Dickinson Brian P, Handel Neal
Brian P. Dickinson, M.D., Inc., Newport Beach, CA, USA.
Ann Plast Surg. 2012 Jan;68(1):12-6. doi: 10.1097/SAP.0b013e3182110ff3.
Breast augmentation and mastopexy augmentation procedures are becoming more common. The young plastic and reconstructive surgeon is often challenged revisional surgery operations in these patients. These cases are challenging, require significant operative time, and can be associated with a high revision rate. It is important for the young surgeon to have an approach to deal with these common and difficult scenarios.
A retrospective chart review was conducted on all patients who underwent a revision augmentation or revision mastopexy augmentation procedure between 2008 and 2010 by the authors. The most commonly encountered mitigating circumstances in the revision augmentation or revision mastopexy augmentation populations were identified and an algorithm was created on how to address these difficult problems.
Between July 1, 2008 and July 1, 2010, 264 patients underwent revision augmentation or revision mastopexy augmentation procedures. The most commonly encountered patient scenarios were recurrence of ptosis, recurrent capsular contracture, implant malposition, rippling, and desiring a reduction in implant size. We encountered many mitigating circumstances that complicated the revisions. We devised a stepwise algorithmic approach to address these problems based on the following factors: (1) blood supply to the nipple-areola complex, (2) need to change implant plane, (3) patient desire to reduce or increase in breast implant volume, (4) need for total en bloc capsulectomy or capsulorrhaphy, (5) incision approach used to perform the capsulectomy, and (6) patient-related factors that need to be medically optimized or treated before, during, and after surgery. By adhering to these steps, outcomes can be accomplished more reliably and safely.
Specialized preoperative planning is necessary to consistently deliver safe and aesthetic revision augmentation and revision mastopexy augmentation results. It is important for the operative surgeon to carefully consider the potential adverse effect of implants and prior mastopexy or reduction incisions and patterns on the blood supply to the nipple-areola complex. With educated planning, successful results can be achieved in most cases, and the risk of serious complications can be minimized.
隆胸及隆乳上提手术正变得越来越普遍。年轻的整形与重建外科医生在这些患者的修复手术中常常面临挑战。这些病例具有挑战性，需要较长的手术时间，且可能伴有较高的修复率。对于年轻外科医生而言，掌握应对这些常见且棘手情况的方法很重要。
对2008年至2010年间作者进行修复隆胸或修复隆乳上提手术的所有患者进行回顾性病历审查。确定了修复隆胸或修复隆乳上提人群中最常遇到的缓解情况，并创建了一个关于如何解决这些难题的算法。
2008年7月1日至2010年7月1日期间，264例患者接受了修复隆胸或修复隆乳上提手术。最常遇到的患者情况是乳房下垂复发、包膜挛缩复发、植入物位置不当、波纹形成以及希望减小植入物尺寸。我们遇到了许多使修复变得复杂的缓解情况。我们基于以下因素设计了一种逐步算法方法来解决这些问题：（1）乳头乳晕复合体的血供；（2）改变植入物平面的需求；（3）患者减小或增大乳房植入物体积的愿望；（4）进行整块包膜切除或包膜缝合的需求；（5）进行包膜切除所采用的切口入路；（6）手术前、手术期间及手术后需要进行医学优化或治疗的患者相关因素。遵循这些步骤，可以更可靠、安全地实现手术效果。
需要进行专门的术前规划，以持续实现安全且美观的修复隆胸及修复隆乳上提效果。手术医生必须仔细考虑植入物以及先前的上提或缩小切口和模式对乳头乳晕复合体血供的潜在不良影响。通过合理规划，大多数情况下都能取得成功结果，并可将严重并发症的风险降至最低。
