Horsnell J D, Searle A E, Harris P A
The Royal Marsden NHS Foundation Trust, UK.
Department of Plastic Surgery, The Lister Hospital, London, UK.
Surgeon. 2017 Oct;15(5):282-289. doi: 10.1016/j.surge.2017.03.001. Epub 2017 May 2.
Capsular contracture is a significant complication following aesthetic breast augmentation. Efforts to reduce this incidence have focused on the surgical approach, implant selection and IV antibiotics. Intra-operative methods to reduce the risk have had less investigation. This review focuses on these interventions and will document evidence to support pocket irrigation, nipple shields, drains and the use of an implant insertion funnel.
A comprehensive review of Pubmed, Scopus and Embase was performed to identify relevant papers published since 2000. These were reviewed and pertinent papers selected. Data regarding the intervention and its impact were recorded and compared.
Ten relevant studies were identified. A total of 11,772 patients were included in the studies, with a pooled capsular contracture rate of 2.54%. Six papers reported the use of antibiotic irrigation, two papers reported the use of drains, two the use of an insertion funnel, two the use of povidone-iodine and one the use of nipple shields. Antibiotic irrigation was shown to reduce capsular contracture 10 fold in two papers, have no effect in one and increase it in a further paper. However these changes did not persist after multivariate analysis.
There was limited evidence to support intra-operative techniques to reduce capsular contracture rate. Where available the literature tends to support the use of antibiotic and povidone-iodine irrigation, the use of insertion funnels and nipple shields and the avoidance of drains. However due to the poor quality of the evidence these findings should be treated cautiously.
包膜挛缩是美容隆胸术后的一种严重并发症。降低其发生率的努力主要集中在手术方式、植入物选择和静脉使用抗生素上。术中降低风险的方法研究较少。本综述聚焦于这些干预措施，并将记录支持腔隙冲洗、乳头保护罩、引流管及植入物插入漏斗使用的证据。
全面检索了自2000年以来发表的相关论文，包括Pubmed、Scopus和Embase。对这些论文进行了综述并挑选出相关论文。记录并比较了有关干预措施及其影响的数据。
共确定了10项相关研究。这些研究共纳入了11772例患者，合并包膜挛缩率为2.54%。6篇论文报道了抗生素冲洗的使用，2篇报道了引流管的使用，2篇报道了插入漏斗的使用，2篇报道了聚维酮碘的使用，1篇报道了乳头保护罩的使用。两篇论文显示抗生素冲洗可使包膜挛缩率降低10倍，一篇论文显示无效果，另一篇论文显示会增加包膜挛缩率。然而，多因素分析后这些变化并未持续存在。
支持术中降低包膜挛缩率技术的证据有限。现有文献倾向于支持使用抗生素和聚维酮碘冲洗、插入漏斗和乳头保护罩以及避免使用引流管。然而，由于证据质量较差，这些结果应谨慎对待。
