Leawood, Kans. From the Swanson Center.
Plast Reconstr Surg. 2013 Jul;132(1):30e-45e. doi: 10.1097/PRS.0b013e3182910b2e.
Despite the growing popularity of breast lift surgery, no published study prospectively evaluates mastopexy and augmentation/mastopexy. Several investigators suggest an inordinate risk in combining augmentation and mastopexy, and recommend staging the surgery in some patients. However, no existing study includes the necessary individual and combined treatment cohorts to allow reliable comparisons of safety and efficacy. This study investigates the clinical outcomes and safety of these cosmetic breast procedures, whether performed individually or in combination.
This 10-year prospective study evaluated 759 consecutive women undergoing 784 consecutive cases of breast augmentation (n = 522), mastopexy (n = 57), augmentation/mastopexy (n = 146), reduction (n = 48), and reduction plus implants (n = 11). All patients were treated by the author using submuscular implant placement and vertical parenchymal resection with a medial pedicle and intraoperative determination of nipple positioning. A power analysis confirmed adequacy of the sample sizes.
The complication rate was 36.3 percent for augmentation/mastopexy, 33.3 percent for mastopexy alone, and 17.6 percent for breast augmentation alone. Mammaplasties were complicated by persistent ptosis in 9.5 percent of patients. The revision rate after augmentation/mastopexy was 20.5 percent, compared with 24.6 percent for mastopexy and 10.7 percent for breast augmentation.
Vertical mammaplasty may be used to correct ptosis in breasts of all sizes. Vertical augmentation/mastopexy provides complication and revision rates that are less than the calculated cumulative rates for the procedures performed separately. The combined procedure offers technical advantages and permits safe single-stage surgery using the vertical technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
尽管乳房提升术越来越受欢迎，但尚无前瞻性研究评估乳房提升术和隆胸/乳房提升术。一些研究人员认为，隆胸和乳房提升术联合存在过高的风险，并建议在某些患者中分期手术。然而，没有现有的研究包括必要的个体和联合治疗队列，以允许对安全性和疗效进行可靠的比较。本研究调查了这些美容乳房手术的临床结果和安全性，无论单独进行还是联合进行。
这项为期 10 年的前瞻性研究评估了 759 例连续接受 784 例连续乳房增大（n = 522）、乳房提升（n = 57）、隆胸/乳房提升（n = 146）、乳房缩小（n = 48）和乳房缩小加植入物（n = 11）的连续病例。所有患者均由作者采用胸肌下植入物放置和垂直实质切除术进行治疗，术中确定乳头位置。 功率分析证实样本量充足。
隆胸/乳房提升术的并发症发生率为 36.3%，单纯乳房提升术为 33.3%，单纯乳房增大术为 17.6%。乳房成形术有 9.5%的患者持续出现下垂。隆胸/乳房提升术的修复率为 20.5%，而乳房提升术为 24.6%，乳房增大术为 10.7%。
垂直乳房成形术可用于矫正各种大小乳房的下垂。垂直隆胸/乳房提升术的并发症和修复率低于单独进行的手术的累积计算率。联合手术具有技术优势，并允许使用垂直技术进行安全的单阶段手术。
临床问题/证据水平：治疗，II 级。
