Département de Chirurgie, Institut Curie, 26 rue d'Ulm, Paris 75005, France.
J Plast Reconstr Aesthet Surg. 2011 Oct;64(10):1270-7. doi: 10.1016/j.bjps.2011.05.009. Epub 2011 Jun 25.
Complications of implant-based breast reconstruction are rare but mastectomy flap necrosis and peri-implant infection are the most frequent and remain an important cause of early implant failure. This study aimed to compare the results of three different management strategies employed to deal with these complications at our institution.
A consecutive series of 71 infected/exposed prostheses in 68 patients over a 20-year period were analysed. Management strategies included explantation and delayed reconstruction, implant salvage and explantation and immediate autologous reconstruction.
Only 19 of 45 (42%), managed with implant removal, went on to delayed reconstruction. Methods of delayed reconstruction were distributed equally between implant-only, implant and autologous tissue and autologous-only reconstructions. The implant was successfully salvaged in nine cases, but reducing the implant size or introducing new tissue as a flap increased the success from 45% to 53%. Three patients with infected implant-only breast reconstruction underwent explantation and immediate conversion to autologous-only reconstructions.
All the three interventions reviewed here have their place in the management of infected implant-based breast reconstructions. It is noteworthy that following implant removal, the likelihood of the patient proceeding to delayed reconstruction of any kind is similar to the likelihood of successful salvage (42% vs. 45%). This study population had high numbers of exposed implants in irradiated fields. Reducing implant size or introducing new tissue in the form of a flap increases the chances of successful implant salvage. In the presence of mild infection, removal of exposed/infected implants and immediate conversion to an autologous-only reconstruction can prove to be successful.
植入物乳房重建的并发症很少见，但乳房切除术皮瓣坏死和植入物周围感染是最常见的，仍然是早期植入物失败的重要原因。本研究旨在比较我们机构采用的三种不同处理策略的结果，以应对这些并发症。
在 20 年的时间里，对 68 例患者的 71 例感染/暴露假体进行了连续系列分析。管理策略包括假体取出和延迟重建、假体保留和取出以及即刻自体重建。
仅 45 例（42%）接受假体取出的患者进行了延迟重建。延迟重建的方法在植入物仅重建、植入物和自体组织重建以及自体组织重建之间平均分配。在 9 例病例中成功保留了植入物，但通过缩小植入物的尺寸或引入新的组织作为皮瓣，成功率从 45%提高到 53%。3 例感染性植入物乳房重建仅接受假体取出并立即转换为自体组织重建。
这里回顾的所有三种干预措施都在感染性植入物乳房重建的管理中有其地位。值得注意的是，在假体取出后，患者进行任何类型的延迟重建的可能性与成功保留假体的可能性相似（42%对 45%）。本研究人群中存在大量在辐射区域中暴露的植入物。缩小植入物的尺寸或引入新的组织作为皮瓣可以增加成功保留假体的机会。在轻度感染的情况下，取出暴露/感染的植入物并立即转换为仅自体组织重建可以证明是成功的。
