Spear Scott L, Low Mervin, Ducic Ivica
Division of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA.
Ann Plast Surg. 2003 Dec;51(6):540-6. doi: 10.1097/01.sap.0000096450.04443.be.
In the absence of any published information on the indications, frequency, and outcomes of revision augmentation/mastopexy, an 8-year retrospective review was undertaken of all patients undergoing revision of a previous augmentation/mastopexy in the senior author's practice. The data collected included original implant type, location and mastopexy type, indication for revision, interval from original surgery, new implant type, location, and associated corrective surgical procedures. A simultaneous review was also performed of all primary augmentation/mastopexies done during the same period. Twenty patients underwent revision of 34 previously performed augmentation/mastopexies. Five patients underwent revisions of a prior revision. Fourteen were bilateral, while 6 were unilateral, for a total of 34 breasts. Forty patients underwent primary augmentation/mastopexy during the same period. Among the revisions, 10 implants were originally subglandular, while 24 were either partly or totally submuscular. Twelve of the previous mastopexies were periareolar, 2 were vertical, and 20 were of the inverted T-type. The indications for revision included capsular contracture in 11 of 20 (55%) patients, nipple ptosis in 11 of 20 (55%) patients, implant malposition in 7 of 20 (35%) patients, dissatisfaction with implant size in 6 of 20 (30%) patients, poor scar in 5 of 20 (25%) patients, breast ptosis in 4 of 20 (20%) patients, nipple malposition in 2 of 20 (10%) patients, and patient preference in 1 of 20 (5%) patients. Most patients had 2 or more indications for revision. The average duration to revision was 7 years. In 13 of 20 (65%) patients, no change in implant type was made. The remainder had exchanges to a different type. In 12 of 20 (60%) patients, no change in implant location was made, whereas 8 of 20 (40%) patients had a change to the subpectoral or dual plane position. In 18 of 20 (90%) patients, the revision included the same type of mastopexy, while in 2 of 20 (10%) patients, the type of mastopexy was changed. Corrective surgical procedures performed included repeat mastopexy, capsulectomy, change of implant type, change of implant location, change of implant size, capsulotomy, capsulorrhaphy, and scar revision. To date, all of the patients are satisfied with their appearance. Follow-up ranged from 2 months to 4 years. Revision augmentation mastopexy is not an uncommon procedure, occurring half as often as primary augmentation/mastopexy in our series. There were 8 common indications for revision, with capsular contracture and recurrent ptosis being the most common. Eight surgical procedures, in various combinations, were performed during revision, with repeat mastopexy being the most common.
由于缺乏关于隆乳/乳房上提术修复的适应证、频率和结果的公开信息，对资深作者所做的所有接受过既往隆乳/乳房上提术修复的患者进行了一项为期8年的回顾性研究。收集的数据包括原始植入物类型、位置和乳房上提术类型、修复适应证、距初次手术的时间间隔、新植入物类型、位置以及相关的矫正手术。同时还对同期进行的所有初次隆乳/乳房上提术进行了回顾。20例患者接受了对之前34例隆乳/乳房上提术的修复。5例患者接受了对之前一次修复的再次修复。14例为双侧，6例为单侧，共涉及34个乳房。同期有40例患者接受了初次隆乳/乳房上提术。在修复病例中，最初有10个植入物位于乳腺下，24个部分或全部位于胸大肌下。之前的乳房上提术中，12例为乳晕周围型，2例为垂直型，20例为倒T型。修复的适应证包括：20例患者中有11例（55%）发生包膜挛缩，20例患者中有11例（55%）乳头下垂，20例患者中有7例（35%）植入物位置异常，20例患者中有6例（30%）对植入物大小不满意，20例患者中有5例（25%）瘢痕不佳，20例患者中有4例（20%）乳房下垂，20例患者中有2例（10%）乳头位置异常，20例患者中有1例（5%）出于患者个人偏好。大多数患者有2种或更多的修复适应证。修复的平均时间为7年。20例患者中有13例（65%）未更换植入物类型。其余患者更换为不同类型的植入物。20例患者中有12例（60%）未改变植入物位置；而20例患者中有8例（40%）改为胸大肌下或双平面位置。20例患者中有18例（90%）的修复采用了相同类型的乳房上提术，20例患者中有2例（10%）改变了乳房上提术的类型。进行的矫正手术包括重复乳房上提术、包膜切除术、更换植入物类型、改变植入物位置、改变植入物大小、包膜切开术、包膜缝合术和瘢痕修复。迄今为止，所有患者对其外观均满意。随访时间为2个月至4年。修复性隆乳乳房上提术并非罕见手术，在我们的系列研究中，其发生率是初次隆乳/乳房上提术的一半。修复有8种常见适应证，其中包膜挛缩和复发性下垂最为常见。修复过程中进行了8种手术，以各种组合方式进行，其中重复乳房上提术最为常见。
