Service de Chirurgie Plastique, Reconstructrice Et Esthétique. Centre des Brûlés, Hôpital Saint Louis, 1 avenue Vellefaux, 75010, Paris, France.
Public Health, Saint-Louis Hospital, Paris, France.
Aesthetic Plast Surg. 2021 Feb;45(1):15-23. doi: 10.1007/s00266-020-01876-y. Epub 2020 Jul 21.
Baker grade III and IV breast prosthesis capsular contractures represent a major problem for patients undergoing mammoplasties. The risk factors involved in recurrence are debated, and the best surgical approach for their prevention is not established. The objective was to identify these.
We carried out a retrospective study of patients operated on for capsular contracture at the Saint-Louis Hospital in Paris from 2012 to 2014. The characteristics at inclusion were compared so as to determine the risk factors of recurrence. The surgical approaches were compared between the patients with recurrence and those without at 5 years.
Of the 100 patients included, 24 had a recurrence. The minimal follow-up was 5 years. No risk factors of recurrence of capsular contracture were identified. The surgical approach associated with the lowest rate of recurrence was anterior capsulectomy [OR total capsulectomy = 2.36 (0.73; 8.037) OR capsulotomy = 4.33 (1.37; 14.81)] (p < 0.040) with alteration of the volume of the implant, whether greater or less than initially [OR greater volume = 0.30 (0.096; 0.83); OR smaller volume = 0.14 (0.008; 0.85)] (p < 0.018).
The occurrence of capsular contracture is a major problem with prosthetic breast surgery. The main risk factors identified to date are essentially in regard to the occurrence of a first episode. No significant risk factors for recurrence were identified. The best prevention appears to be an anterior capsulectomy with reducing the volume of the implant.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . IV.
贝克 III 级和 IV 级乳房假体包膜挛缩是乳房成形术患者的主要问题。关于复发的相关危险因素存在争议，且尚未确定预防包膜挛缩的最佳手术方法。本研究旨在确定这些因素。
我们对 2012 年至 2014 年在巴黎圣路易医院接受包膜挛缩手术的患者进行了回顾性研究。对纳入的患者特征进行了比较，以确定复发的危险因素。比较了 5 年时复发患者和未复发患者的手术方法。
在纳入的 100 例患者中，有 24 例患者出现复发。最小随访时间为 5 年。未发现包膜挛缩复发的危险因素。复发率最低的手术方法是前包膜切除术[总包膜切除术的 OR=2.36（0.73；8.037）或囊切开术的 OR=4.33（1.37；14.81）]（p<0.040），同时改变了植入物的体积，无论是增加还是减少[体积增加的 OR=0.30（0.096；0.83）；体积减少的 OR=0.14（0.008；0.85）]（p<0.018）。
包膜挛缩的发生是假体乳房手术的一个主要问题。迄今为止，确定的主要危险因素主要与首次发作有关。未发现明显的复发危险因素。最好的预防方法似乎是前包膜切除术，同时减少植入物的体积。
证据等级 IV：本杂志要求作者为每篇文章指定一个证据等级。有关这些循证医学等级的完整描述，请参阅目录或在线作者指南 www.springer.com/00266。IV。
