Montemurro Paolo, Papas Athanasios, Hedén Per
Stockholm, Sweden.
From the Akademikliniken.
Plast Reconstr Surg. 2017 Jun;139(6):1367-1378. doi: 10.1097/PRS.0000000000003387.
Since their introduction in 1993, anatomical implants have provided a more natural appearance in breast augmentation, and many surgeons advocate their use and promote the good aesthetic results. However, the risk of implant rotation makes some of them reluctant to use these devices. The rotation rate varies among authors.
The authors present a 6.5-year series of 531 patients who underwent primary breast augmentation with macrotextured anatomical implants in a Swedish facility performed by one consultant surgeon (P.M.). The authors examined the rotation rate and the correlation with possible predisposing factors such as preoperative breast cup size, childbirth, and body mass index.
A total of 20 implants (1.88 percent; 95 percent CI, 1.15 to 2.89 percent) in 19 patients (3.58 percent; 95 percent CI, 2.17 to 5.53 percent) were rotated. In one patient (0.22 percent), both implants rotated, whereas in the remaining patients, the rotation was unilateral. The authors were unable to establish a statistically significant correlation between implant rotation and previous childbirth or increased body mass index. However, there was a relation between rotation rate and preoperative breast cup size that showed an upward trend as the cup size increased from A to C.
The authors believe that if the implant is correctly selected and the operation is performed meticulously with proper pocket dissection, the rotation rate is minimal and it should not be considered a disadvantage for the use of anatomical implants.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
自1993年引入以来，解剖型乳房植入物在隆胸手术中能提供更自然的外观，许多外科医生提倡使用并宣扬其良好的美学效果。然而，植入物旋转的风险使一些医生不愿使用这些装置。不同作者报道的旋转率有所不同。
作者呈现了一组为期6.5年的病例系列，共531例患者，均在瑞典一家机构由同一位顾问外科医生（P.M.）使用大纹理解剖型乳房植入物进行初次隆胸手术。作者研究了植入物的旋转率以及与可能的诱发因素如术前乳房罩杯大小、分娩史和体重指数之间的相关性。
19例患者（3.58%；95%置信区间，2.17%至5.53%）中共20枚植入物（1.88%；95%置信区间，1.15%至2.89%）发生旋转。其中1例患者（0.22%）双侧植入物均旋转，其余患者为单侧旋转。作者未能证实植入物旋转与既往分娩史或体重指数增加之间存在统计学上的显著相关性。然而，旋转率与术前乳房罩杯大小之间存在关联，随着罩杯大小从A增加到C，旋转率呈上升趋势。
作者认为，如果正确选择植入物并在手术中进行细致的操作及合适的腔隙剥离，旋转率将降至最低，不应将其视为使用解剖型乳房植入物的不利因素。
临床问题/证据级别：风险，III级
