功应对了皮瓣缺血情况。中位随访5.1个月后，采用钟形模式的乳房出现严重和轻微并发症的数量分别为0（0%）和9（32%）。最常见的轻微并发症是血清肿（5例，18%）和小切口伤口（3例，11%）。采用钟形模式未出现重建失败情况。
对于乳房较大或下垂的患者，钟形模式是传统缩乳乳房切除术的一种安全且适应性强的替代方法。
