Los Angeles, Calif.; and Dallas, Texas From the Division of Plastic Surgery, University of California, Los Angeles Medical Center, and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2010 Jan;125(1):363-371. doi: 10.1097/PRS.0b013e3181c2a4b0.
Difficulties that arise with subpectoral breast implant placement include the following: malpositioning of the implant; improper superior contouring; and unnatural movement with chest muscle contraction. Correction of these deformities is easily achieved by removal of the subpectoral implant, resuspension of the pectoralis major muscle to the chest wall, and reaugmentation with a new implant in the subglandular plane. This study defines a correction modality for the adverse results of subpectoral implant placement in augmentation mammaplasty.
Pectoralis major resuspension was performed in 36 patients undergoing revision aesthetic breast surgery from 1995 to 2006. All patients had previously placed subpectoral breast implants performed elsewhere with unwanted movement, malposition, and/or capsular contracture. All patients underwent explantation of the breast implant, modified capsulectomy, pectoralis major resuspension, and reaugmentation of the breast in the subglandular position. In cases of symmastia, medial capsulodesis and sternal bolster sutures were used. Patients were evaluated for resolution of symptoms, satisfaction, and complications.
Malposition (62 percent), capsular contracture (53 percent), and symmastia (10 percent) were the most common indications for revision, but 100 percent of patients were dissatisfied with abnormal breast movement. The average follow-up time was 20 months. The silicone implants were commonly used, with an average volume change decrease of 27 cc. Unwanted implant movement was eliminated completely (100 percent), symmastia was corrected (100 percent), and capsular contraction was significantly decreased in each respective group. Patient satisfaction with this procedure was high, with a low complication rate.
Pectoralis major resuspension can be performed successfully in aesthetic breast surgery. It can be applied safely to correct problems of unwanted implant movement, symmastia implant malposition, and capsular contraction. The use of silicone gel implants in a novel tissue plane may be beneficial in this diverse, reoperative patient population.
胸肌下乳房植入物放置过程中出现的困难包括以下几点：植入物位置不当；上轮廓不当；以及胸肌收缩时的不自然运动。通过移除胸肌下植入物、将胸大肌重新悬置于胸壁、并在胸下腺平面重新植入新的植入物，很容易纠正这些畸形。本研究定义了一种纠正隆胸术下胸肌下植入物放置不良结果的方法。
1995 年至 2006 年，对 36 例接受美容乳房修复手术的患者进行了胸大肌悬吊术。所有患者均因先前在其他地方进行的胸肌下乳房植入术出现不想要的运动、位置不当和/或包膜挛缩而接受手术。所有患者均接受乳房植入物取出术、改良包膜切除术、胸大肌悬吊术和乳房下腺平面的乳房再填充。对于对称性乳房问题，使用内侧包膜缝合术和胸骨支撑缝线。评估患者的症状缓解、满意度和并发症情况。
最常见的翻修指征是位置不当（62%）、包膜挛缩（53%）和对称性乳房（10%），但 100%的患者对异常乳房运动不满意。平均随访时间为 20 个月。常用的是硅胶植入物，平均体积减少 27cc。完全消除了不想要的植入物运动（100%）、纠正了对称性乳房（100%），并显著减少了每个组的包膜收缩。患者对该手术的满意度高，并发症发生率低。
胸大肌悬吊术可在美容乳房手术中成功实施。它可以安全地应用于纠正不想要的植入物运动、对称性乳房植入物位置不当和包膜挛缩等问题。在这个多样化的再次手术患者群体中，在新的组织平面使用硅胶凝胶植入物可能是有益的。
