Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy.
Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy.
Medicina (Kaunas). 2023 Jun 30;59(7):1231. doi: 10.3390/medicina59071231.
: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. : A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. : Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. : The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.
: 胸前预置假体在乳房重建中是目前乳房外科医生必备的技能。新工具和保乳手术的引入改变了这一领域的游戏规则。胸前预置平面通常与假体的 ADM 包裹同时进行。ADM 是一种无细胞真皮基质，包含结构整合的基底膜复合物和细胞外基质。文献报道 ADM 可能有用，但适当的患者选择、手术放置和术后管理对于释放该工具的潜力至关重要，因为这些因素有助于基质与周围组织的适当整合。: 2016 年至 2022 年期间，我们机构共进行了 245 例胸前预置假体或扩张器联合 ADM 的乳房重建。我们进行了一项回顾性研究，以记录患者特征、危险因素、手术程序、重建过程和并发症。根据我们的经验，我们制定了细致的重建方案，以优化手术实践并降低并发症发生率。我们比较了 DTI 和两阶段重建。: 血清肿是我们观察到的最常见的早期并发症（术后 90 天内）；然而，大多数在门诊引流并迅速愈合。需要更多几周敷料处理的伤口二期愈合是第二常见的早期并发症（10.61%）。波纹是最常见的晚期并发症，尤其是在 DTI 患者中。比较 DTI 和两阶段重建后，未发现并发症显著增加。: 胸前预置乳房重建的缺点是基质整合不良，导致血清肿和其他并发症。ADM 起移植物的作用；它需要固定和健康的组织来固定。为了实现这一点，有三个关键步骤需要遵循：（1）患者选择适当；（2）术中技术的保存和轻柔处理；（3）术后管理细致。
