Jong Justin, Gabriel Allen, Trekell Melissa, Lawser Amy S, Heidel Eric, Buchanan Dallas, Chun Joseph T
Department of Surgery, University of Tennessee Medical Center-Knoxville, Knoxville, Tenn.
Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, Calif.
Plast Reconstr Surg Glob Open. 2020 Dec 22;8(12):e3321. doi: 10.1097/GOX.0000000000003321. eCollection 2020 Dec.
Fifth-generation, round, form-stable implants have a higher cohesive gel, a higher fill volume, and distinct anterior and posterior profiles. Due to these implant features, anterior-posterior (AP) flipping of round, form-stable implants is discernible, but little is known of this complication of implant reconstruction.
Patients who underwent skin- or nipple-sparing mastectomy followed by direct-to-implant reconstruction with round, cohesive, smooth implants were included in this retrospective study. Implants were placed submuscularly or prepectorally. Incidence of flipping was retrieved from patient records. Patients were stratified by presence or absence of flipping; data on patient demographic characteristics, neoadjuvant/adjuvant treatment, mastectomy characteristics, and acellular dermal matrix (ADM) type (AlloDerm or FlexHD) and coverage technique (inferior pole, tenting, or wrapping) were compared between the groups to identify risk factors associated with flipping.
A total of 117 patients (230 breasts) were evaluated. Sixteen cases of implant flipping were documented for a flip rate of 7.0%, all occurring in patients with prepectoral implants. On univariate analysis, prepectoral implant placement, highly cohesive implants, use of AlloDerm, and ADM wrapping/tenting were found to be significantly associated with AP flipping. On logistic regression analyses, ADM type and ADM coverage technique were no longer significant predictors of AP flipping.
Patients who undergo prepectoral implant reconstruction with highly cohesive round implants appear to be at an increased risk of AP flipping. Subpectoral reconstruction is not associated with AP flipping.
第五代圆形、形态稳定的乳房植入物具有更高的凝聚性凝胶、更大的填充量以及明显的前后轮廓。由于这些植入物的特性，圆形、形态稳定的植入物的前后翻转是可以察觉的，但对于这种植入物重建并发症的了解却很少。
本回顾性研究纳入了接受保乳或保乳头乳房切除术后直接植入圆形、凝聚性、光滑乳房植入物进行重建的患者。植入物置于胸大肌下或胸大肌前。从患者记录中获取翻转发生率。根据是否发生翻转对患者进行分层；比较两组患者的人口统计学特征、新辅助/辅助治疗、乳房切除术特征以及脱细胞真皮基质（ADM）类型（AlloDerm或FlexHD）和覆盖技术（下极、帐篷式或包裹式）的数据，以确定与翻转相关的危险因素。
共评估了117例患者（230侧乳房）。记录到16例植入物翻转，翻转率为7.0%，均发生在胸大肌前置入植入物的患者中。单因素分析发现，胸大肌前置入植入物、高凝聚性植入物、使用AlloDerm以及ADM包裹/帐篷式覆盖与前后翻转显著相关。逻辑回归分析显示，ADM类型和ADM覆盖技术不再是前后翻转的显著预测因素。
采用高凝聚性圆形植入物进行胸大肌前植入重建的患者似乎发生前后翻转的风险增加。胸大肌后重建与前后翻转无关。
