Maxwell G P, Falcone P A
Institute for Aesthetic and Reconstructive Surgery, Baptist Hospital, Nashville, Tenn.
Plast Reconstr Surg. 1992 Jun;89(6):1022-34; discussion 1035-6.
Breast reconstruction utilizing smooth-surface silicone tissue expanders is associated with certain problems. Significant capsular contracture may develop around the expander with subsequent expander displacement necessitating repositioning or capsulectomy at the time of expander removal. Infection, pain on expansion, chest-wall compression, and complications related to the remote fill valve also have been reported. A textured-surface silicone expander with an integrated fill valve was developed to address these issues. Eighty-four consecutive breast reconstructions were performed by a single surgeon using textured expanders in 55 patients. Intraexpander pressures were measured during expansion for a group of these patients, and both initial and postinflation pressure readings were quite low (average initial pressure 2.88 mmHg; average postinflation pressure 12.87 mmHg). Eighty-one of the reconstructions have been completed without any expander losses and with minimal complications. Tissue expander volume averaged 580 cc, and the expansion duration averaged 5.6 months. Various types and configurations of permanent implants were used to complete the reconstructions. Eighty-four percent of our patients' completed reconstructions (including nippleareola reconstruction and opposite breast alteration, when necessary) were accomplished with just two procedures. Seventeen long-term adjustable textured-surface expander/implants with anatomic breast shape are still in place, all after only one operation. The inframmary fold has generally been established passively by the expansion process alone. Textured-surface silicone expanders have stayed where positioned, have expanded easily with minimal patient pain, and have created a noncontractile soft-tissue cover for the final implant. The textured expander with an integrated fill valve has simplified breast reconstruction by helping to limit the problems encountered with smooth silicone expanders. The resulting reconstructions have remained soft with a very acceptable aesthetic appearance. The patient office and hospital charts and photographs of this consecutive series were notarized and submitted to the Editor of this Journal, whose biostatistician randomly selected the cases illustrated.
使用表面光滑的硅胶组织扩张器进行乳房重建存在一些问题。扩张器周围可能会出现严重的包膜挛缩，随后扩张器移位，在取出扩张器时需要重新定位或进行包膜切除术。也有报道称存在感染、扩张时疼痛、胸壁压迫以及与远程填充阀相关的并发症。为了解决这些问题，研发了一种带有集成填充阀的表面有纹理的硅胶扩张器。一位外科医生连续为55例患者使用有纹理的扩张器进行了84例乳房重建手术。对其中一组患者在扩张过程中测量了扩张器内压力，初始压力读数和充气后压力读数都相当低（平均初始压力2.88 mmHg；平均充气后压力12.87 mmHg）。81例重建手术已完成，没有任何扩张器丢失，并发症也很少。组织扩张器的平均体积为580 cc，扩张持续时间平均为5.6个月。使用了各种类型和配置的永久性植入物来完成重建。我们84%的患者完成的重建手术（必要时包括乳头乳晕重建和对侧乳房改变）仅通过两次手术就完成了。17个具有解剖学乳房形状的长期可调节表面有纹理的扩张器/植入物仍在位，均仅经过一次手术。乳房下皱襞通常仅通过扩张过程被动形成。表面有纹理的硅胶扩张器保持在放置的位置，扩张容易，患者疼痛最小，并为最终植入物创造了无挛缩的软组织覆盖。带有集成填充阀的有纹理扩张器通过帮助限制光滑硅胶扩张器遇到的问题，简化了乳房重建。最终的重建效果柔软，美学外观非常令人满意。这一系列连续病例的患者办公室和医院病历以及照片经过公证后提交给本刊编辑，其生物统计学家随机选择了文中展示的病例。
