Zingaretti Nicola, De Lorenzi Francesca, Dell'Antonia Francesco, De Biasio Fabrizio, Riccio Michele, Parodi Pier Camillo
Breast Unit, Department of Plastic Reconstructive Surgery, Ospedale "S. Maria della Misericordia", University of Udine, Piazzale santa maria della misericordia 15, 33100, Udine, Italy.
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
Aesthetic Plast Surg. 2016 Oct;40(5):716-23. doi: 10.1007/s00266-016-0683-0. Epub 2016 Jul 21.
Periprosthetic capsule formation is a physiological phenomenon occurring around breast implants. In case of capsular contracture, several surgical techniques are described; among them, total capsulectomy is considered the gold standard, but it is not free of complications. A more conservative procedure is the use of "precapsular space", leaving intact the preexisting capsule. The method presents minor complications and further advantages over total capsulectomy.
From November 2010 to June 2014, we treated 92 postmastecttomy patients who previously underwent implant-based reconstruction. They presented implant malposition (bottoming-out, double bubble deformity, upward migration) and different degrees of capsular contracture. The implant was repositioned in a neoprecapsular pocket. Sixty-eight out of 92 patients presented a follow-up longer than 24 months, and they are included in the present study. They were evaluated with a questionnaire 1 month before surgery, at 6 months and 2 years postoperatively. Moreover, two independent plastic surgeons completed the same questionnaire at 6 months and 2 years after surgery.
Mean follow-up is 29 months. Baker III-IV capsular contracture occurred in 9.5 % of the patients, implant malposition in 2.9 % of the cases and no implant displacement rotation was observed. Patient self-assessment preoperatively and postoperatively (at 2 years) revealed improved cosmetic outcomes (p < 0.01). Surgeon assessment correlated with patient self-assessment.
The use of precapsular space, first described for aesthetic augmentation, is a valid alternative to total capsulectomy for the treatment of capsular contracture or implant malposition, even in the reconstructive field.
This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
假体周围包膜形成是乳房植入物周围发生的一种生理现象。在包膜挛缩的情况下，描述了几种手术技术；其中，全包膜切除术被认为是金标准，但并非没有并发症。一种更保守的方法是利用“包膜前间隙”，保留原有的包膜。该方法比全包膜切除术并发症少且有其他优势。
2010年11月至2014年6月，我们治疗了92例先前接受基于植入物重建的乳房切除术后患者。他们存在植入物位置异常（底部下垂、双泡畸形、向上移位）和不同程度的包膜挛缩。将植入物重新放置在新的包膜前囊袋中。92例患者中有68例随访时间超过24个月，他们被纳入本研究。在手术前1个月、术后6个月和2年对他们进行问卷调查评估。此外，两名独立的整形外科医生在术后6个月和2年完成相同的问卷。
平均随访29个月。9.5%的患者发生贝克III-IV级包膜挛缩，2.9%的病例存在植入物位置异常，未观察到植入物移位旋转。患者术前和术后（2年）的自我评估显示美容效果得到改善（p<0.01）。外科医生的评估与患者的自我评估相关。
首次描述用于美容隆乳的包膜前间隙的应用，是治疗包膜挛缩或植入物位置异常的全包膜切除术的有效替代方法，即使在重建领域也是如此。
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