Karp Nolan, Sorenson Thomas J, Boyd Carter J, Hemal Kshipra, Lin Alexandra, Robinson Isabel S, Choi Mihye
From the Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health.
Plast Reconstr Surg. 2025 Mar 1;155(3):488e-491e. doi: 10.1097/PRS.0000000000011592. Epub 2024 Jun 24.
Prepectoral breast reconstruction poses unique challenges, including a lower tolerance for mastectomy flap skin necrosis and seroma formation. With appropriate patient selection, prepectoral breast reconstruction is a valuable reconstructive option with numerous benefits. Although mastectomy skin necrosis is largely out of the control of the reconstructive surgeon, mitigation of seroma formation is critical. Strategies to reduce its incidence have been thoroughly discussed. Whereas there are many contributing factors, one tenet of prepectoral breast reconstruction is adequate pocket control. Reducing dead space and microshifting of the implant in the breast pocket is an important factor for averting seroma formation and implant displacement. Textured devices allowed the breast implant to sit more securely in the soft-tissue pocket. Given widespread concern for their involvement with breast implant-associated anaplastic large-cell lymphoma, macrotextured devices are no longer used in the United States. The authors describe their method of using poly-4-hydroxybutyrate synthetic absorbable mesh to effectively create a textured breast implant for use in prepectoral implant-based breast reconstruction.
胸肌前乳房重建带来了独特的挑战，包括对乳房切除皮瓣皮肤坏死和血清肿形成的耐受性较低。通过适当的患者选择，胸肌前乳房重建是一种具有诸多益处的有价值的重建选择。虽然乳房切除皮肤坏死在很大程度上超出了重建外科医生的控制范围，但减轻血清肿的形成至关重要。降低其发生率的策略已得到充分讨论。虽然有许多促成因素，但胸肌前乳房重建的一个原则是对腔隙的充分控制。减少乳房腔隙内的死腔和植入物的微动是避免血清肿形成和植入物移位的重要因素。有纹理的装置能使乳房植入物更稳固地置于软组织腔隙中。鉴于对其与乳房植入物相关的间变性大细胞淋巴瘤关联的广泛关注，美国已不再使用大纹理装置。作者描述了他们使用聚4-羟基丁酸合成可吸收网片有效制造有纹理乳房植入物以用于胸肌前基于植入物的乳房重建的方法。
