Paydar Keyianoosh Z, Kohan Emil, Hansen Scott L, Roostaeian Jason, Gradinger Gilbert P
From the *Aesthetic and Plastic Surgery Institute, University of California, Irvine, Orange; †Division of Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco; and ‡Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA.
Ann Plast Surg. 2013 Apr;70(4):427-31. doi: 10.1097/SAP.0b013e31828b7e2c.
PURPOSE: Although most patients with implants have an uneventful course, some will require explantation. Moreover, women's breasts and their perception of their body habitus change with time. This study covering greater than a 32-year period will address the reconstruction options available after breast implant explantation. METHODS: Augmentation mammoplasty was performed on 42 patients who subsequently underwent explantation. The following data were recorded: age at time of implantation and explantation, length of implant, type, reason for explantation, and decision after explantation. Recommendations were made based on patient preferences, degree of ptosis, clinical history, opinions regarding scars, and breast contour. Reconstruction options were categorized into none, mastopexy, capsulectomy and reaugmentation with saline implants, and mastopexy with immediate or delayed augmentation. RESULTS: The average age of patients at implantation was 32.3 years, 46.8 years at explantation, with a length of implantation of 14.4 years. Thirty-six (86%) of 42 patients received explantation for capsular contracture, 7 (17%) for negative publicity of silicone implants, 7 (17%) for change in body habitus and perception of implants, 6 (14%) for rupture, 5 (12%) for ptosis, and 1 (2.4%) each for synmastia, breast cancer, and painful implants. Sixteen (38%) patients underwent mastopexy after explantation, 15 (36%) underwent no reconstruction after explantation, 6 (14%) with mastopexy and reaugmentation (2 immediate and 4 delayed), 4 (9.5%) with implant exchange, and 1 (2.4%) with mastectomy and reconstruction. All patients demonstrated satisfactory to excellent results. CONCLUSIONS: This study provides long-term results of augmentation mammoplasty by a single surgeon (G.P.G.) evaluating available options and reasonable expectations after explantation. Although most of the augmentation patients have a good outcome, some require removal of implants for a variety of reasons and long-term satisfactory options do exist after explantation.
目的：尽管大多数植入假体的患者病程顺利，但仍有一些患者需要取出假体。此外，女性的乳房及其对自身身体形态的认知会随时间变化。这项涵盖超过32年时间的研究将探讨乳房假体取出后可用的重建方案。 方法：对42例行隆乳术且随后接受假体取出的患者进行研究。记录以下数据：植入和取出时的年龄、假体长度、类型、取出原因以及取出后的决定。根据患者偏好、乳房下垂程度、临床病史、对瘢痕的看法以及乳房轮廓提出建议。重建方案分为不进行重建、乳房上提术、包膜切除术及盐水假体再植入术、即刻或延迟隆乳的乳房上提术。 结果：患者植入时的平均年龄为32.3岁，取出时为46.8岁，植入时间为14.4年。42例患者中，36例（86%）因包膜挛缩取出假体，7例（17%）因硅胶假体的负面宣传取出，7例（17%）因身体形态改变和对假体的认知改变取出，6例（14%）因假体破裂取出，5例（12%）因乳房下垂取出，1例（2.4%）因胸骨融合、乳腺癌和假体疼痛分别取出。16例（38%）患者取出假体后行乳房上提术，15例（36%）取出后未进行重建，6例（14%）行乳房上提术及再植入术（2例即刻，4例延迟），4例（9.5%）行假体置换，1例（2.4%）行乳房切除术及重建术。所有患者均显示出满意至极佳的效果。 结论：本研究提供了由单一外科医生（G.P.G.）进行隆乳术的长期结果，评估了假体取出后的可用方案及合理预期。尽管大多数隆乳患者预后良好，但一些患者因各种原因需要取出假体，且取出后确实存在长期令人满意的方案。
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