Bushong Elizabeth E, Wesely Nicholas, Huffman Cuyler, Komorowska-Timek Ewa D
From Corewell Health/Michigan State University, Integrated Plastic Surgery Residency, Grand Rapids, Mich.
Advanced Plastic Surgery, Grand Rapids, Mich.
Plast Reconstr Surg Glob Open. 2024 Aug 7;12(8):e5820. doi: 10.1097/GOX.0000000000005820. eCollection 2024 Aug.
Nipple-sparing mastectomy (NSM) is aesthetically superior to skin-sparing only mastectomy or reconstructed nipples. However, nipple-sparing mastectomy partially preserves nipple ducts, which are remaining communications between the environment and breast pocket that can potentially allow bacteria transfer and compromise the prosthesis. Previous methods to create a subareolar "barrier" to reduce through-duct bacteria penetration involve subpectoral implant placement, adjunct meshes or acellular dermal matrix, and external nipple adhesives. To further protect the implant from nipple-derived contamination, we propose subareolar sealant (SAS). SAS involves the application of a synthetic sealant on the nipple undersurface before implant placement. In our study, we analyzed 77 breasts that received prepectoral prosthetic breast reconstruction. SAS was used in 70 of 77 breasts. All breasts received adjunctive acellular dermal matrix. Comparing SAS versus no-SAS, we found that no-SAS was associated with 10.4-fold more infections ( = 0.032) and 17.3-fold more re-hospitalizations ( = 0.017). No-SAS also resulted in more "at least one major complication" ( < 0.001), capsular contracture ( < 0.001), and necrosis requiring surgery ( < 0.001). Due to the small no-SAS sample size, goodness-of-fit (Quasi-likelihood independence model) criteria was applied, and a post hoc power analysis was calculated. Erythema, all minor complications, dehiscence, and necrosis requiring surgery remained significant (all < 0.0001). This innovative technique markedly reduces overall minor complications and necrosis requiring surgery. A larger no-SAS sample size is required to adequately determine whether SAS reduces infection and hospitalization rates. Nonetheless, SAS reduces complications and is cost effective compared with other adjunct materials.
保乳乳晕切除术在美学上优于仅保留皮肤的乳房切除术或再造乳头。然而，保乳乳晕切除术部分保留了乳头导管，这些导管是外界与乳房腔隙之间的残留通道，可能会使细菌转移并损害假体。以往为在乳晕下形成“屏障”以减少细菌通过导管渗透的方法包括胸肌下植入假体、辅助使用网片或脱细胞真皮基质以及外用乳头粘合剂。为了进一步保护假体免受乳头来源的污染，我们提出了乳晕下密封剂（SAS）。SAS是在植入假体前在乳头下表面涂抹一种合成密封剂。在我们的研究中，我们分析了77例行胸肌前假体乳房再造的乳房。77例乳房中有70例使用了SAS。所有乳房均使用了辅助脱细胞真皮基质。比较使用SAS与未使用SAS的情况，我们发现未使用SAS的感染发生率高10.4倍（P = 0.032），再次住院率高17.3倍（P = 0.017）。未使用SAS还导致更多的“至少一种主要并发症”（P < 0.001）、包膜挛缩（P < 0.001）以及需要手术的坏死（P < 0.001）。由于未使用SAS的样本量较小，应用了拟合优度（拟似然独立性模型）标准，并计算了事后效能分析。红斑、所有轻微并发症、裂开以及需要手术的坏死仍具有显著性差异（均P < 0.0001）。这项创新技术显著降低了总体轻微并发症和需要手术的坏死发生率。需要更大的未使用SAS样本量才能充分确定SAS是否能降低感染率和住院率。尽管如此，与其他辅助材料相比，SAS能降低并发症发生率且具有成本效益。
