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Efficacy of Partial- Versus Full-Sling Acellular Dermal Matrix Use in Implant-Based Breast Reconstruction: A Head-to-Head Comparison.
- Source :
-
Aesthetic plastic surgery [Aesthetic Plast Surg] 2018 Apr; Vol. 42 (2), pp. 422-433. Date of Electronic Publication: 2018 Jan 24. - Publication Year :
- 2018
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Abstract
- Background: Acellular dermal matrix (ADM), popularly used in tissue expander-based breast reconstruction, is applied either as a partial or full sling, but without any consensus regarding which method of application produces better outcomes. We aimed to compare the outcomes between two patient groups who underwent tissue expander-based breast reconstruction using these techniques.<br />Methods: A retrospective review was conducted for consecutive patients who underwent immediate two-stage implant-based breast reconstruction using ADM between January 2013 and June 2016. They were categorized into two cohorts: cohort 1 included patients in whom ADM was applied using the partial-sling technique, insetting it obliquely after releasing the pectoralis major muscle from its costal origin, and cohort 2 included those who underwent a full-sling technique, insetting it transversely after releasing the muscle from its costal and lower sternal origin. Postoperative complications and aesthetic outcomes were compared between the two groups.<br />Results: We analysed 329 cases (167 in cohort 1 and 162 in cohort 2) with similar baseline characteristics in both cohorts. Reconstruction failure occurred in 2.4% of overall patients. The rates of each and overall acute complications did not differ significantly between the cohorts. Cohort 2 showed significantly lower rates of tissue expander displacement and malposition following the first-stage operation and rippling following the second-stage operation, differences that retained the influences in multivariate analyses. Higher aesthetic scores were obtained in cohort 2.<br />Conclusion: Using the full-sling ADM might reduce unintended migration of prostheses and enable proper tissue expansion, resulting in better overall outcomes without increasing morbidities.<br />Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
- Subjects :
- Adult
Analysis of Variance
Cohort Studies
Female
Follow-Up Studies
Graft Rejection
Humans
Mastectomy methods
Middle Aged
Multivariate Analysis
Prognosis
Prosthesis Failure
Republic of Korea
Retrospective Studies
Risk Assessment
Time Factors
Treatment Outcome
Acellular Dermis
Breast Implants
Breast Neoplasms surgery
Mammaplasty methods
Tissue Expansion Devices
Subjects
Details
- Language :
- English
- ISSN :
- 1432-5241
- Volume :
- 42
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Aesthetic plastic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29368031
- Full Text :
- https://doi.org/10.1007/s00266-018-1084-3