Piccolo Paulo P, Venturi Mark, Mesbahi Alex N, Nahabedian Maurice Y
National Center for Plastic Surgery, McLean, VA, USA.
Gland Surg. 2023 Dec 26;12(12):1794-1805. doi: 10.21037/gs-23-279. Epub 2023 Dec 22.
Breast cancer remains the most commonly diagnosed cancer in women in the United States. In the setting of a mastectomy, implant-based reconstruction (IBR) remains the most common type of breast reconstruction performed. IBR is typically performed in two-stages (tissue expander - implant) or one stage [direct-to-implant (DTI)]. As a consequence of the limitations associated with submuscular placement of implants, prepectoral implant placement has been gaining more acceptance worldwide. The prepectoral plane eliminates the need for chest wall muscle dissection, disinsertion and manipulation avoiding the muscle related complications of the subpectoral approach such as increased pain, spasm and animation deformity. In addition, prepectoral placement shortens the recovery time and provides greater control of breast shape and contour. With the latest generation form-stable silicone implants coupled with the wide use and acceptance of acellular dermal matrices (ADMs) and other meshes to support the implant, this technique is becoming the mainstay of implant-based reconstruction, under these circumstances the subpectoral technique will continue to be the benchmark to which the prepectoral technique will be compared to. The authors sought to review the literature emanating from North America that pertains to this topic and provide an up-to-date assessment of the current practices of the prepectoral and submuscular technique.
乳腺癌仍然是美国女性中最常被诊断出的癌症。在乳房切除术的情况下，基于植入物的乳房重建（IBR）仍然是最常见的乳房重建类型。IBR通常分两阶段进行（组织扩张器 - 植入物）或一阶段进行[直接植入（DTI）]。由于与植入物胸肌下放置相关的局限性，胸肌前植入物放置在全球范围内越来越被接受。胸肌前平面消除了对胸壁肌肉进行解剖、离断和操作的需要，避免了胸肌下植入途径的肌肉相关并发症，如疼痛加剧、痉挛和动态畸形。此外，胸肌前放置缩短了恢复时间，并能更好地控制乳房形状和轮廓。随着最新一代形状稳定的硅酮植入物，以及脱细胞真皮基质（ADM）和其他网片被广泛使用和接受以支撑植入物，在这种情况下，该技术正成为基于植入物的乳房重建的主流方法，在此背景下，胸肌下技术仍将是与胸肌前技术进行比较的基准。作者试图回顾来自北美的有关该主题的文献，并对胸肌前和胸肌下技术的当前实践提供最新评估。
