Daytz Anna E, Silverman Julia B, Minasian Raquel A, Sanchez Susana Benitez, Yom Jina, Aiello Christopher, Robinson Emma, Smith Mark L, Tanna Neil
Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, New York.
Eplasty. 2025 Jan 14;25:e1. eCollection 2025.
Many patients who require breast reconstruction prefer a flap-based approach for various reasons, including the permanence and aesthetic benefit of a breast that looks and feels natural. For patients who desire autologous breast reconstruction following mastectomy but lack adequate donor site volume, the authors utilize the novel hybrid flap, prepectoral acellular dermal matrix (HyPAD) approach. In this technique, the deep inferior epigastric perforator (DIEP) flap is augmented with a stacked acellular dermal matrix (ADM). The purpose of this study is to quantify the soft tissue augmentation and core projection achieved with this technique during autologous flap-based breast reconstruction.
Consecutive patients who underwent the HyPAD technique during the study period (August 2021 to December 2022) were identified. All patients lacked adequate donor site volume and wished to avoid the placement of implants during their reconstruction. Demographic information and outcomes were assessed. Intraoperatively, the weights (g) of the mastectomy specimen, the flap donor site, and the stacked ADM were recorded.
During the study period, 21 patients (n = 21) were identified. The mean age of patients at the time of surgery was 48.9 ± 7.85 years. The mean body mass index was 24.1 kg/m ± 3.3 kg/m. The mean mastectomy specimen weight was 436.35 g, and the mean flap weight was 370.73 g, posing an average discrepancy of 15.04% or 65.62 g. The average weight of the ADM used to augment the flap was 81.76 g. This weight accounted for an average of 18.07% of the total reconstructed breast weight.
The use of ADM during autologous breast reconstruction provides patients with an alternative to implants that allows them to obtain their desired breast volume. Given the aesthetic impact that ADM has on the total amount of flap weight and projection, it is recommended that the HyPAD technique be considered for patients who desire a breast that cannot be restored with their own flap weight and wish to avoid implants.
许多需要乳房重建的患者出于各种原因更喜欢基于皮瓣的方法，包括乳房外观和触感自然的永久性和美学益处。对于乳房切除术后希望进行自体乳房重建但供区体积不足的患者，作者采用了新型混合皮瓣，即胸肌前脱细胞真皮基质（HyPAD）方法。在该技术中，腹壁下深动脉穿支（DIEP）皮瓣用堆叠的脱细胞真皮基质（ADM）进行增强。本研究的目的是量化该技术在自体皮瓣乳房重建过程中实现的软组织增强和核心突出。
确定在研究期间（2021年8月至2022年12月）接受HyPAD技术的连续患者。所有患者供区体积不足，且希望在重建过程中避免植入假体。评估人口统计学信息和结果。术中记录乳房切除标本、皮瓣供区和堆叠ADM的重量（克）。
在研究期间，确定了21例患者（n = 21）。手术时患者的平均年龄为48.9±7.85岁。平均体重指数为24.1 kg/m±3.3 kg/m。乳房切除标本的平均重量为436.35克，皮瓣的平均重量为370.73克，平均差异为15.04%或65.62克。用于增强皮瓣的ADM的平均重量为81.76克。该重量平均占重建乳房总重量的18.07%。
在自体乳房重建中使用ADM为患者提供了一种替代植入物的方法，使他们能够获得所需的乳房体积。鉴于ADM对皮瓣总重量和突出度的美学影响，建议考虑将HyPAD技术用于那些希望乳房体积无法通过自身皮瓣重量恢复且希望避免植入假体的患者。
