Acellular dermal matrix assisted one-stage breast reconstruction with prosthesis can significantly improve cosmetic effect and quality of life：Evaluation of immediate breast reconstruction in 68 patients with breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Ye , ZHAO Jing , LI Kaifu , WANG Yajun ,  KANG Hua

Center for Thyroid and Breast Surgery, Department of General Surgery of Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding author：

KANG Hua, Email: kanghua@xwh.ccmu.edu.cn

Keywords：

beast cancer; immediate breast reconstruction; prosthetic implantation; cosmetic effect; acellular dermal matrix

DOI：

10.7507/1007-9424.202107036

Video：

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Objective To evaluate the application effect of acellular dermal matrix (ADM) in immediate breast reconstruction after mammary mastectomy with prosthetic implants. Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group (n=43) and non-ADM group (n=25), according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not. The size of breast prosthesis, operative time, intraoperative blood loss, drainage duration, total drainage, total hospital stay, postoperative complications, postoperative cosmetic effect and quality of life of patients were compared between the two groups. Results Patients in the ADM group showed no statistically significant difference regarding operative time, drainage duration, total drainage, hospital stay, postoperative complications and intraoperative removed gland volume with the non-ADM group (P>0.05). The average intraoperative blood loss in the ADM group was less than that of the non-ADM group, the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group, the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group, which was considered statistically significant difference (P<0.05). The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group, especially in the symmetry of breast, surgical scar and distance of lateral displacement of nipple (P<0.05). The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image, sexual function and sexual interest (P<0.01). Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipple-sparing mammary mastectomy with prosthetic implantation. As an extension of the pectoralis major muscle, ADM can enlarge the posterior space for the prosthesis implantation, making the choice of the prosthesis much more easier. The combined application of ADM can obtain a better cosmetic effect, meanwhile improving the postoperative quality of life and satisfaction of patients.

Citation： ZHAO Ye, ZHAO Jing, LI Kaifu, WANG Yajun, KANG Hua. Acellular dermal matrix assisted one-stage breast reconstruction with prosthesis can significantly improve cosmetic effect and quality of life：Evaluation of immediate breast reconstruction in 68 patients with breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(5): 623-631. doi: 10.7507/1007-9424.202107036 Copy

