Dowden R V
Plastic Surgery Department, Cleveland Clinic Foundation, Ohio.
Plast Reconstr Surg. 1991 Oct;88(4):628-34. doi: 10.1097/00006534-199110000-00011.
To evaluate the factors leading to success in immediate breast reconstruction after mastectomy, 176 consecutive immediate reconstructions done with implants or expanders over a 5-year period were analyzed. None of these 176 had "complete muscle coverage." There were only five failures: four with implant loss (one involving radiation) and one removed electively. The failures were 1 in 40 regular implants, 4 in 77 temporary expanders, and 0 in 59 long-term expanders. There is no other report in the literature comparing these different types of implants. Various hypotheses for failure are reviewed. It is concluded that failure in immediate reconstruction is not related to use of drains, bilaterality, or lack of "complete muscle coverage." It is concluded that failure is related to implant type, prior radiation, and most of all to suboptimal patient selection. Specific selection criteria and operative techniques are discussed.
为评估乳房切除术后即刻乳房重建成功的相关因素，我们分析了在5年期间连续进行的176例使用假体或扩张器的即刻乳房重建病例。这176例均无“完全肌肉覆盖”。仅有5例失败：4例假体丢失（1例涉及放疗），1例为择期取出。失败率在40例常规假体中为1例，77例临时扩张器中为4例，59例长期扩张器中为0例。文献中尚无其他比较这些不同类型假体的报告。本文回顾了各种失败的假说。得出的结论是，即刻重建失败与引流管的使用、双侧性或缺乏“完全肌肉覆盖”无关。得出的结论是，失败与假体类型、既往放疗有关，最重要的是与患者选择欠佳有关。文中讨论了具体的选择标准和手术技术。
