Pennisi V R
Plast Reconstr Surg. 1990 Aug;86(2):368-71. doi: 10.1097/00006534-199008000-00033.
I have used polyurethane prostheses for the past 14 years, implanting 220 implants into 130 patients who desired breast reconstruction after subcutaneous mastectomy or cancer ablation or simply breast augmentation. I theorize that a polyurethane-covered implant resists contracture, retaining its compressibility because the fibroblasts proliferate into the polyurethane in many different directions. When the fibrils contract, the forces of contracture counterbalance one another, resisting contracture. However, when smooth prostheses are implanted, fibrils are directed in a circular fashion around the implant and naturally contract, leading to firmer breasts. There were 115 prostheses inserted following subcutaneous mastectomy, and 22 percent developed contracted capsules. Seven implants became exposed because of skin necroses; one was removed because of a Staphylococcus infection; and two patients developed a combination of polyurethane and silicone granulomas. These developed only with the earlier implant, where there was shedding of the polyurethane sponge layer and silicone bled from the low-viscosity silicone used in the earlier implants. No granulomas were noted with the currently used Surgitek Replicon implant. Eighty-five breasts were reconstructed after cancer ablation with polyurethane implants, and the contracture rate was 2.3 percent. Other complications were minimal. A smaller group of patients had augmentation mammaplasty, and 20 prostheses were placed in 10 patients. A 15 percent contracture rate was noted in this group. In this study, 82 percent of patients were followed for up to 14 years. Capsular contractures occurred in 30 implants between 1 and 11 years, for an average recurrence at 6.3 years. The overall contracture rate was 13 percent. Other complications were minimal. All implants were placed subcutaneously or subglandularly, and all were drained.
在过去14年里，我一直使用聚氨酯假体，为130名患者植入了220个假体，这些患者因皮下乳房切除术、癌症切除术后希望进行乳房重建，或者只是单纯想隆乳。我的理论是，覆盖聚氨酯的假体可抵抗挛缩，保持其可压缩性，因为成纤维细胞会向许多不同方向增殖进入聚氨酯。当纤维束收缩时，挛缩力相互抵消，从而抵抗挛缩。然而，当植入光滑的假体时，纤维束会以环绕假体的圆形方式排列并自然收缩，导致乳房变硬。皮下乳房切除术后植入了115个假体，其中22%出现了包膜挛缩。7个假体因皮肤坏死而外露；1个因葡萄球菌感染而被取出；2名患者出现了聚氨酯和硅胶肉芽肿的组合。这些仅在早期植入物中出现，当时聚氨酯海绵层有脱落，且早期植入物中使用的低粘度硅胶有渗出现象。目前使用的Surgitek Replicon假体未发现肉芽肿。85例癌症切除术后用聚氨酯假体进行了乳房重建，挛缩率为2.3%。其他并发症极少。一小部分患者进行了隆乳手术，10名患者植入了20个假体。该组挛缩率为15%。在本研究中，82%的患者随访了长达14年。30个假体在1至11年之间出现包膜挛缩，平均复发时间为6.3年。总体挛缩率为13%。其他并发症极少。所有假体均植入皮下或乳腺下，且均进行了引流。
