From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth School of Medicine.
Plast Reconstr Surg. 2022 Mar 1;149(3):579-584. doi: 10.1097/PRS.0000000000008850.
Prepectoral prosthetic breast reconstruction continues to gain popularity, largely due to its decreased postoperative pain, animation deformity, and operative time as compared to subpectoral reconstruction. Widespread use has led to opportunities for surgical revisions. While some techniques for submuscular reconstruction revisions, such as implant exchange and fat grafting, also apply to prepectoral revisions, others require modification for the prepectoral space. The prosthesis' unique reliance on the mastectomy flaps and acellular dermal matrix for support leads to a progressive alteration of the breast footprint, conus, envelope, and nipple-areola complex position. To date, revisions of prepectoral reconstructions have not been addressed in the literature. This article presents the senior author's (N.P.B.) techniques for (1) revising prepectoral breast reconstructions, including staged and direct-to-implant reconstructions, with a special focus on nipple-sparing reconstruction, and (2) minimizing undesirable outcomes of prepectoral reconstruction.
胸肌前假体乳房重建术继续受到欢迎，这主要是因为与胸肌下重建术相比，其术后疼痛、动态畸形和手术时间减少。广泛的应用导致了手术修复的机会。虽然一些用于胸肌下重建术修复的技术，如植入物置换和脂肪移植，也适用于胸肌前重建术修复，但其他技术需要针对胸肌前空间进行修改。假体独特地依赖于乳房切除术皮瓣和脱细胞真皮基质来支撑，这导致乳房足迹、圆锥、包膜和乳头乳晕复合体位置的逐渐改变。迄今为止，胸肌前重建术的修复尚未在文献中报道。本文介绍了资深作者（N.P.B.）的技术，用于（1）修复胸肌前乳房重建术，包括分期和直接植入重建术，特别关注乳头保留重建术，以及（2）尽量减少胸肌前重建术的不良后果。
