Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:266-275. doi: 10.1016/j.bjps.2023.06.070. Epub 2023 Jul 3.
Acellular dermal matrices (ADMs) play an essential role in prepectoral implant-based breast reconstructions; however, the most appropriate method for ADMs is unknown.
We conducted a retrospective analysis of our institutional database. Patients who underwent mastectomy and prepectoral breast reconstruction using tissue expanders or breast implants covered with ADMs between March 2018 and June 2021 were included. Patient characteristics, postoperative complications, and long-term outcomes were investigated.
In total, 112 patients (126 breasts) were included. The anterior tenting and wrapping techniques were used in the reconstruction of 32 (25.3%) and 94 (74.7%) breasts, respectively. Using propensity score matching, nine breasts were selected for each technique within the direct-to-implant reconstruction group, while 16 breasts were selected for each technique within the 2-stage reconstruction group. The choice of technique (anterior vs. wrapping) in implementing ADM did not generate any significant differences in postoperative complications, including seroma formation and capsular contracture, for the direct-to-implant and 2-stage reconstruction groups. Regarding the direct-to-implant reconstruction group, the average postoperative drain volume was less in the anterior tenting group than that in the wrapping group (anterior tenting vs. wrapping; 495.09 ± 156.118 mL vs. 673.43 ± 307.954 mL, p = 0.006), but the difference was insignificant after propensity score matching.
We report our experience with covering prosthetic devices with ADMs during postmastectomy breast reconstruction. No differences in the postoperative drain volume or postoperative outcomes were found between the study groups. Future studies are needed to determine the method that provides the most satisfactory results.
脱细胞真皮基质（ADM）在胸肌前置假体乳房重建中起着重要作用；然而，最合适的 ADM 方法尚不清楚。
我们对我院的数据库进行了回顾性分析。纳入 2018 年 3 月至 2021 年 6 月期间接受组织扩张器或 ADM 覆盖的假体乳房切除术和胸肌前置乳房重建的患者。研究了患者特征、术后并发症和长期结果。
共纳入 112 例（126 侧乳房）患者。重建中分别使用前悬带和包裹技术的乳房分别为 32（25.3%）和 94（74.7%）侧。在直接植入重建组中，每个技术选择 9 个乳房，在 2 期重建组中，每个技术选择 16 个乳房进行倾向评分匹配。在直接植入重建组中，ADM 实施中技术（前悬带与包裹）的选择对术后并发症（包括血清肿形成和包膜挛缩）没有显著差异。对于直接植入重建组，前悬带组的术后平均引流体积小于包裹组（前悬带与包裹；495.09 ± 156.118 ml vs. 673.43 ± 307.954 ml，p = 0.006），但倾向评分匹配后差异无统计学意义。
我们报告了在乳房切除术后重建中使用 ADM 覆盖假体装置的经验。研究组之间在术后引流体积或术后结果方面没有发现差异。需要进一步的研究来确定提供最满意结果的方法。
