Robbins Chad M, Long James N, Fix R Jobe, de la Torre Jorge I, Vasconez Luis O
Department of Surgery, University of Alabama Birmingham Medical Center, Birmingham, AL 35294-0016, USA.
Ann Plast Surg. 2008 Nov;61(5):500-5. doi: 10.1097/SAP.0b013e31817e9cef.
Surgeons performing breast reconstruction in previously augmented patients can either leave the preexisting implant in place and incorporate the implant into the reconstruction, or remove the implant, usually performing an implant exchange. The focus of this study is to identify indications for implant removal in previously augmented patients undergoing mastectomy with breast reconstruction. We performed a retrospective chart review of patients who underwent breast reconstruction from 1997-2007 at University of Alabama, Birmingham Medical Center. Of these patients, 54 had previous augmentation with silicone or saline implants. Twenty-two of these underwent bilateral breast reconstruction, making a total of 76 reconstructed breasts. Patients were followed for a mean of 2.1 years (range 0.1-5.1 years). The mean body mass index was 23.0 (range 18-30). Implants were explanted in all but one patient. Reasons for implant removal or exchange included subglandular position (n = 39), aged silicone implant (n = 50), rupture or leak (n = 24), implant exposure (n = 1), and infection (n = 1). Some patients had more than one reason for explantation. We recommend removal of preexisting implants for patients who have implants in a subglandular position, ruptures or leaks, site infections, implant exposures, capsular contractures, pain, indolent seromas, aged silicone implants, poor cosmesis, plans for or history of radiotherapy, and close proximity of tumor to implant. We also remove implants to respect patient preferences and to achieve symmetry in our reconstruction. Consequently, we find in our practice that most of previously augmented patients who undergo breast reconstruction will also undergo implant removal.
为曾接受过隆胸手术的患者实施乳房重建的外科医生，既可以保留原有的植入物并将其纳入重建手术中，也可以取出植入物，通常是进行植入物置换。本研究的重点是确定在接受乳房切除并乳房重建的曾隆胸患者中取出植入物的指征。我们对1997年至2007年在阿拉巴马大学伯明翰医学中心接受乳房重建的患者进行了回顾性病历审查。在这些患者中，有54人曾接受过硅胶或盐水植入物隆胸。其中22人接受了双侧乳房重建，共计76个重建乳房。患者的平均随访时间为2.1年（范围0.1 - 5.1年）。平均体重指数为23.0（范围18 - 30）。除一名患者外，所有患者的植入物均被取出。取出或置换植入物的原因包括植入物位于乳腺下（n = 39）、硅胶植入物老化（n = 50）、破裂或渗漏（n = 24）、植入物外露（n = 1）以及感染（n = 1）。一些患者有不止一个取出植入物的原因。对于植入物位于乳腺下、破裂或渗漏、局部感染、植入物外露、包膜挛缩、疼痛、慢性血清肿、硅胶植入物老化、美容效果差、有放疗计划或放疗史以及肿瘤与植入物距离过近的患者，我们建议取出原有的植入物。我们还会根据患者的意愿取出植入物，以在重建手术中实现对称。因此，我们在实践中发现，大多数接受乳房重建的曾隆胸患者也会接受植入物取出手术。
