Liu Hung-Hui, Chiang I-Han, Wang Chih-Hsin, Chiao Hao-Yu, Chou Chang-Yi, Wang Chi-Yu, Tzeng Yuan-Sheng, Chen Tim-Mo, Chen Shyi-Gen
From the Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China.
Ann Plast Surg. 2017 Mar;78(3 Suppl 2):S102-S107. doi: 10.1097/SAP.0000000000001014.
Although autogenous tissue-based breast reconstruction has been widely used in the past decade, implant-based breast reconstruction is more often used in Taiwan because Asian women are generally slender with small breasts. For patients with very small breasts, it is hard to achieve the goal of reconstructing a similar breast to the contralateral one, even with the smallest size implant available commercially. Therefore, these patients need not only breast reconstruction but also contralateral breast augmentation. Here we report the surgical outcomes and cosmetic results of breast reconstruction using cohesive gel implants combined with simultaneous contralateral breast augmentation.
A retrospective chart review was conducted to identify all patients with AA-sized to B-sized breast cups undergoing expander-implant reconstruction combined with contralateral breast augmentation between 2002 and 2015. Thirty patients were included. For each patient, patient profile (age, body mass index, and initial breast size), type and stage of breast cancer, surgical information (including implant sizes and the type of reconstruction and augmentation), and postoperative subjective pain scales were recorded. Outcomes were analyzed by identifying complications, the need for surgical revision, the presence of local or distant metastases, and patient satisfaction ratings.
At a mean 2.3-year follow-up (range, 4 months to 12 years), problems occurred in 7 of the 30 patients, with 9 complications in 8 reconstructed breasts and in 1 augmented breast. Complications were mostly capsule contracture. Aesthetic satisfaction was rated as "excellent" or "good" by most of the patients, and only 1 commented "poor" on both overall and reconstructed results because of postoperative radiotherapy-associated skin necrosis. The total mean subjective pain scale was 1.9/10; a higher mean pain scale of 3.08 was noted in those patients undergoing augmentation with no extra incision.
This is the first report of implant-based breast reconstruction with simultaneous contralateral augmentation in Taiwan, showing its efficacy, safety, and good cosmetic outcomes with relatively low complication and revision rates.
尽管自体组织乳房重建在过去十年中已被广泛应用，但在台湾，基于植入物的乳房重建更为常用，因为亚洲女性通常身材苗条且乳房较小。对于乳房非常小的患者，即使使用市面上最小尺寸的植入物，也很难实现重建出与对侧相似乳房的目标。因此，这些患者不仅需要乳房重建，还需要对侧乳房增大术。在此，我们报告使用粘性凝胶植入物联合同期对侧乳房增大术进行乳房重建的手术结果和美容效果。
进行一项回顾性病历审查，以确定2002年至2015年间所有接受扩张器-植入物重建联合对侧乳房增大术的AA罩杯至B罩杯患者。共纳入30例患者。记录每位患者的个人资料（年龄、体重指数和初始乳房大小）、乳腺癌的类型和分期、手术信息（包括植入物尺寸以及重建和增大的类型）以及术后主观疼痛量表。通过确定并发症、手术翻修的必要性、局部或远处转移的存在以及患者满意度评分来分析结果。
平均随访2.3年（范围为4个月至12年），30例患者中有7例出现问题，8个重建乳房和1个增大乳房出现9例并发症。并发症主要是包膜挛缩。大多数患者对美学满意度评为“优秀”或“良好”，只有1例因术后放疗相关的皮肤坏死对整体和重建结果均评价为“差”。主观疼痛量表的总平均分是1.9/10；在那些未额外切口进行增大术的患者中，平均疼痛量表得分更高，为3.08。
这是台湾首例关于基于植入物的乳房重建联合同期对侧增大术的报告，显示出其有效性、安全性以及良好的美容效果，并发症和翻修率相对较低。
