, 2/40 Clyde Road, Berwick, VIC, 3806, Australia.
Aesthetic Plast Surg. 2021 Jun;45(3):845-850. doi: 10.1007/s00266-020-02010-8. Epub 2020 Oct 19.
The management of capsular contraction following breast augmentation has numerous, often conflicting potential treatment protocols, each designed to reduce the incidence of further recurrence. The use of the subfascial plane has not been investigated as an alternative to other treatment options.
To examine the outcomes from patients presenting with recurrent capsular contraction after being treated for the first capsule by placement of an implant into the subfascial (SF) plane.
Retrospective analysis of 111 case notes of patients who presented with capsular contraction. 65 had undergone SF augmentation, 17 submuscular (SM) and 29 subglandular (SG) placement of implant at the primary procedure. At a secondary procedure, those with SF implants underwent open capsulotomy and those with SM and SG implants underwent a change in plane to SF.
There is a significant difference in the proportion of patients that developed a capsule following the second surgery between the groups that had undergone capsulotomy (SF = 16.9%) or plane change (SM = 47% and SG = 37.9%, X (2,111) = 8.6, P = 0.02). When recurrence at the same site was examined, there was also a significant difference between the groups (X (2111) = 10.7, P < 0.01). A ruptured implant significantly increased the incidence of further capsular contraction when in the SG plane (X (2,29) = 12.1, P < 0.01).
In the absence of implant rupture, changing the plane of an implant to a SF position at revision surgery does not reduce the incidence of subsequent capsular contracture compared with open capsulotomy. Open capsulotomy is a reasonable choice following recurrence of capsular contraction following initial SF placement.
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 .
乳房隆乳术后包膜挛缩的处理方法众多，且常常相互矛盾，每种方法都旨在降低进一步复发的发生率。筋膜下平面的应用尚未被研究为其他治疗选择的替代方法。
检查初次包膜切开术后再次出现包膜挛缩的患者，通过将植入物置于筋膜下（SF）平面来治疗的结果。
对 111 例包膜挛缩患者的病历进行回顾性分析。其中 65 例行 SF 增强术，17 例行胸肌下（SM）植入物放置，29 例行胸下（SG）植入物放置。在二次手术中，SF 植入物患者行开放性包膜切开术，SM 和 SG 植入物患者行平面改变至 SF。
在接受包膜切开术（SF=16.9%）或平面改变（SM=47%和 SG=37.9%）的患者中，第二次手术后发生包膜的患者比例存在显著差异（X (2,111) = 8.6，P = 0.02）。当检查同一部位的复发情况时，两组之间也存在显著差异（X (2111) = 10.7，P < 0.01）。在 SG 平面中，破裂的植入物显著增加了进一步包膜挛缩的发生率（X (2,29) = 12.1，P < 0.01）。
在没有植入物破裂的情况下，与开放性包膜切开术相比，在翻修手术中将植入物的平面改为 SF 位置并不能降低随后包膜挛缩的发生率。对于初次 SF 放置后包膜挛缩复发，开放性包膜切开术是合理的选择。
证据水平 IV：本杂志要求作者为每篇文章分配一个证据水平。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
