Park Si-Hyun, Sim Hyung-Bo
Department of Plastic and Reconstructive Surgery, Soonchunhyang University Hospital, Seoul, Korea.
Arch Plast Surg. 2018 Mar;45(2):158-164. doi: 10.5999/aps.2017.01263. Epub 2018 Mar 5.
During breast augmentation, the transaxillary approach provides the advantage of allowing the mammary prosthesis to be placed through incisions that are remote from the breast itself, thereby reducing the visibility of postoperative scars. For patients experiencing capsular contracture who do not want additional scars, the previous transaxillary scar can be used for site change and implant exchange.
This study analyzed 17 patients (34 breasts) with submuscular breast implants with grade III-IV capsular contracture who received treatment from 2010 to 2015. The mean age of the patients was 29 years (range, 20-38 years). The inclusion criterion was a pinch test of more than 3 cm at the upper pole of the breast. Previous axillary scars were used to expose the pectoralis fascia, and submuscular breast implants were removed carefully. The dissection underneath the pectoralis fascia was performed with endoscopic assistance, using electrocautery under direct visualization.
The mean follow-up period was 14 months (range, 6-24 months). The entire dissection plane was changed from the submuscular plane to the subfascial plane. Round textured gel implants were used, with a mean implant size of 220 mL (range, 160-300 mL). Two patients developed grade II capsular contracture. There were no cases of malposition or asymmetry. Three patients complained of minor implant palpability. None of the patients required additional surgery.
Endoscopic subfascial conversion may be an effective technique for treating capsular contracture and avoiding scarring of the breast in selected patients.
在隆胸手术中，经腋窝入路具有一定优势，即允许通过远离乳房本身的切口置入乳房假体，从而减少术后瘢痕的可见度。对于发生包膜挛缩且不希望有额外瘢痕的患者，先前的腋窝瘢痕可用于更换手术部位和更换植入物。
本研究分析了2010年至2015年期间接受治疗的17例（34侧乳房）患有III-IV级包膜挛缩的肌下乳房植入物患者。患者的平均年龄为29岁（范围20-38岁）。纳入标准为乳房上极捏起试验超过3厘米。利用先前的腋窝瘢痕暴露胸肌筋膜，并小心取出肌下乳房植入物。在胸肌筋膜下进行剥离时借助内镜辅助，在直视下使用电灼。
平均随访期为14个月（范围6-24个月）。整个剥离平面从肌下平面改为筋膜下平面。使用圆形表面有纹理的凝胶植入物，植入物平均大小为220毫升（范围160-300毫升）。2例患者发生II级包膜挛缩。无植入物位置不当或不对称的情况。3例患者主诉植入物可轻微触及。所有患者均无需再次手术。
对于特定患者，内镜下筋膜下转换术可能是治疗包膜挛缩并避免乳房瘢痕形成的有效技术。
