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Early experience of direct-to-implant breast reconstruction using acellular dermal matrix after robot-assisted nipple-sparing mastectomy

医学 外科 乳房再造术 植入 乳房切除术 患者满意度 前瞻性队列研究 乳腺癌 癌症 内科学
作者
Shin Hyun Kim,Seonghyuk Park,Dong Won Lee,Hyung Seok Park,Dae Hyun Lew,Seung Yong Song
出处
期刊:Plastic and Reconstructive Surgery [Lippincott Williams & Wilkins]
卷期号:154 (3): 512-520 被引量:3
标识
DOI:10.1097/prs.0000000000011105
摘要

Background: The authors performed a retrospective review to analyze operative outcomes of breast mound reconstruction after robot-assisted mastectomy. Methods: Patients who underwent nipple-sparing mastectomy (NSM) with a robotic device (Da Vinci Xi) and immediate prepectoral prosthetic reconstruction by lateral incision from June of 2018 to July of 2019 were enrolled. Patient characteristics, complications, and satisfaction rates as assessed by BREAST-Q were analyzed. The surgical technique was described in detail. Results: Thirty-nine cases, including 7 bilateral cases (total 46 breasts), underwent robot-assisted NSM followed by immediate prepectoral prosthetic implant reconstruction. The median patient age was 46.63 years (range, 21 to 63 years). The mean operation time for each prepectoral breast mound reconstruction using the direct-to-implant technique was 126.55 minutes. Robot-assisted reconstruction resulted in superior BREAST-Q scores compared with the conventional reconstruction method. Major infection occurred in 7 cases (15.2%), and complete nipple loss occurred in 3 cases (6.6%). Severe complications requiring breast implant removal occurred in 4 breasts (8.7%). Two cases were due to the coexistence of infection and skin necrosis; in 1 case, the skin flap became congested on postoperative day 3 and required additional surgery to change the expander. Other complications were resolved with conservative care or minor revision. Conclusions: This report is the first concerning robot-assisted NSM followed by prepectoral acellular dermal matrix–wrapped prosthetic reconstruction. This procedure was not inferior to other methods. Further prospective research to evaluate oncologic outcomes is warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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