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无网片的皮肤缩减乳房切除术和直接植入式乳房重建：单机构经验

Skin-Reducing Mastectomy and Direct-to-Implant Breast Reconstruction Without Mesh: A Single-Institute Experience.

作者信息

Abdelmageed Ahmed E, Awad Ahmed T, El-Fayoumi Tarek A, Alhussini Mahmoud A, Shalaby Mahmoud O, Abdelkader Ahmed A

机构信息

Department of General Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, GBR.

Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY.

出版信息

Cureus. 2025 Mar 29;17(3):e81417. doi: 10.7759/cureus.81417. eCollection 2025 Mar.

DOI:10.7759/cureus.81417
PMID:40296963
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12036642/
Abstract

INTRODUCTION

Performing breast reconstruction in large and ptotic breasts remains technically challenging, with a high incidence of postoperative complications and unsatisfactory cosmetic results. Skin-reducing mastectomy (SRM) was introduced for breast reconstruction for females with macromastia. In this study, we report the experience in Alexandria Main University Hospital (AMUH), Alexandria, Egypt, with SRM and direct-to-implant (DTI) breast reconstruction without the utilization of biological or synthetic meshes.

PATIENTS AND METHODS

A prospective study was carried out at AMUH from October 2020 to October 2022. It included 20 female patients having large and ptotic breasts who were indicated for mastectomy, with the exclusion of non-motivated patients, inflammatory breast cancer, significant clinical comorbidities, and patients indicated for postoperative radiotherapy. All the operations were done as a single stage in which the SRM was performed through a Wise-pattern skin incision, along with the creation of a dermal sling to cover the implant.

RESULTS

A total of 20 surgeries were performed, in which the implant was placed in a pre-pectoral position in 10 cases. In the other 10 cases, the implant was inserted partially subpectoral by creating a musculo-dermal pouch to envelop the implant. The most prevalent complication encountered was delayed wound healing at the area of the inverted T-junction. None of the studied patients experienced wound infection, capsular contracture, or implant loss.

CONCLUSION

SRM and DTI breast reconstruction is a feasible technique that can be safely used in patients with large and ptotic breasts. The inferior dermal sling allows for a single-stage implant-based breast reconstruction without the utilization of biological or synthetic meshes.

摘要

引言

对乳房较大且下垂的患者进行乳房重建在技术上仍然具有挑战性，术后并发症发生率高且美容效果不理想。皮肤缩减乳房切除术（SRM）被引入用于巨乳症女性的乳房重建。在本研究中，我们报告了埃及亚历山大市亚历山大主大学医院（AMUH）采用SRM和直接植入式（DTI）乳房重建且不使用生物或合成网片的经验。

患者与方法

2020年10月至2022年10月在AMUH进行了一项前瞻性研究。该研究纳入了20例乳房较大且下垂、需行乳房切除术的女性患者，排除了无手术意愿的患者、炎性乳腺癌患者、有明显临床合并症的患者以及需术后放疗的患者。所有手术均为一期完成，其中SRM通过Wise式皮肤切口进行，并创建一个真皮吊带以覆盖植入物。

结果

共进行了20例手术，其中10例将植入物置于胸肌前位置。在另外10例中，通过创建一个肌肉 - 真皮袋来包裹植入物，将植入物部分置于胸肌下。最常见的并发症是倒T形交界处区域的伤口愈合延迟。所有研究患者均未出现伤口感染、包膜挛缩或植入物丢失。

结论

SRM和DTI乳房重建是一种可行的技术，可安全用于乳房较大且下垂的患者。低位真皮吊带允许在不使用生物或合成网片的情况下进行基于植入物的单阶段乳房重建。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/4906a0964107/cureus-0017-00000081417-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/5d7eb3a32e1f/cureus-0017-00000081417-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/84c529e6733b/cureus-0017-00000081417-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/b37cb2ff5921/cureus-0017-00000081417-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/0c0f0b500ddf/cureus-0017-00000081417-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/f7e2bb82b717/cureus-0017-00000081417-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/4906a0964107/cureus-0017-00000081417-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/5d7eb3a32e1f/cureus-0017-00000081417-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/84c529e6733b/cureus-0017-00000081417-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/b37cb2ff5921/cureus-0017-00000081417-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/0c0f0b500ddf/cureus-0017-00000081417-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/f7e2bb82b717/cureus-0017-00000081417-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d0/12036642/4906a0964107/cureus-0017-00000081417-i06.jpg

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