School of Medicine, Queen's University, Kingston, Ontario, Canada.
Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada.
J Plast Reconstr Aesthet Surg. 2022 Mar;75(3):1123-1129. doi: 10.1016/j.bjps.2021.11.017. Epub 2021 Nov 14.
Direct-to-implant (DTI) reconstruction when performed using the dual-plane technique can be associated with increased postoperative pain, longer recovery, functional impairment, and animation deformity. These issues can be avoided by using the pre-pectoral technique that traditionally uses larger pieces of the acellular dermal matrix (ADM) and results in increased costs. It is unclear how these two methods compare when the technique is modified to avoid the use of additional ADM.
A retrospective chart review was conducted of all patients who underwent DTI breast reconstruction using a dual-plane or pre-pectoral technique between January 2014 and December 2019. Pre-pectoral breast reconstruction was performed using a partial anterior coverage technique, and therefore no additional ADM was used per case as compared to the dual-plane technique. Rates of post-surgical complications were compared between the two groups.
Of 77 patients, 48 (86 breasts) underwent dual-plane reconstruction, whereas 29 (48 breasts) underwent pre-pectoral reconstruction. Mean follow-up time for the dual-plane and pre-pectoral groups was 23.3 and 8.7 months, respectively (p<0.001). There were no significant differences in the rates of any of the short-term post-surgical outcomes between the two groups: seroma (14% vs 6.3%, p = 0.175); hematoma (2.3% vs 4.2%, p = 0.617); skin/nipple necrosis (7% vs 10.4%, p = 0.522); wound skin infection (2.3% vs 2.1%, p = 1.0); wound dehiscence (4.7% vs 2.1, p = 0.654); and implant loss (1.2% vs 8.3%, p = 0.055).
Pre-pectoral reconstruction using a partial anterior coverage technique appears to be a safe alternative to dual-plane reconstruction when considering short-term post-surgical complications.
使用双平面技术进行直接到植入物（DTI）重建可能会增加术后疼痛、恢复时间延长、功能障碍和动画畸形。通过使用传统上使用更大的脱细胞真皮基质（ADM）的胸肌前技术可以避免这些问题，但会增加成本。当修改技术以避免使用额外的 ADM 时，尚不清楚这两种方法如何比较。
对 2014 年 1 月至 2019 年 12 月期间接受 DTI 乳房重建的所有患者进行了回顾性图表审查，使用双平面或胸肌前技术进行了回顾性图表审查。胸肌前乳房重建采用部分前覆盖技术，因此与双平面技术相比，每个病例均不使用额外的 ADM。比较两组术后并发症发生率。
在 77 名患者中，48 名（86 只乳房）接受了双平面重建，而 29 名（48 只乳房）接受了胸肌前重建。双平面和胸肌前组的平均随访时间分别为 23.3 个月和 8.7 个月（p<0.001）。两组的短期术后结果发生率没有显着差异：血清肿（14%比 6.3%，p=0.175）；血肿（2.3%比 4.2%，p=0.617）；皮肤/乳头坏死（7%比 10.4%，p=0.522）；皮肤感染（2.3%比 2.1%，p=1.0）；伤口裂开（4.7%比 2.1%，p=0.654）；和植入物丢失（1.2%比 8.3%，p=0.055）。
当考虑短期术后并发症时，使用部分前覆盖技术的胸肌前重建似乎是双平面重建的安全替代方法。
