From the Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA.
Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester.
Ann Plast Surg. 2022 May 1;88(3 Suppl 3):S156-S162. doi: 10.1097/SAP.0000000000003177.
The use of an inferiorly based dermal flap (IBDF) with implant insertion allows for 1-step reconstruction of a ptotic breast after mastectomy. An IBDF allows for secondary protection of the inferior pole and provides a vascularized pocket for implant insertion. Previous literature has demonstrated the use of this surgical approach for optimal patient satisfaction and higher patient-reported outcomes.For this approach, the dermal flap epidermis is removed before insetting; however, invaginations containing epithelial components may serve as a nidus for infection. There is no study that has compared the safety of an IBDF technique to standard reconstruction. We hypothesize that there is no increase in surgical complications in the IBDF approach versus standard reconstruction.
This is a single-institution retrospective chart review of all patients who underwent implant-based reconstruction from June 2016 through December 2020. Patients who did not have a permanent implant placed by December 2020 or had delayed reconstruction were excluded. Two cohorts were established: those who underwent immediate reconstruction after mastectomy via IBDF and reconstruction without an IBDF. Patient demographics, use of the IBDF technique, and surgical complications were recorded and compared.
A total of 208 breasts were included: 52 breasts in the IBDF cohort and 156 breasts in the control cohort. There were no statistically significant differences between cohorts, except that the IBDF cohort has a significantly higher body mass index (mean = 30.9 vs 26.5, P ≤ .001).There was no statistically significant difference in the rate of complications between the IBDF and control groups, including seroma (5.8% vs 3.8%), hematoma (3.8% vs 0.6%), wound dehiscence (0.0% vs. 1.9%), mastectomy flap necrosis (11.5% vs 6.4%), breast infection (5.8% vs 7.1%), implant salvage (0.0% vs 5.8%), and implant loss (5.8% vs. 5.8%), respectively.
Using an IBDF to reconstruct a ptotic breast immediately after mastectomy has a similar risk profile to an immediate standard breast reconstruction. This technique has resulted in optimal patient satisfaction scores and allows for a "one-stop reconstruction" of ptotic breasts that normally would undergo sequential revisions. In conclusion, immediate implant-based reconstruction of a ptotic breast after mastectomy using a IBDF can be performed safely.
在乳房切除术后，使用下蒂真皮瓣（IBDF）联合植入物置入可实现乳房下垂的 1 步重建。IBDF 可对下极进行二次保护，并为植入物置入提供一个血管化的口袋。先前的文献已经证明了这种手术方法可以获得最佳的患者满意度和更高的患者报告结果。对于这种方法，在嵌入之前去除真皮瓣表皮；然而，含有上皮成分的内陷可能成为感染的根源。目前尚无研究比较 IBDF 技术与标准重建的安全性。我们假设在 IBDF 方法与标准重建相比，手术并发症没有增加。
这是一项单机构回顾性图表研究，纳入了 2016 年 6 月至 2020 年 12 月期间所有接受基于植入物重建的患者。未在 2020 年 12 月前永久性植入物或延迟重建的患者被排除在外。建立了两个队列：一组是通过 IBDF 进行乳房切除术后即刻重建的患者，另一组是未行 IBDF 重建的患者。记录并比较了患者的人口统计学特征、IBDF 技术的使用情况和手术并发症。
共有 208 个乳房被纳入研究：IBDF 组 52 个乳房，对照组 156 个乳房。除 IBDF 组的体质指数明显更高（平均值为 30.9 比 26.5，P ≤.001）外，两组间无统计学显著差异。IBDF 组和对照组之间的并发症发生率无统计学差异，包括血清肿（5.8%比 3.8%）、血肿（3.8%比 0.6%）、伤口裂开（0.0%比 1.9%）、乳房皮瓣坏死（11.5%比 6.4%）、乳房感染（5.8%比 7.1%）、植入物保留（0.0%比 5.8%）和植入物丢失（5.8%比 5.8%）。
在乳房切除术后即刻使用 IBDF 重建下垂乳房的风险与即刻标准乳房重建相似。这种技术已经产生了最佳的患者满意度评分，并允许对通常需要序贯修复的下垂乳房进行“一站式重建”。总之，使用 IBDF 即刻进行乳房切除术后的下垂乳房植入物重建是安全的。
