Pülzl Petra, Huemer Georg M, Schoeller Thomas
From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck; †Section of Plastic and Reconstructive Surgery, Linz General Hospital, Linz, Austria; and ‡Department of Hand-, Micro- and Reconstructive Surgery, Marienhospital Stuttgart, Stuttgart, Germany.
Ann Plast Surg. 2015 Feb;74(2):167-72. doi: 10.1097/SAP.0b013e3182933dc2.
Capsular contracture is a common complication associated with implant-based breast reconstruction and augmentation leading to pain, displacement, and rupture. After capsulectomy and implant exchange, the problem often reappears. We performed 52 deepithelialized free transverse musculocutaneous gracilis (TMG) flaps in 33 patients for tertiary breast reconstruction or augmentation of small- and medium-sized breasts. The indications for implant removal were unnatural feel and emotion of their breasts with foreign body feel, asymmetry, pain, and sensation of cold. Anyway, most of the patients did not have a severe capsular contracture deformity. The TMG flap is formed into a cone shape by bringing the tips of the ellipse together. Depending on the contralateral breast, the muscle can also be shaped in an S-form to get more projection if needed. The operating time for unilateral TMG flap breast reconstruction or augmentation was on average 3 hours and for bilateral procedure 5 hours. One patient had a secondary revision of the donor site due to disruption of the normal gluteal fold. Eighty percent of the unilateral TMG flap reconstructions had a lipofilling procedure afterward to correct small irregularities or asymmetry. The advantages of the TMG flap such as short harvesting time, inconspicuous donor site, and the possibility of having a natural breast shape make it our first choice to treat capsular contracture after breast reconstruction and augmentation.
包膜挛缩是基于植入物的乳房重建和增大术常见的并发症，可导致疼痛、移位和破裂。在进行包膜切除术和植入物置换后，该问题常常再次出现。我们为33例患者实施了52例去上皮游离股薄肌横形肌皮瓣（TMG瓣）手术，用于三期乳房重建或中、小型乳房增大。取出植入物的指征包括乳房有异物感、不自然的触感和情绪、不对称、疼痛以及冷感。无论如何，大多数患者并未出现严重的包膜挛缩畸形。通过将椭圆形的两端聚拢，TMG瓣可形成锥形。根据对侧乳房的情况，如果需要，肌肉也可塑形成S形以获得更多的突出效果。单侧TMG瓣乳房重建或增大术的平均手术时间为3小时，双侧手术为5小时。1例患者因正常臀褶中断而对供区进行了二次修复。80%的单侧TMG瓣重建术后进行了脂肪填充手术，以纠正小的不规则或不对称情况。TMG瓣具有取材时间短、供区不明显以及能够塑造自然乳房形态等优点，使其成为我们治疗乳房重建和增大术后包膜挛缩的首选方法。
