Luo Jessica, Willis Rhett N, Ohlsen Suzanna M, Piccinin Meghan, Moores Neal, Kwok Alvin C, Agarwal Jayant P
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
Michigan State University College of Osteopathic Medicine, East Lansing, Michigan.
Arch Plast Surg. 2022 Apr 6;49(2):166-173. doi: 10.1055/s-0042-1744408. eCollection 2022 Mar.
The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26-70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1-25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%, = 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8-32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.
脱细胞真皮基质（ADM）应用于乳房重建，使外科医生能够在乳房切除术后乳房重建中重新探索胸肌前植入物放置技术。我们机构采用了一种新颖的方法，即使用网状ADM来减轻胸肌前乳房重建中ADM使用量增加带来的经济负担。这是一项回顾性、单中心研究，对使用人源网状ADM进行前侧假体覆盖的两阶段胸肌前乳房重建进行了评估。研究了患者的人口统计学数据、肿瘤学数据、围手术期特征和并发症，并以均值和标准差的形式进行报告。评估了网状技术的成本节约情况。本研究纳入了48例患者（72侧乳房），平均年龄为48.5±15.0岁（范围26 - 70岁）。平均随访时间为13.2±4.4个月（范围4.1 - 25.8个月）。19侧乳房（24.6%）出现并发症，其中血清肿是最常见的并发症（12.5%，n = 9）。扩张器取出和再次手术的发生率分别为8.3%和9.7%。引流管拔除的平均时间为18.8±6.6天（范围8 - 32天）。网状ADM单侧重建平均节约成本6601美元，双侧重建平均节约成本13202美元。我们的研究发现，人源网状ADM可安全用于两阶段胸肌前组织扩张器乳房重建，并可显著节约成本。
