Chimay Plastic Surgery Clinic, 2F, No. 50, Section 4, Ren'ai Road, Da'an District, Taipei 106, Taiwan; School of Health Care Administration, Taipei Medical University, Taiwan.
J Plast Reconstr Aesthet Surg. 2020 Dec;73(12):2225-2231. doi: 10.1016/j.bjps.2020.05.054. Epub 2020 May 26.
Capsulectomy is a standard treatment for capsular contracture after breast augmentation. Incision via the endoscopic transaxillary approach is generally preferred by Asian women, but relevant literature addressing endoscopic transaxillary capsulectomy is limited. This study described the techniques of endoscopic transaxillary capsulectomy with reimplantation performed as a single-operator outpatient procedure. This retrospective study included patients with diagnosis of capsular contracture underwent endoscopic transaxillary capsulectomy with immediate reimplantation between January 1, 2013 and December 31, 2017. Data regarding history, implant type, operation time, duration of postoperative drainage, and complications were collected and analyzed. A total of 42 patients with a mean age of 36 years were included (11 unilateral and 31 bilateral capsulectomy). Total capsulectomy was performed on four (10%) patients for previous subglandular augmentation, and anterior capsulectomy was performed on 38 (91%) patients for previous submuscular augmentation. Mean sizes of previous and new (or reused) implants were 268 ml (median 283 ml, SD 57) and 317 ml (median 307 ml, SD 49), respectively. Mean operation time for unilateral and bilateral procedures were 4 h 15 min and 6 h 28 min, respectively. Postoperatively, mean duration of wound drainage was 10 (SD 3) days. Six (14%) patients experienced complications, including two (5%) patients with seroma, two (5%) with hematoma, one (2%) with infection, and four (10%) with recurrent capsular contracture. The four recurrent cases underwent repeat endoscopic transaxillary capsulectomy. All of the 42 patients had satisfactory clinical and esthetic outcomes. This study demonstrated the feasibility of endoscopic transaxillary capsulectomy with immediate reimplantation performed as an ambulatory surgery by a single surgeon who is in a stable and comfortable sitting position without the aid of a surgical assistant.
乳房假体隆胸术后发生包膜挛缩时，常需行包膜切除术。亚洲女性通常倾向于经腋窝内镜入路切口，但目前针对经腋窝内镜下包膜切除术的相关文献较少。本研究描述了一种在稳定、舒适的坐姿下，无需手术助手辅助，由单名术者完成的、作为门诊手术的经腋窝内镜下包膜切除术联合即刻假体再植入的技术。本回顾性研究纳入了 2013 年 1 月 1 日至 2017 年 12 月 31 日期间因包膜挛缩而行经腋窝内镜下包膜切除术联合即刻假体再植入的患者。收集并分析了患者的病史、假体类型、手术时间、术后引流时间及并发症等数据。共纳入 42 例患者，平均年龄 36 岁（11 例单侧，31 例双侧）。4 例（10%）因之前行乳腺下假体隆胸而行全层包膜切除术，38 例（91%）因之前行胸大肌下假体隆胸而行前层包膜切除术。之前和新（或再用）假体的平均尺寸分别为 268ml（中位数 283ml，SD 57）和 317ml（中位数 307ml，SD 49）。单侧和双侧手术的平均手术时间分别为 4 小时 15 分钟和 6 小时 28 分钟。术后，伤口引流平均时间为 10 天（SD 3 天）。6 例（14%）患者出现并发症，包括 2 例（5%）血清肿、2 例（5%）血肿、1 例（2%）感染和 4 例（10%）复发性包膜挛缩。4 例复发病例再次行经腋窝内镜下包膜切除术。所有 42 例患者均获得了满意的临床和美学效果。本研究证实了由一名术者在稳定、舒适的坐姿下，无需手术助手辅助完成经腋窝内镜下包膜切除术联合即刻假体再植入作为门诊手术的可行性。
