From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University; and the Department of Biological Science and Technology, National Chiao-Tung University.
Plast Reconstr Surg. 2020 Jan;145(1):11-17. doi: 10.1097/PRS.0000000000006314.
Animation deformity can occur following subpectoral breast reconstruction and is an oft-touted rationale for prepectoral reconstruction. Despite increasing recognition, there is a paucity of patient-reported outcome studies in women with animation deformity.
Women presenting after subpectoral implant-based breast reconstruction were evaluated for animation deformity. Video analysis and quantitative deformity assessment were performed in conjunction with BREAST-Q surveys. BREAST-Q data were compared to our quantitative animation grading scale to assess the relationship between animation severity and patient-reported outcomes.
One hundred forty-one subpectoral breast reconstructions met inclusion criteria. Average scores were 67.8 ± 17.9 of 100 for satisfaction with breasts and 78.3 ± 14.1 of 100 for physical well-being. Animation deformity severity did not correlate with satisfaction with breasts (p = 0.44). Physical well-being, particularly pain-related questions, increased with increasing animation (p = 0.01); specifically, patients reported significantly less pulling, nagging, and aching in the breast (p = 0.01, p = 0.001, and p = 0.004, respectively). Patients with the least and most severe animation deformity had significantly higher numbers of revision procedures (0.89 and 1.03 procedures, respectively) compared with patients with intermediate deformity (0.49 procedures; p = 0.01 and p = 0.009, respectively).
Although pectoralis release creates a more mobile-and more animating-reconstruction, this same release may lead to less pain because muscle is no longer contracting against a fixed space. This may lead to two distinct origins of subpectoral revision: (1) patients in pain (but low animation) and (2) patients with visibly distorted animation (but low pain).
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
乳房下皱襞入路乳房重建后可能会出现畸形，这是前入路乳房重建的常用理由。尽管人们越来越认识到这一点，但患有运动畸形的女性患者的报告结果研究仍然很少。
对接受乳房下皱襞入路假体乳房重建的患者进行运动畸形评估。结合 BREAST-Q 问卷调查进行视频分析和定量畸形评估。将 BREAST-Q 数据与我们的定量运动畸形分级量表进行比较，以评估运动畸形严重程度与患者报告结果之间的关系。
共有 141 例乳房下皱襞入路乳房重建符合纳入标准。满意度平均得分为 67.8 ± 17.9 分（满分 100 分），生理健康平均得分为 78.3 ± 14.1 分（满分 100 分）。运动畸形严重程度与乳房满意度无相关性（p = 0.44）。生理健康，特别是与疼痛相关的问题，随着运动畸形的增加而增加（p = 0.01）；具体来说，患者报告乳房的牵拉、隐痛和酸痛明显减少（p = 0.01、p = 0.001 和 p = 0.004）。运动畸形程度最小和最大的患者分别接受了 0.89 次和 1.03 次修复手术，而畸形程度中等的患者接受了 0.49 次修复手术（分别为 p = 0.01 和 p = 0.009）。
尽管胸大肌松解术可使重建更具活动性和运动性，但该松解术也可能导致疼痛减轻，因为肌肉不再收缩于固定空间内。这可能导致两种不同的乳房下皱襞入路修复术的原因：（1）疼痛患者（但运动畸形程度低）；（2）可见运动畸形明显扭曲患者（但疼痛程度低）。
临床问题/证据水平：风险，Ⅱ级。
