基于植入物的乳房重建术后辐射性囊袋挛缩：处理与结果。
Postirradiation Capsular Contracture in Implant-Based Breast Reconstruction: Management and Outcome.
机构信息
From the Department of Plastic and Reconstructive Surgery and the Department of Surgery, Breast Health Center, Tel-Aviv Sourasky Medical Center; Sackler Faculty of Medicine, Tel Aviv University; and the School of Medicine, Ben Gurion University.
出版信息
Plast Reconstr Surg. 2021 Jan 1;147(1):11-19. doi: 10.1097/PRS.0000000000007453.
BACKGROUND
Implant-based breast reconstruction is commonly avoided in the setting of radiation therapy, mainly because of risks of capsular contracture. Nevertheless, as breast reconstruction is becoming more available, more patients undergo both implant-based breast reconstruction and radiotherapy. The dilemma is how to manage capsular contracture if it does occur. The goal of this study was to examine the outcome of patients with implant-based breast reconstruction who developed postirradiation capsular contracture and were treated with capsulotomy or capsulectomy, with or without fat grafting.
METHODS
The authors reviewed charts of patients who developed capsular contracture following alloplastic breast reconstruction followed by radiation therapy, between 2008 and 2018. The surgical treatment methods for capsular contracture were evaluated along with their outcomes. A follow-up of at least 1 year was required.
RESULTS
Forty-eight breasts with postirradiation capsular contracture underwent surgical implant exchange with capsular release, of which 15 had combined fat grafting and 33 did not. Overall, 35 breasts (72.9 percent) showed long-term resolution of capsular contracture; 24 underwent a single procedure and 11 required an additional fat grafting procedure. Some patients [six breasts (12.5 percent)] were offered a consecutive round of fat grafting, and some [seven breasts (14.5 percent)] were offered autologous reconstruction because of lack of improvement. Fat grafting increased the success rate by more than 30 percent when it was initially and consecutively used.
CONCLUSIONS
Postirradiation capsular contracture may be treated successfully by secondary procedures, sustaining implant-based breast reconstruction in over 70 percent of breasts. Fat grafting may elevate resolution rates even further, to 86 percent. Larger prospective studies are required to validate these findings.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
在放疗的情况下，通常避免采用植入物乳房重建，主要是因为包膜挛缩的风险。然而，随着乳房重建变得更加普及，越来越多的患者同时接受植入物乳房重建和放疗。问题是如果确实发生包膜挛缩，该如何处理。本研究的目的是检查接受过放疗后发生包膜挛缩的植入物乳房重建患者的治疗结果，这些患者接受了包膜切开术或包膜切除术，伴或不伴脂肪移植。
方法
作者回顾了 2008 年至 2018 年间接受过所有oplastic 乳房重建和放疗后发生包膜挛缩的患者的病历。评估了包膜挛缩的手术治疗方法及其结果。需要至少 1 年的随访。
结果
48 个乳房因放疗后发生包膜挛缩而行手术更换植入物并松解包膜，其中 15 个乳房联合了脂肪移植，33 个乳房未进行脂肪移植。总的来说，35 个乳房（72.9％）的包膜挛缩得到了长期缓解；24 个乳房只进行了一次手术，11 个乳房需要进行额外的脂肪移植手术。一些患者（6 个乳房，12.5％）接受了连续一轮的脂肪移植，一些患者（7 个乳房，14.5％）由于改善不明显而选择自体重建。当最初和连续使用脂肪移植时，成功率提高了 30％以上。
结论
继发性手术可成功治疗放疗后包膜挛缩，维持 70％以上乳房的植入物乳房重建。脂肪移植甚至可以进一步提高缓解率，达到 86％。需要更大规模的前瞻性研究来验证这些发现。
临床问题/证据水平：治疗，III 级。
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