Sood Aditya, Xue Erica Y, Sangiovanni Christopher, Therattil Paul J, Lee Edward S
Department of Plastic and Reconstructive Surgery, The Ohio State University Medical Center, Columbus, OH.
Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Eplasty. 2017 Dec 21;17:e41. eCollection 2017.
Capsular contracture, the most common complication following breast augmentation with implants, is a complex inflammatory reaction that ultimately leads to fibrosis at the contact site between the implant and tissue. A number of peri-, pre-, and postoperative techniques have been postulated and implemented by many surgeons to reduce the incidence of capsular contracture. Breast massage and implant displacement technique is a commonly recommended practice that has not been well studied in regard to capsular contracture prevention. The authors present a review of the literature addressing methods and efficacy of massage and implant displacement techniques after breast augmentation. A literature review was performed using PubMed and the Cochrane Collaboration Library for primary research articles on breast massage or implant displacement after breast augmentation with implants for breast contracture prevention between January 1975 and March 2017. Exclusion criteria were studies that were focused on the treatment rather than prevention of breast contracture, addressed other strategies of preventing contracture as the main focus, or did not report the number of patients studied. Information related to massage technique and capsular contracture outcomes was extracted. The literature search yielded 4 relevant studies, with a total of 587 patients. Outcomes evaluated included massage technique, onset of massage, frequency of massage, and incidence of capsular contracture. Breast massage was introduced between 2 days and 2 weeks postoperatively, performed twice daily, and lasted from 2 to 5 minutes for each breast. Final postoperative follow-up concluded between 6 and 36 months. The average capsular contracture rate was similar, 31% (range, 0-35) in the massage group versus 40% (range, 30-90) in the nonmassage group. While multiple techniques have been proposed and practiced in the prevention of capsular contracture, breast massage and implant displacement techniques remain controversial. While there is a method to measure adequacy of breast massage pressure, it is not widely utilized. The available data do not support breast massage to prevent capsular contracture; more studies with standardized techniques are needed to better assess the efficacy of breast massage in preventing capsular contracture.
包膜挛缩是隆乳术后最常见的并发症，是一种复杂的炎症反应，最终导致植入物与组织接触部位发生纤维化。许多外科医生提出并实施了多种围手术期、术前和术后技术，以降低包膜挛缩的发生率。乳房按摩和植入物移位技术是一种常用的推荐方法，但在预防包膜挛缩方面尚未得到充分研究。作者对有关隆乳术后按摩和植入物移位技术的方法及疗效的文献进行了综述。利用PubMed和Cochrane协作图书馆进行文献综述，检索1975年1月至2017年3月期间关于隆乳术后乳房按摩或植入物移位预防乳房挛缩的原发性研究文章。排除标准为专注于治疗而非预防乳房挛缩、以其他预防挛缩策略为主要关注点或未报告研究患者数量的研究。提取了与按摩技术和包膜挛缩结果相关的信息。文献检索产生了4项相关研究，共587例患者。评估的结果包括按摩技术、按摩开始时间、按摩频率和包膜挛缩发生率。术后2天至2周开始进行乳房按摩，每天进行两次，每个乳房持续2至5分钟。术后最终随访时间为6至36个月。按摩组的平均包膜挛缩率为31%（范围为0-35），非按摩组为40%（范围为30-90）。虽然已经提出并实践了多种预防包膜挛缩的技术，但乳房按摩和植入物移位技术仍存在争议。虽然有一种测量乳房按摩压力是否足够的方法，但尚未广泛使用。现有数据不支持乳房按摩预防包膜挛缩；需要更多采用标准化技术的研究，以更好地评估乳房按摩预防包膜挛缩的疗效。
