Ma Irene T, Rebecca Alanna M, Notrica David M, McMahon Lisa E, Jaroszewski Dawn E
Phoenix, Ariz. From the Department of General Surgery and the Divisions of Plastic and Reconstructive Surgery and Cardiothoracic Surgery, Mayo Clinic Arizona; the Division of Pediatric Surgery, Phoenix Children's Hospital; and the University of Arizona College of Medicine-Phoenix.
Plast Reconstr Surg. 2015 Feb;135(2):303e-312e. doi: 10.1097/PRS.0000000000000990.
Women present with pectus excavatum five times less frequently than men. Adult women may have additional, associated cosmetic factors, including hypoplastic or asymmetric breasts, or prior augmentation. The authors evaluated the impact of prior or concurrent cosmetic breast surgery in an adult female cohort undergoing repair of pectus excavatum deformity.
A retrospective review was performed of women (≥18 years old) who underwent pectus excavatum repair at a single institution from January of 2010 to September of 2013.
Pectus excavatum repair was performed on 47 women with a median age of 35 years (range, 18 to 63 years). Mean pectus severity index was 6.2 (range, 3.1 to 16). All patients had physiologic symptoms as the primary purpose for seeking repair. Twenty patients (43 percent) presented with existing implants or the desire for implants at the time of repair. Fifteen patients (32 percent) had a history of implant placement including prior breast augmentation (n = 14) and/or pectus implant (n = 4). Concurrent augmentation (n = 5), breast implant exchange (n = 8), and/or removal of chest wall implants (n = 4) was performed during repair. Morbidity included one implant-related hematoma. Complications and hospital stay were not significantly different for patients undergoing primary repair alone versus those with prior or concurrent augmentation.
Breast cosmesis was a concern in nearly half of adult women presenting for pectus excavatum repair. The authors' experience suggests neither prior nor concurrent breast augmentation increases the risk of complications in repair. The authors recommend that cosmetic breast surgery be performed concurrently with pectus excavatum repair.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
女性漏斗胸患者的出现频率比男性低五倍。成年女性可能有其他相关的美容因素，包括乳房发育不全或不对称，或既往隆胸手术史。作者评估了既往或同期进行的美容性乳房手术对成年女性漏斗胸畸形修复队列的影响。
对2010年1月至2013年9月在单一机构接受漏斗胸修复手术的女性（≥18岁）进行回顾性研究。
47名女性接受了漏斗胸修复手术，中位年龄为35岁（范围18至63岁）。平均漏斗胸严重指数为6.2（范围3.1至16）。所有患者均以生理症状作为寻求修复的主要原因。20名患者（43%）在修复时已有植入物或有植入物需求。15名患者（32%）有植入物放置史，包括既往隆胸手术（n = 14）和/或漏斗胸植入物（n = 4）。在修复过程中同时进行了隆胸手术（n = 5）、乳房植入物置换（n = 8）和/或胸壁植入物取出（n = 4）。并发症包括1例与植入物相关的血肿。单纯进行初次修复的患者与有既往或同期隆胸手术的患者相比，并发症和住院时间无显著差异。
在接受漏斗胸修复手术的成年女性中，近一半人关注乳房美容。作者的经验表明，既往或同期隆胸手术均不会增加修复手术的并发症风险。作者建议在进行漏斗胸修复手术的同时进行美容性乳房手术。
临床问题/证据级别：治疗性，III级