1.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2015版). 中国癌症杂志, 2015, 25(9): 692-754.
2.	刘金涛, 郭文斌. Ⅰ期假体植入乳房重建在乳腺癌术后的临床应用分析. 中国妇幼健康研究, 2017, 28(11): 1473-1474, 1486.
3.	何益腾, 宋牧, 陈晶, 等. 硅凝胶假体植入乳房重建. 中国组织工程研究, 2015, 19(3): 455-459.
4.	Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages Ⅰ and Ⅱ carcinoma of the breast. Int J Radiat Oncol Biol Phys, 1979, 5(2): 257-261.
5.	朱江, 康骅, 海涛, 等. 乳房整形技术在乳腺癌保乳手术中的应用. 癌症进展, 2013, 11(5): 392-399, 419.
6.	康骅, 朱江, 海涛, 等. 乳房整形技术在乳腺癌保乳手术中的应用体会. 中国普外基础与临床杂志, 2011, 18(9): 917-921.
7.	赵启生, 钦传辉, 杨贵义. 保留乳头乳晕的改良根治术联合假体即刻置入术治疗早期乳腺癌的临床研究. 中华普外科手术学杂志(电子版), 2018, 12(5): 431-434.
8.	高德宗, 张强, 李亮, 等. Ⅰ期假体植入乳房再造在保留乳头乳腺癌改良根治术中的临床应用. 山东大学学报(医学版), 2010, 48(4): 106-108, 112.
9.	冯跃庆, 周勇, 张志敏. 假体在即刻乳房重建术中的应用. 中国普外基础与临床杂志, 2018, 25(10): 1206-1212.
10.	American College of Radiology. Practice guideline for the breast conservation therapy in the management of invasive breast carcinoma. J Am Coll Surg, 2007, 205(2): 362-376.
11.	Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5): 365-376.
12.	Sprangers MA, Groenvold M, Arraras JI, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol, 1996, 14(10): 2756-2768.
13.	Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg, 2005, 55(3): 232-239.
14.	Potter S, Conroy EJ, Cutress RI, et al. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study. Lancet Oncol, 2019, 20(2): 254-266.
15.	Leong M, Basu CB, Hicks MJ. Further evidence that human acellular dermal matrix decreases inflammatory markers of capsule formation in implant-based breast reconstruction. Aesthet Surg J, 2015, 35(1): 40-47.
16.	Lee KT, Mun GH. Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol, 2016, 23(2): 600-610.
17.	Loustau HD, Mayer HF, Sarrabayrouse M. Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP). J Plast Reconstr Aesthet Surg, 2007, 60(11): 1233-1238.
18.	Ibrahim AM, Koolen PG, Ganor O, et al. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast Surg, 2015, 39(3): 359-368.
19.	Casella D, Calabrese C, Bianchi S, et al. Subcutaneous tissue expander placement with synthetic titanium-coated mesh in breast reconstruction: long-term results. Plast Reconstr Surg Glob Open, 2016, 3(12): e577. doi: 10.1097/GOX.0000000000000549.
20.	Basu CB, Leong M, Hicks MJ. Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. Plast Reconstr Surg, 2010, 126(6): 1842-1847.
21.	Basu CB, Jeffers L. The role of acellular dermal matrices in capsular contracture: a review of the evidence. Plast Reconstr Surg, 2012, 130(5 Suppl 2): 118S-124S.
22.	Becker H, Lind JG, Hopkins EG. Immediate implant-based prepectoral breast reconstruction using a vertical incision. Plast Reconstr Surg Glob Open, 2015, 3(6): e412. doi:10.1097/GOX.0000000000000384.
23.	Uzunismail A, Duman A, Perk C, et al. The effects of acellular dermal allograft (AlloDerm^®) interface on silicone-related capsule formation—experimental study. Eur J Plast Surg, 2008, 31(4): 179-185.
24.	Alderman A, Gutowski K, Ahuja A, et al. ASPS clinical practice guideline summary on breast reconstruction with expanders and implants. Plast Reconstr Surg, 2014, 134(4): 648e-655e. doi: 10.1097/PRS.0000000000000541.
25.	Vidya R, Iqbal FM. A Guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction. Clin Breast Cancer, 2017, 17(4): 266-271.
26.	Logan Ellis H, Asaolu O, Nebo V, et al. Biological and synthetic mesh use in breast reconstructive surgery: a literature review. World J Surg Oncol, 2016, 14: 121. doi: 10.1186/s12957-016-0874-9.
27.	杨青峰, 张学, 龚益平. 乳房切除即刻假体乳房再造的临床应用. 中华普通外科学文献(电子版), 2018, 12(1): 6-8.
28.	De La Cruz L, Moody AM, Tappy EE, et al. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol, 2015, 22(10): 3241-3249.
29.	Galimberti V, Morigi C, Bagnardi V, et al. Oncological outcomes of nipple-sparing mastectomy: a single-center experience of 1 989 patients. Ann Surg Oncol, 2018, 25(13): 3849-3857.
30.	夏想厚, 俞洋, 扬红健. 保留乳头乳晕乳房切除-重建术研究进展. 中华乳腺病杂志(电子版), 2016, 10(4): 243-246.
31.	Salibian AA, Frey JD, Choi M, et al. Subcutaneous implant-based breast reconstruction with acellular dermal matrix/mesh: a systematic review. Plast Reconstr Surg Glob Open, 2016, 4(11): e1139. doi: 10.1097/GOX.0000000000001139.
32.	Heidemann LN, Gunnarsson GL, Salzberg CA, et al. Complications following nipple-sparing mastectomy and immediate acellular dermal matrix implant-based breast reconstruction-a systematic review and meta-analysis. Plast Reconstr Surg Glob Open, 2018, 6(1): e1625. doi: 10.1097/GOX.0000000000001625.
33.	Kornblith AB, Herndon JE, Weiss RB, et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer, 2003, 98(4): 679-689.
34.	牛杰, 刘园园, 李洪利, 等. 乳腺癌术后即刻乳房重建对病人生活质量影响的研究进展. 全科护理, 2019, 17(4): 396-399.
35.	Rim CH, Ahn SJ, Kim JH, et al. An assessment of quality of life for early phase after adjuvant radiotherapy in breast cancer survivors: a Korean multicenter survey (KROG 14-09). Health Qual Life Outcomes, 2017, 15(1): 96. doi: 10.1186/s12955-017-0673-1.
36.	Yoon AP, Qi J, Brown DL, et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast, 2018, 37: 72-79.
37.	张斌, 姜鹏, 郭慕红. 不同手术方式对乳腺癌患者术后生活质量的影响分析. 贵州医药, 2017, 41(11): 1170-1171.

1. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2015版). 中国癌症杂志, 2015, 25(9): 692-754.
2. 刘金涛, 郭文斌. Ⅰ期假体植入乳房重建在乳腺癌术后的临床应用分析. 中国妇幼健康研究, 2017, 28(11): 1473-1474, 1486.
3. 何益腾, 宋牧, 陈晶, 等. 硅凝胶假体植入乳房重建. 中国组织工程研究, 2015, 19(3): 455-459.
4. Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages Ⅰ and Ⅱ carcinoma of the breast. Int J Radiat Oncol Biol Phys, 1979, 5(2): 257-261.
5. 朱江, 康骅, 海涛, 等. 乳房整形技术在乳腺癌保乳手术中的应用. 癌症进展, 2013, 11(5): 392-399, 419.
6. 康骅, 朱江, 海涛, 等. 乳房整形技术在乳腺癌保乳手术中的应用体会. 中国普外基础与临床杂志, 2011, 18(9): 917-921.
7. 赵启生, 钦传辉, 杨贵义. 保留乳头乳晕的改良根治术联合假体即刻置入术治疗早期乳腺癌的临床研究. 中华普外科手术学杂志(电子版), 2018, 12(5): 431-434.
8. 高德宗, 张强, 李亮, 等. Ⅰ期假体植入乳房再造在保留乳头乳腺癌改良根治术中的临床应用. 山东大学学报(医学版), 2010, 48(4): 106-108, 112.
9. 冯跃庆, 周勇, 张志敏. 假体在即刻乳房重建术中的应用. 中国普外基础与临床杂志, 2018, 25(10): 1206-1212.
10. American College of Radiology. Practice guideline for the breast conservation therapy in the management of invasive breast carcinoma. J Am Coll Surg, 2007, 205(2): 362-376.
11. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5): 365-376.
12. Sprangers MA, Groenvold M, Arraras JI, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol, 1996, 14(10): 2756-2768.
13. Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg, 2005, 55(3): 232-239.
14. Potter S, Conroy EJ, Cutress RI, et al. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study. Lancet Oncol, 2019, 20(2): 254-266.
15. Leong M, Basu CB, Hicks MJ. Further evidence that human acellular dermal matrix decreases inflammatory markers of capsule formation in implant-based breast reconstruction. Aesthet Surg J, 2015, 35(1): 40-47.
16. Lee KT, Mun GH. Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol, 2016, 23(2): 600-610.
17. Loustau HD, Mayer HF, Sarrabayrouse M. Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP). J Plast Reconstr Aesthet Surg, 2007, 60(11): 1233-1238.
18. Ibrahim AM, Koolen PG, Ganor O, et al. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast Surg, 2015, 39(3): 359-368.
19. Casella D, Calabrese C, Bianchi S, et al. Subcutaneous tissue expander placement with synthetic titanium-coated mesh in breast reconstruction: long-term results. Plast Reconstr Surg Glob Open, 2016, 3(12): e577. doi: 10.1097/GOX.0000000000000549.
20. Basu CB, Leong M, Hicks MJ. Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. Plast Reconstr Surg, 2010, 126(6): 1842-1847.
21. Basu CB, Jeffers L. The role of acellular dermal matrices in capsular contracture: a review of the evidence. Plast Reconstr Surg, 2012, 130(5 Suppl 2): 118S-124S.
22. Becker H, Lind JG, Hopkins EG. Immediate implant-based prepectoral breast reconstruction using a vertical incision. Plast Reconstr Surg Glob Open, 2015, 3(6): e412. doi:10.1097/GOX.0000000000000384.
