Panettiere P, Marchetti L, Accorsi D
Dipartimento A. Valsalva, Discipline Chirurgiche, Rianimatorie e dei Trapianti, Università degli Studi di Bologna, Via Massarenti 9, 40128 Bologna (BO), Italy.
J Plast Reconstr Aesthet Surg. 2007;60(5):482-9. doi: 10.1016/j.bjps.2006.04.020. Epub 2006 Sep 6.
The flexibility of lower cohesivity silicone prostheses is the main reason for wrinkling, rippling and evidence of implant edges. The soft cohesive silicone implants promise to minimize such effects with minimal softness reduction. Forty consecutive patients received soft cohesive prostheses (INAMED Style 110 ST) and were studied prospectively. A historical group, made up by the 40 consecutive patients who received lower cohesivity silicone implants (INAMED Style 110) in the immediately preceding months, was used as a control. Wrinkling, prosthetic edge perceptibility and capsular contracture degree were assessed six months after surgery. The tissue coverage thickness was measured using ultrasonography. The patients were then asked to evaluate the breast softness by means of an anonymous questionnaire, where they also expressed their overall satisfaction by means of the five-steps linear analogical scales. The wrinkling prevalence was 9.2% in the soft cohesive group vs. 55% in the lower cohesivity one (p<0.01). The edge perceptibility was 14% in the soft cohesive group vs. 22% in the lower cohesivity one (no statistical significance). The coverage tissue thickness was not found to be significantly related to the wrinkling prevalence or to the edge perceptibility. The capsular contracture rate was almost identical in the two groups (Baker II: 2.6% vs. 2.7%, no Baker III or IV). A higher stiffness was noted in the soft cohesive group (average score: 4.2 vs. 4.4 in the control group, p<0.05), but the overall satisfaction degree was higher for soft cohesive implants (average score: 4.5 vs. 3.8, p<0.01). The soft cohesive prostheses offered better overall results than the lower cohesivity silicone prostheses, even if a longer term follow-up should be advised. The soft cohesive prostheses showed a higher firmness, but this seemed not to have any influence on the overall satisfaction degree.
低内聚性硅胶假体的柔韧性是出现褶皱、波纹以及假体边缘明显可见的主要原因。柔软的内聚性硅胶假体有望在将柔软度降低到最低限度的同时，将上述影响降至最低。连续40例患者接受了柔软的内聚性假体（INAMED 110 ST型），并进行了前瞻性研究。将前几个月连续接受低内聚性硅胶假体（INAMED 110型）的40例患者组成的历史队列作为对照组。在术后6个月评估褶皱、假体边缘可感知性和包膜挛缩程度。使用超声测量组织覆盖厚度。然后要求患者通过匿名问卷评估乳房的柔软度，他们还通过五步线性模拟量表表达总体满意度。柔软内聚性组的褶皱发生率为9.2%，而低内聚性组为55%（p<0.01）。柔软内聚性组的边缘可感知性为14%，低内聚性组为22%（无统计学意义）。未发现覆盖组织厚度与褶皱发生率或边缘可感知性有显著相关性。两组的包膜挛缩率几乎相同（Baker II级：2.6%对2.7%，无Baker III级或IV级）。柔软内聚性组的硬度更高（平均评分：4.2对对照组的4.4，p<0.05），但柔软内聚性假体的总体满意度更高（平均评分：4.5对3.8，p<0.01）。即使建议进行更长时间的随访，柔软内聚性假体的总体效果也优于低内聚性硅胶假体。柔软内聚性假体表现出更高的硬度，但这似乎对总体满意度没有任何影响。
