Seify Hisham, Sullivan Kelly, Hester T Roderick
Division of Plastic Reconstructive and Maxillofacial Surgery, Emory University, Atlanta, GA.
Ann Plast Surg. 2005 Mar;54(3):231-5; discussion 235.
The goal of this study is to obtain data concerning the incidence of capsular contracture and reoperation rates in patients having primary breast augmentation utilizing modern low-bleed smooth-wall silicone gel implants. Data were collected retrospectively and consisted of 44 patients who underwent primary breast augmentation using smooth silicone gel implants (Mentor Corporation) in the period between 2001 and 2003. Of the 131 patients identified, 44 patients fit the criteria of primary breast augmentation. Secondary cases and primary augmentation with mastopexy were excluded from this study. This group of patients is still followed, and the data are being updated periodically. A total of 44 patients underwent primary breast augmentation. Average age was 32 years (range, 19-57). Average follow-up was 34 months (range, 28-40). Average operative time was 52 minutes. The inframammary incision was used in 65% of patients and the areolar incision in 35%. The subglandular position was used in 35% of patients versus the submuscular position in 65%. Nine patients (20%) developed capsular contracture. Six patients (13.6%) had Baker 3 capsular contracture, which required revision. Four of the 9 patients with capsular contracture had implants placed in the submuscular space and 5 in the subglandular position. Relative to the implant position, 4 patients (9%) with implants placed in the submuscular position developed capsular contracture. Relative to the subglandular position, 5 patients (11.3%) with implants placed in the subglandular position developed capsular contracture. Eight patients (19%) required implant revision, 6 patients for capsular contracture, and 2 patients requested size change. Preliminary data from this study indicate that the use of the new generation of gel implants yields less capsular contracture, as well as decreased revision rates. Subglandular placement of gel implants did not significantly increase the risk of capsular contracture. Longer follow-up and multicenter studies are still needed to confirm these findings. This cumulative data could challenge the current status of gel implant moratorium imposed by the incidence of capsular contracture and revision rates.
本研究的目的是获取有关采用现代低出血光滑壁硅胶乳房植入物进行初次隆乳手术的患者包膜挛缩发生率和再次手术率的数据。数据采用回顾性收集，包括2001年至2003年期间44例行初次隆乳手术并使用光滑硅胶乳房植入物（曼托公司）的患者。在确定的131例患者中，44例符合初次隆乳的标准。本研究排除了二次手术病例和隆乳同时行乳房上提术的初次手术病例。这组患者仍在随访中，数据也在定期更新。共有44例患者接受了初次隆乳手术。平均年龄为32岁（范围19 - 57岁）。平均随访时间为34个月（范围28 - 40个月）。平均手术时间为52分钟。65%的患者采用乳房下皱襞切口，35%采用乳晕切口。35%的患者采用乳腺下植入，65%采用胸大肌下植入。9例患者（20%）发生包膜挛缩。6例患者（13.6%）出现贝克3级包膜挛缩，需要进行修复手术。9例发生包膜挛缩的患者中，4例植入物置于胸大肌下间隙，5例置于乳腺下。相对于植入位置，4例（9%）植入物置于胸大肌下间隙的患者发生包膜挛缩。相对于乳腺下位置，5例（11.3%）植入物置于乳腺下的患者发生包膜挛缩。8例患者（19%）需要更换植入物，6例因包膜挛缩，2例因要求改变植入物大小。本研究的初步数据表明，使用新一代凝胶乳房植入物可降低包膜挛缩发生率及再次手术率。凝胶乳房植入物置于乳腺下并未显著增加包膜挛缩风险。仍需更长时间的随访及多中心研究来证实这些发现。这些累积数据可能对当前因包膜挛缩发生率和再次手术率而暂停使用凝胶乳房植入物的现状构成挑战。
