Hakimian Sayyed Mohammad Reza, Mahmoodzadeh Habibollah
Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Surgical Oncology, Medical School, Tehran University of Medical Sciences, Tehran, Iran.
BMC Surg. 2025 Jul 22;25(1):310. doi: 10.1186/s12893-025-03055-9.
Breast reconstruction with implants immediately after mastectomy has attracted great attention in recent years. Acellular dermal matrices (ADM) are commonly used for breast reconstruction. However, it has drawbacks such as high cost, infection, and seroma formation. Herein, we present a method for implant-based breast reconstruction using hand-meshed free dermal autograft in pre-pectoral (harvested corium-covered implant (HACCIM)) and partial subpectoral implant-based breast reconstruction procedures.
A total of 22 patients, including 17 patients with unilateral and 5 patients with bilateral breast reconstruction were included in this study. Twenty-seven breasts underwent one-stage pre-pectoral (n = 11) and partial subpectoral (n = 16) implant-based breast reconstructive surgery using patients-derived hand-meshed free dermal autograft. Patients' characteristics, clinical and operative data, and outcomes of interest were examined and recorded.
The median age and BMI of patients who underwent breast reconstruction were 44.5 years (ranging from 34 to 65 years) and 24.97 kg/m (ranging from 20.57 to 32.87 kg/m) respectively. The follow-up duration ranged from 2 to 13 months (Median: 8 months). The mean time of free dermal autograft harvest and preparation was 30.26 ± 6.22 min. Superficial skin flap necrosis was observed in 8 breasts (29.63%) with 4 breasts in the partial subpectoral group and 4 in the pre-pectoral group. All minor skin flap necroses were managed successfully by outpatient care. Implant failure occurred in 4 breasts (14.81%), comprising 3 breasts in the partial subpectoral group and one in the pre-pectoral group. Three of the patients who showed implant failure had a history of radiation therapy, and the last one had full-thickness skin flap necrosis related to skin-sparing mastectomy.
Our study indicated that free dermal autograft can be utilized safely in one-stage pre-pectoral and subpectoral implant-based breast reconstruction. Further interventional studies are required to affirm our findings.
乳房切除术后立即使用植入物进行乳房重建近年来备受关注。脱细胞真皮基质（ADM）常用于乳房重建。然而，它存在成本高、感染和血清肿形成等缺点。在此，我们介绍一种在胸肌前（带真皮下血管网的植入物覆盖法（HACCIM））和部分胸肌下植入物乳房重建手术中使用手工编织的自体真皮游离移植进行基于植入物的乳房重建的方法。
本研究共纳入22例患者，其中17例为单侧乳房重建，5例为双侧乳房重建。27个乳房接受了一期胸肌前（n = 11）和部分胸肌下（n = 16）植入物乳房重建手术，使用患者自身手工编织的自体真皮游离移植。检查并记录患者的特征、临床和手术数据以及感兴趣的结果。
接受乳房重建患者的中位年龄和体重指数分别为44.5岁（范围34至65岁）和24.97kg/m（范围20.57至32.87kg/m）。随访时间为2至13个月（中位值：8个月）。自体真皮游离移植获取和制备的平均时间为30.26±6.22分钟。8个乳房（29.63%）出现浅表皮瓣坏死，其中部分胸肌下组4个乳房，胸肌前组4个乳房。所有轻微皮瓣坏死均通过门诊护理成功处理。4个乳房（14.81%）出现植入物失败，其中部分胸肌下组3个乳房，胸肌前组1个乳房。出现植入物失败的3例患者有放疗史，最后1例与保乳乳房切除术相关的全层皮瓣坏死有关。
我们的研究表明，自体真皮游离移植可安全用于一期胸肌前和胸肌下植入物乳房重建。需要进一步的干预性研究来证实我们的发现。
