Image Plastic Surgery Clinic, Seoul, Republic of Korea.
Aesthetic Plast Surg. 2011 Dec;35(6):1126-32. doi: 10.1007/s00266-011-9714-z. Epub 2011 Apr 22.
BACKGROUND: Although capsule formation is a natural-healing process following breast augmentation using implants, a contracted capsule around a poorly positioned implant can act as an obstacle during the corrective procedure to reposition the implant. The ideal treatment of capsular contracture is removal of the capsule and covering the implant with a healthy envelope without scar tissue. However, total capsulectomy in the submuscular space may be difficult, especially if the capsule is firmly attached to the chest wall. This situation may require a highly skilled technique because aggressive capsulectomy could injure the intercostal muscles and vasculature and cause further complications such as pneumothorax. Therefore, the authors have developed a new, less traumatic method of leaving the capsule behind the new implant. METHOD: From February 2001 through February 2009, the authors treated 74 patients (139 breasts) using a subpectoral, precapsular implant repositioning technique. These patients suffered from capsular contracture or implant malposition after submuscular breast augmentation. The technique is composed of three parts. First, a plane was developed between the anterior wall of the capsule and the posterior surface of the pectoralis major muscle using a periareolar or inframammary approach. After removing the previous implant, the anterior wall of the capsule was fully released from the posterior surface of the pectoralis major muscle and fixed to the posterior wall of the capsule which adhered to the chest wall. The new implant was inserted into the developed subpectoral space, anterior to the capsule. RESULTS: The mean age of the patients was 31 years (range = 24-52) and the time between the primary and the secondary augmentation was 42 months (range = 4 months to 12 years). The range for follow-up was from 12 months to 5 years. Median follow-up was 26 months. Postoperative complications included two cases of hematoma but no cases of infection, muscle distortion, or double-bubble deformity. CONCLUSION: This technique is a valid alternative treatment for capsular contracture or malpositioned implant after breast augmentation surgery. It may be less traumatic than the conventional method of total capsulectomy. In addition, this technique reduces the relapse rate of capsular contracture significantly compared to a partial capsulectomy or capsulotomy as the new implant is inserted into a scar tissue-free environment. Good aesthetic results and patient satisfaction was achieved using this method. In our experience, this novel technique is a good alternative method of correcting complications of submuscular implant augmentation.
背景:尽管包膜形成是乳房植入术后自然愈合过程,但在矫正术重新定位植入物时,位置不佳的植入物周围的收缩包膜可能会成为一个障碍。包膜挛缩的理想治疗方法是切除包膜,并在没有疤痕组织的情况下用健康的包膜覆盖植入物。然而,在胸肌下空间进行全包膜切除术可能很困难,尤其是当包膜与胸壁紧密相连时。这种情况可能需要高度熟练的技术,因为激进的包膜切除术可能会损伤肋间肌和脉管系统,并导致气胸等进一步的并发症。因此,作者开发了一种新的、创伤较小的方法,将包膜留在新植入物后面。
方法:从 2001 年 2 月至 2009 年 2 月,作者使用胸肌下、包膜前置植入物重新定位技术治疗了 74 例(139 例乳房)患者。这些患者在胸肌下乳房增大术后患有包膜挛缩或植入物位置不当。该技术由三个部分组成。首先,从前包膜的前壁和胸大肌的后表面之间用乳晕或乳晕下入路形成一个平面。取出先前的植入物后,从前包膜的前壁完全从胸大肌的后表面释放,并固定到粘附在胸壁上的后包膜上。将新的植入物插入在前包膜前面的新开发的胸肌下空间中。
结果:患者的平均年龄为 31 岁(范围= 24-52 岁),初次和二次增大之间的时间为 42 个月(范围= 4 个月至 12 年)。随访范围为 12 个月至 5 年。中位随访时间为 26 个月。术后并发症包括两例血肿,但无感染、肌肉变形或双泡畸形。
结论:对于乳房增大术后的包膜挛缩或植入物位置不当,该技术是一种有效的替代治疗方法。与传统的全包膜切除术相比,它可能创伤更小。此外,与部分包膜切除术或包膜切开术相比,由于新植入物插入无疤痕组织的环境中,该技术显著降低了包膜挛缩的复发率。该方法获得了良好的美学效果和患者满意度。根据我们的经验,这种新的技术是一种纠正胸肌下植入物增大并发症的好方法。
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