O'Shaughnessy Kristina
Chief of Plastic Surgery, St. Thomas Midtown Hospital, Nashville, TN, USA.
Gland Surg. 2015 Apr;4(2):97-110. doi: 10.3978/j.issn.2227-684X.2015.03.09.
Over the past decade, the leading breast reconstruction modality has shifted from autologous tissue to implants. This trend reversal is multi-factorial but includes increasing bilateral mastectomies and the more widespread acceptance of implants due to stringent quality and safety regulatory surveillance by the US Food and Drug Administration (FDA). Since 2012, the US FDA has approved several new implant styles, shapes and textures, increasing the choices for patients and surgeons. Predictable, superior aesthetic results after prosthetic breast reconstruction are attainable, but require thoughtful planning, precise surgical technique and appropriate device selection based on several different patient and surgeon parameters, such as patient desires, body mass index, breast shape, mastectomy flap quality and tissue based bio-dimensional assessment. This article briefly reviews historic devices used in prosthetic breast reconstruction beginning in the 1960s through the modern generation devices used today. We reflect on the rigorous hurdles endured over the last several decades leading to the approval of silicone gel devices, along with their well-established safety and efficacy. The various implant characteristics can affect feel and performance of the device. The many different styles and features of implants and expanders are described emphasizing surgical indications, advantages and disadvantages of each device.
在过去十年中，主要的乳房重建方式已从自体组织转向植入物。这种趋势的逆转是多因素的，但包括双侧乳房切除术的增加以及由于美国食品药品监督管理局（FDA）严格的质量和安全监管监督，植入物得到了更广泛的接受。自2012年以来，美国FDA已批准了几种新的植入物样式、形状和纹理，增加了患者和外科医生的选择。假体乳房重建后可获得可预测的、卓越的美学效果，但需要基于患者和外科医生的几个不同参数进行深思熟虑的规划、精确的手术技术和合适的器械选择，这些参数包括患者的期望、体重指数、乳房形状、乳房切除皮瓣质量和基于组织的生物维度评估。本文简要回顾了从20世纪60年代开始用于假体乳房重建的历史器械，直至如今使用的现代器械。我们回顾了过去几十年为使硅胶假体获得批准所经历的严格障碍，以及它们已确立的安全性和有效性。各种植入物特性会影响器械的触感和性能。文中描述了植入物和扩张器的多种不同样式和特点，重点介绍了每种器械的手术适应症、优缺点。
