Wickman M, Olenius M, Malm M, Jurell G, Serup J
Department of Plastic and Reconstructive Surgery, Karolinska Hospital, Stockholm, Sweden.
Plast Reconstr Surg. 1992 Dec;90(6):945-50. doi: 10.1097/00006534-199212000-00001.
This study comprises 23 women who had had mastectomies because of breast cancer. They were randomly divided into two groups when they were admitted for breast reconstruction by tissue expansion. The first group was expanded rapidly, i.e., every day, and the other group was expanded slowly, i.e., every week. There were no other differences in the treatment between the two groups. Three months after completion of expansion, the expander was replaced by a permanent prosthesis. The follow-up time was up to 6 months after the second operation. Three different parameters--distensibility, elasticity, and hysteresis--were measured noninvasively on the breast skin and at a control site on several occasions throughout the treatment. During the treatment period there were no differences in skin properties between rapidly and slowly expanded patients. Of the three parameters, distensibility showed the most prominent changes: decreasing during the expansion period, increasing after the expander had been replaced by a permanent prosthesis, and decreasing during the following 6 months. Elasticity did not change significantly, except decreasing after insertion of the permanent prosthesis, and the hysteresis increased at the same time. These findings indicate that tissue expansion alters breast skin only to a small extent and that the mechanical resistance sometimes encountered during tissue expansion is due to deeper structures such as underlying muscles or capsule formation.
本研究包括23名因乳腺癌接受乳房切除术的女性。她们在因组织扩张进行乳房重建入院时被随机分为两组。第一组快速扩张，即每天扩张，另一组缓慢扩张，即每周扩张。两组在治疗上没有其他差异。扩张完成3个月后，扩张器被永久性假体替代。随访时间长达第二次手术后6个月。在整个治疗过程中，多次在乳房皮肤和一个对照部位无创测量三个不同参数——伸展性、弹性和滞后现象。在治疗期间，快速扩张和缓慢扩张患者的皮肤特性没有差异。在这三个参数中，伸展性变化最为显著：在扩张期降低，在扩张器被永久性假体替代后升高，在接下来的6个月中降低。弹性没有显著变化，只是在插入永久性假体后降低，同时滞后现象增加。这些发现表明，组织扩张对乳房皮肤的改变程度较小，组织扩张期间有时遇到的机械阻力是由于更深层的结构，如深层肌肉或包膜形成。
