Rubino Corrado, Trignano Emilio, Rodio Manuela, Fancellu Alessandro, Pili Nicola, Nonnis Rita, Pagliara Domenico, Spissu Noemi, Rampazzo Silvia
Plastic Surgery Unit, University Hospital Trust of Sassari, Sassari, Italy.
Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Case Reports Plast Surg Hand Surg. 2024 Aug 1;11(1):2383677. doi: 10.1080/23320885.2024.2383677. eCollection 2024.
Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch. We retrospectively review the clinical data of the patients who underwent Type IV/V mastectomy and DTI breast reconstruction with the described technique. Minor and major post operative complications were analyzed. Patient satisfaction and aesthetic outcomes were evaluated at one year of follow-up through Breast-Q and Validated Aesthetic Scale. Ten patients (fourteen breasts) were included in the study. Skin and/or NAC necrosis occurred in three breasts. One patient underwent implant removal due to periprosthetic infection. At one of follow-up no capsular contracture nor migration of the implant were clinically detected in all patients. One patient had a visible rippling at the upper quadrants of the new breast. Good patient satisfaction and aesthetic outcomes were reported. The association of fascial flaps and dermal sling is a viable option for breast reconstruction in patients with large and ptotic breasts. Along with providing an autologous coverage for the implant, it allows to maintain a good projection, maximize symmetrization in case of concomitant contralateral reduction mammoplasty and avoid any implant displacement.
在大而下垂乳房的皮肤缩减乳房切除术后进行直接植入式（DTI）乳房重建的特点是并发症发生率高。真皮吊带通常用于为乳房植入物的下极提供额外覆盖，以降低在T形交界处伤口裂开时植入物暴露的风险。本文的目的是详细介绍一种将下真皮吊带与胸肌和前锯肌筋膜瓣相结合的原创技术，以创建一个胸肌前囊袋。我们回顾性地分析了接受IV/V型乳房切除术并采用上述技术进行DTI乳房重建的患者的临床资料。分析了术后的轻微和严重并发症。通过乳房Q和验证美学量表在随访一年时评估患者满意度和美学效果。该研究纳入了10名患者（14个乳房）。3个乳房发生了皮肤和/或乳头乳晕复合体坏死。1例患者因假体周围感染而取出植入物。在随访时，所有患者临床均未检测到包膜挛缩或植入物移位。1例患者新乳房上象限出现明显的波纹。报告了良好的患者满意度和美学效果。筋膜瓣和真皮吊带联合应用是大而下垂乳房患者乳房重建的一种可行选择。除了为植入物提供自体覆盖外，它还能保持良好的凸度，在同期对侧乳房缩小成形术时最大限度地实现对称，并避免任何植入物移位。
