Spear Scott L, Carter Mary Ella, Ganz Jason C
Division of Plastic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
Plast Reconstr Surg. 2006 Dec;118(7 Suppl):103S-113S; discussion 114S.
Little has been published regarding the treatment of patients with long-established capsular contracture after previous submuscular or subglandular breast augmentation. This study reviews 7 years of experience in treating established capsular contracture after augmentation mammaplasty by relocating implants to the "dual-plane" or partly subpectoral position. A retrospective chart review was performed on all patients who were treated for capsular contracture using this technique between 1993 and 1999. Data collected included the date of the original augmentation, the original implant location, date of revision and type of implant used, length of follow-up, outcome, and any ensuing complications. Different surgical techniques were used, depending on whether the prior implant was located in a subglandular or submuscular plane. All patients had revisions such that their implants were relocated to a dual plane, with the superior two thirds or so of the implant located beneath the pectoralis major muscle and the inferior one third located subglandularly. Of 85 patients reviewed, 54 had their original implants in a submuscular position and 31 had their initial augmentation in a subglandular position. Of the 54 patients whose implants were initially submuscular, 23 patients (43 percent) had silicone gel implants, 15 patients (28 percent) had double-lumen implants, and the remaining 16 patients (30 percent) had saline implants. Of the 31 patients whose implants were initially subglandular, 20 patients (65 percent) had silicone gel implants, three patients (10 percent) had double-lumen implants, and the remaining eight patients (26 percent) had saline implants. Fifty-one patients (60 percent) had replacement with saline implants (37 smooth saline, 14 textured saline), whereas 34 (40 percent) had silicone gel implants (seven smooth gel, 27 textured gel). The average time from previous augmentation to revision was 9 years 9 months. The average follow-up time after conversion to the dual-plane position was 11.5 months. Only three of 85 patients required reoperation for complications, all of which involved some degree of implant malposition. Of patients converted to the dual plane, 98 percent were free of capsular contracture and were Baker class I at follow-up, whereas 2 percent were judged as Baker class II. There were no Baker level III or IV contractures at follow-up. The dual-plane method of breast augmentation has proved to be an effective technique for correcting established capsular contracture after previous augmentation mammaplasty. This technique appears to be effective when performed with either silicone or saline-filled implants.
关于对先前接受胸大肌下或乳腺后隆胸术且已形成包膜挛缩的患者的治疗,相关文献报道较少。本研究回顾了7年以来通过将假体重新放置于“双平面”或部分胸大肌下位置来治疗隆胸术后已形成包膜挛缩的经验。对1993年至1999年间使用该技术治疗包膜挛缩的所有患者进行了回顾性病历分析。收集的数据包括初次隆胸日期、初次假体位置、修复日期及所用假体类型、随访时间、结果以及任何随之发生的并发症。根据先前假体位于乳腺后还是胸大肌下平面,采用了不同的手术技术。所有患者均进行了修复手术,使假体重新放置于双平面,假体上三分之二左右位于胸大肌下方,下三分之一位于乳腺后。在接受评估的85例患者中,54例初次假体位于胸大肌下,31例初次隆胸位于乳腺后。在初次假体位于胸大肌下的54例患者中,23例(43%)使用硅胶假体,15例(28%)使用双腔假体,其余16例(30%)使用盐水假体。在初次假体位于乳腺后的31例患者中,20例(65%)使用硅胶假体,3例(10%)使用双腔假体,其余8例(26%)使用盐水假体。51例患者(60%)更换为盐水假体(37例光面盐水假体,14例毛面盐水假体),而34例(40%)使用硅胶假体(7例光面硅胶假体,27例毛面硅胶假体)。从先前隆胸到修复的平均时间为9年9个月。转换至双平面位置后的平均随访时间为11.5个月。85例患者中只有3例因并发症需要再次手术,所有这些均涉及某种程度的假体位置不当。转换至双平面的患者中,98%在随访时无包膜挛缩,为贝克I级,而2%被判定为贝克II级。随访时无贝克III级或IV级挛缩。双平面隆胸法已被证明是一种有效矫正先前隆胸术后已形成包膜挛缩的技术。无论使用硅胶还是盐水填充假体,该技术似乎均有效。
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