Department of Plastic and Reconstructive Surgery, Breast Unit, Catholic University of "Sacro Cuore"-University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy.
Aesthetic Plast Surg. 2012 Apr;36(2):313-22. doi: 10.1007/s00266-011-9809-6. Epub 2011 Sep 10.
Breast reconstruction for previously augmented patients differs from breast reconstruction for nonaugmented patients. Many surgeons regard conservation therapy as not feasible for these patients because of implant complications, whether radiotherapy-induced or not. Despite this, most authors agree that mastectomy with immediate breast reconstruction is the most suitable choice, ensuring both a good cosmetic result and a low complication rate. Implant retention or removal remains a controversial topic in addition to the best available surgical technique. This study reviewed the authors' experience with immediate breast reconstruction after skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with anatomically definitive implants.
The retrospective records of 12 patients were examined (group A). These patients were among 254 patients who underwent SSM or NSM for breast carcinoma. The control group comprised 12 of the 254 patients submitted to SSM or NSM (group B) who best matched the 12 patients in the studied group. All of them underwent immediate breast reconstruction, with an anatomically definitive implant placed in a submuscular-subfascial pocket. The demographic, technical, and oncologic data of the two groups were compared as well as the aesthetic outcomes using the Breast Q score. The proportion of complications, the type of implant, the axillary lymph node procedure, and the histology were compared between the two groups using Fisher's exact test. Student's t test was used to compare the scores for the procedure-specific modules of the breast Q questionnaire in the two groups.
A validated patient satisfaction score was obtained using the breast Q questionnaire after breast reconstruction. The demographic, technical, and oncologic characteristics were not significantly different between the two groups. The previously augmented patients reported a significantly higher level of satisfaction with their breast than the control patients. The scores for the other procedure-specific modules were similar in the two groups.
A valid immediate one-stage implant reconstruction can be obtained for previously augmented patients by placing the implant in a submuscular-subfascial pocket reinforced by the periprosthetic capsule of the previous prosthesis.
对于之前接受过隆胸手术的患者，乳房重建与非隆胸患者有所不同。许多外科医生认为，由于植入物并发症，无论是放疗引起的还是其他原因，这些患者不适合采用保留治疗方法。尽管如此，大多数作者都认为，乳房切除术联合即刻乳房重建是最合适的选择，既能获得良好的美容效果，又能降低并发症发生率。除了选择最佳的手术技术外，植入物的保留或移除仍然是一个有争议的话题。本研究回顾了作者在接受皮肤保留乳房切除术（SSM）和乳头保留乳房切除术（NSM）后，使用解剖学定义型植入物即刻乳房重建的经验。
回顾性分析了 12 例患者（A 组）的病历资料。这些患者均为因乳腺癌接受 SSM 或 NSM 手术的 254 例患者之一。对照组为同期因乳腺癌接受 SSM 或 NSM 手术且与研究组 12 例患者相匹配的 12 例患者（B 组）。所有患者均接受即刻乳房重建，将解剖学定义型植入物置于胸肌筋膜下袋中。比较两组患者的人口统计学、技术和肿瘤学数据，以及使用乳房 Q 评分评估美学效果。使用 Fisher 确切概率法比较两组患者的并发症比例、植入物类型、腋窝淋巴结清扫术和组织学类型。使用 Student's t 检验比较两组患者乳房 Q 问卷各程序特定模块的评分。
通过乳房 Q 问卷对乳房重建后的患者进行了满意度评分，结果有效。两组患者的人口统计学、技术和肿瘤学特征无显著差异。与对照组患者相比，之前接受过隆胸手术的患者对乳房重建的满意度显著更高。两组患者其他程序特定模块的评分相似。
通过在先前假体的假体周围包膜的支撑下，将植入物置于胸肌筋膜下袋中，可以为之前接受过隆胸手术的患者提供有效的即刻一期植入物重建。
