From private practice.
Plast Reconstr Surg. 2020 Dec;146(6):1249-1257. doi: 10.1097/PRS.0000000000007333.
Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. There are few large series with longitudinal follow-up and outcome measures.
Seven hundred eighty-three patients underwent subfascial breast augmentation and were followed up for 10 years. Adverse outcomes, changes in breast morphometry, and patient satisfaction were outcome measures.
All morphometry increased except soft-tissue thickness at the lateral sternal margin. The distance from the nipple-areola complex to the inframammary crease increased by 40 percent, with a concomitant 6.2 percent increase in the distance from the suprasternal notch to the nipple-areola complex. The capsular contracture rate was 6.48 percent, and correlates with a lateral sternal margin of less than 20 mm (r = 0.57, p < 0.001). Ripples occurred in patients with less than 10 mm of soft tissue at the lateral sternal margin; 11.6 percent of patients would choose a larger implant and 2.7 percent would choose a smaller implant.
Subfascial placement of breast implants provides a reliable technique. It can be used in patients with at least 20 mm of soft tissue at the lateral sternal margin. Those with 10 to 20 mm should be counseled that ripples may occur if they lose body fat. The technique is unsuitable for individuals with less than 10 mm measurable at the lateral sternal margin.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
乳腺假体的筋膜下放置具有亚腺体和肌肉下放置的优点，而没有不良后果。很少有大型的具有纵向随访和结果测量的系列。
783 例患者接受了筋膜下乳房增大术，并随访了 10 年。不良结果、乳房形态变化和患者满意度是结果测量指标。
除胸骨旁外侧软组织厚度外，所有形态学指标均增加。乳晕复合体到乳房下皱襞的距离增加了 40%，胸骨上切迹到乳晕复合体的距离增加了 6.2%。包膜挛缩率为 6.48%，与胸骨旁外侧缘小于 20mm 相关(r=0.57，p<0.001)。在胸骨旁外侧缘软组织小于 10mm 的患者中出现了波纹；11.6%的患者会选择更大的植入物，2.7%的患者会选择更小的植入物。
乳腺假体的筋膜下放置提供了一种可靠的技术。它可以用于至少有 20mm 胸骨旁外侧软组织的患者。对于胸骨旁外侧缘有 10 到 20mm 的患者，应该告知他们如果失去体脂可能会出现波纹。对于胸骨旁外侧缘可测量的软组织小于 10mm 的患者，该技术不适用。
临床问题/证据水平：治疗，IV。
