Headon Hannah, Kasem Adbul, Mokbel Kefah
King's College London Medical School, London, UK.
Oncoplastic Breast Surgeon Medway NHS Trust, Kent, UK.
Arch Plast Surg. 2015 Sep;42(5):532-43. doi: 10.5999/aps.2015.42.5.532. Epub 2015 Sep 15.
Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.
包膜挛缩是基于植入物的乳房手术最常见的并发症，也是再次手术最常见的原因之一。因此，了解其发生原因以及如何降低其发生率非常重要。我们使用MEDLINE数据库进行了文献检索，检索词包括“包膜挛缩隆胸”“包膜挛缩发病机制”“包膜挛缩发生率”和“包膜挛缩治疗”，共得到82条符合纳入标准的结果。包膜挛缩是由对异物（植入物）的过度纤维化反应引起的，总体发生率为10.6%。已确定的风险因素包括使用光面（对比毛面）植入物、乳腺下（对比胸肌下）植入、使用硅胶（对比盐水）填充植入物以及既往乳房放疗。包膜挛缩的标准治疗方法是通过包膜切除术或包膜切开术进行手术治疗。据报道，使用未获批准的白三烯受体拮抗剂扎鲁司特进行药物治疗可减轻严重程度并有助于预防包膜挛缩形成，使用脱细胞真皮基质、肉毒素和新囊袋形成也有同样效果。然而，几乎所有治疗方法都有较高的复发率。包膜挛缩是一个多因素纤维化过程，其确切原因仍不清楚。使用毛面植入物、胸肌下植入和聚氨酯涂层植入物时，挛缩发生的发生率较低。有症状的包膜挛缩通常通过手术治疗，然而最近的研究集中在预防包膜挛缩的发生或通过自体脂肪移植进行治疗。
