Choi Seung-Ho, Lee Sang-Oh, Chung Kyu-Jin, Kim Il-Kug, Lee Jun-Ho
Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea.
J Clin Med. 2024 Dec 9;13(23):7486. doi: 10.3390/jcm13237486.
Implant-based breast reconstruction (IBBR) is increasingly favored over autologous reconstruction due to its procedural simplicity and recovery benefits. Conducting this reconstruction using either the subpectoral or prepectoral planes has varied aesthetic outcomes. This study utilizes VECTRA XT 3D imaging to objectively assess breast symmetry differences between these surgical techniques. A retrospective cohort study was conducted analyzing data from patients undergoing unilateral total mastectomy followed by immediate silicone implant reconstruction via subpectoral or prepectoral techniques. The VECTRA XT 3D system provided measurements, including sternal-notch-to-nipple (SN-N), midline-to-nipple (ML-N), and nipple-to-inframammary fold (N-IMF) distances, as well as breast width, volume, and projection, taken more than a year postoperatively, to assess symmetry and aesthetic outcomes. The study included 63 patients-29 in the subpectoral group and 38 in the prepectoral group. The SN-N ratio was 0.91 for the subpectoral group compared to 0.95 for the prepectoral group ( = 0.014). Among patients with a BMI of 25 or higher, the prepectoral group had an SN-N ratio significantly closer to 1 (0.97 ± 0.07) than the subpectoral group (0.89 ± 0.06) ( = 0.027). No statistically significant differences were found in metrics based on the surgical method across age categories divided at 50. The prepectoral IBBR technique shows improved nipple positioning and breast symmetry compared to subpectoral methods, as assessed via precise 3D imaging. This finding suggests potential advantages for surgical planning and patient satisfaction, indicating the need for large cohort studies to further investigate the factors influencing breast symmetry.
由于手术操作简单且恢复效果良好，基于植入物的乳房重建（IBBR）越来越受到青睐，相较于自体组织重建。采用胸大肌下或胸大肌前平面进行这种重建会产生不同的美学效果。本研究利用VECTRA XT 3D成像技术客观评估这些手术技术之间的乳房对称性差异。进行了一项回顾性队列研究，分析了接受单侧全乳切除术后通过胸大肌下或胸大肌前技术立即进行硅胶植入物重建的患者数据。VECTRA XT 3D系统提供了测量数据，包括胸骨切迹至乳头（SN-N）、中线至乳头（ML-N）以及乳头至乳房下皱襞（N-IMF）的距离，还有乳房宽度、体积和突出度，这些测量是在术后一年多进行的，以评估对称性和美学效果。该研究纳入了63名患者，其中胸大肌下组29名，胸大肌前组38名。胸大肌下组的SN-N比率为0.91，而胸大肌前组为0.95（P = 0.014）。在体重指数（BMI）为25或更高的患者中，胸大肌前组的SN-N比率（0.97±0.07）比胸大肌下组（0.89±0.06）显著更接近1（P = 0.027）。在以50岁划分的不同年龄类别中，基于手术方法的各项指标未发现统计学上的显著差异。通过精确的3D成像评估，胸大肌前IBBR技术相较于胸大肌下方法显示出更好的乳头定位和乳房对称性。这一发现表明在手术规划和患者满意度方面具有潜在优势，这表明需要进行大规模队列研究以进一步探究影响乳房对称性的因素。
