From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2024 Apr 1;153(4):786-793. doi: 10.1097/PRS.0000000000010712. Epub 2023 May 23.
Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other early complications remain unknown. Therefore, the aim of this study was to compare early postoperative complications in patients who underwent prepectoral breast implant reconstruction with or without ADM use.
The authors performed a retrospective cohort study of all patients at their institution who underwent prepectoral breast reconstruction from January of 2018 to June of 2021. The primary outcome was TE loss within 90 days of surgery; secondary outcomes included other complications such as infection, TE exposure, mastectomy skin flap necrosis requiring revision, and seroma.
Data on 714 patients with 1225 TEs (1060 with ADM and 165 without) were analyzed. Baseline demographics did not differ by ADM use, although mastectomy breast tissue weight was higher in patients without ADM (750.3 g versus 540.8 g; P < 0.001). Rates of TE loss were similar in reconstructions with (3.8%) ADM and without (6.7%; P = 0.09). We also did not find differences in the rates of secondary outcomes between cohorts.
ADM use had no statistically significant effect on early complication rates among patients undergoing breast reconstruction with prepectoral TEs. Still, this study was underpowered, and data trended toward statistical significance; thus, larger studies are required in the future. Additional research and randomized studies should focus on larger cohorts and examine long-term complications such as capsular contracture and implant malposition.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
胸肌前置组织扩张器（TE）用于二期乳房切除术后重建，通常与脱细胞真皮基质（ADM）的插入一起进行。然而，ADM 的使用对 TE 丢失或其他早期并发症的影响尚不清楚。因此，本研究的目的是比较接受胸肌前置乳房植入物重建的患者中使用 ADM 与不使用 ADM 的早期术后并发症。
作者对 2018 年 1 月至 2021 年 6 月期间在其机构接受胸肌前置乳房重建的所有患者进行了回顾性队列研究。主要结局是手术 90 天内 TE 丢失；次要结局包括感染、TE 暴露、需要修正的乳房皮瓣坏死、血清肿等其他并发症。
分析了 714 例患者的 1225 个 TE（1060 个有 ADM，165 个没有）的数据。ADM 使用与否的基线人口统计学特征没有差异，尽管没有 ADM 的患者乳房组织重量更高（750.3 克比 540.8 克；P < 0.001）。有（3.8%）和没有（6.7%；P = 0.09）ADM 的重建中 TE 丢失率相似。我们还没有发现两个队列之间的次要结局发生率有差异。
在接受胸肌前置 TE 乳房重建的患者中，ADM 的使用对早期并发症发生率没有统计学上的显著影响。尽管如此，本研究的效力不足，数据也有统计学意义的趋势；因此，未来需要更大规模的研究。未来的研究应侧重于更大的队列，研究长期并发症，如包膜挛缩和植入物错位。
临床问题/证据水平：治疗性，III 级。