23. Uzunismail A, Duman A, Perk C, et al. The effects of acellular dermal allograft (AlloDerm^®) interface on silicone-related capsule formation—experimental study. Eur J Plast Surg, 2008, 31(4): 179-185.
24. Alderman A, Gutowski K, Ahuja A, et al. ASPS clinical practice guideline summary on breast reconstruction with expanders and implants. Plast Reconstr Surg, 2014, 134(4): 648e-655e. doi: 10.1097/PRS.0000000000000541.
25. Vidya R, Iqbal FM. A Guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction. Clin Breast Cancer, 2017, 17(4): 266-271.
26. Logan Ellis H, Asaolu O, Nebo V, et al. Biological and synthetic mesh use in breast reconstructive surgery: a literature review. World J Surg Oncol, 2016, 14: 121. doi: 10.1186/s12957-016-0874-9.
27. 杨青峰, 张学, 龚益平. 乳房切除即刻假体乳房再造的临床应用. 中华普通外科学文献(电子版), 2018, 12(1): 6-8.
28. De La Cruz L, Moody AM, Tappy EE, et al. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol, 2015, 22(10): 3241-3249.
29. Galimberti V, Morigi C, Bagnardi V, et al. Oncological outcomes of nipple-sparing mastectomy: a single-center experience of 1 989 patients. Ann Surg Oncol, 2018, 25(13): 3849-3857.
30. 夏想厚, 俞洋, 扬红健. 保留乳头乳晕乳房切除-重建术研究进展. 中华乳腺病杂志(电子版), 2016, 10(4): 243-246.
31. Salibian AA, Frey JD, Choi M, et al. Subcutaneous implant-based breast reconstruction with acellular dermal matrix/mesh: a systematic review. Plast Reconstr Surg Glob Open, 2016, 4(11): e1139. doi: 10.1097/GOX.0000000000001139.
32. Heidemann LN, Gunnarsson GL, Salzberg CA, et al. Complications following nipple-sparing mastectomy and immediate acellular dermal matrix implant-based breast reconstruction-a systematic review and meta-analysis. Plast Reconstr Surg Glob Open, 2018, 6(1): e1625. doi: 10.1097/GOX.0000000000001625.
33. Kornblith AB, Herndon JE, Weiss RB, et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer, 2003, 98(4): 679-689.
34. 牛杰, 刘园园, 李洪利, 等. 乳腺癌术后即刻乳房重建对病人生活质量影响的研究进展. 全科护理, 2019, 17(4): 396-399.
35. Rim CH, Ahn SJ, Kim JH, et al. An assessment of quality of life for early phase after adjuvant radiotherapy in breast cancer survivors: a Korean multicenter survey (KROG 14-09). Health Qual Life Outcomes, 2017, 15(1): 96. doi: 10.1186/s12955-017-0673-1.
36. Yoon AP, Qi J, Brown DL, et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast, 2018, 37: 72-79.
37. 张斌, 姜鹏, 郭慕红. 不同手术方式对乳腺癌患者术后生活质量的影响分析. 贵州医药, 2017, 41(11): 1170-1171.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Acellular dermal matrix assisted one-stage breast reconstruction with prosthesis can significantly improve cosmetic effect and quality of life：Evaluation of immediate breast reconstruction in 68 patients with breast cancer

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