Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
Aesthetic Plast Surg. 2021 Dec;45(6):2602-2617. doi: 10.1007/s00266-021-02276-6. Epub 2021 Apr 16.
Hematoma after non-oncologic breast surgery is a common concern requiring expeditious treatment. The purpose of this study is to perform an evidence-based review of perioperative factors that may contribute to hematoma in non-oncologic breast procedures.
A comprehensive literature review was performed of non-oncologic breast procedures: breast augmentation, single-stage augmentation-mastopexy, mastopexy, and reduction. In total, 28 studies highlighting incidence and potential risk factors for hematoma were included; overall level of evidence was established regarding each perioperative factor examined and hematoma rate.
The hematoma rate in breast augmentation ranges from 0.2 to 5.7%. There is inconclusive evidence to support an association between pocket choice or incision location and hematoma rate (Level III) and no evidence of an association between implant type and hematoma (Level V). Single-stage augmentation-mastopexy may have a lower hematoma rate than augmentation alone (Level II). Hematoma may increase the risk of capsular contracture (Level III). In breast reduction, the hematoma rate ranges from 1.0 to 9.3%. Evidence of an association between incision choice and hematoma rate is inconclusive (Level III). Use of epinephrine-containing solution, pedicle choice, and resection weight do not appear to affect hematoma rate (Level V, II, and II, respectively). The use of postoperative drains and ketorolac do not affect the incidence of hematoma (Level I and III, respectively). Intraoperative hypotension may increase the risk of hematoma after breast reduction (Level III).
Breast hematomas are not uncommon complications. Current literature lacks ample evidence for risk factors for hematoma after non-oncologic breast procedures, warranting further, high-powered investigations.
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 .
非肿瘤性乳房手术后血肿是一种常见的问题，需要及时治疗。本研究旨在对可能导致非肿瘤性乳房手术血肿的围手术期因素进行循证综述。
对非肿瘤性乳房手术（乳房隆乳术、一期隆乳乳房下垂矫正术、乳房下垂矫正术和乳房缩小术）进行了全面的文献回顾。共纳入了 28 项研究，强调了血肿的发生率和潜在危险因素；对每个检查的围手术期因素和血肿发生率进行了总体证据水平的评估。
乳房隆乳术的血肿发生率为 0.2%至 5.7%。关于口袋选择或切口位置与血肿发生率之间的关联，证据尚无定论（III 级），关于植入物类型与血肿之间的关联，没有证据（V 级）。一期隆乳乳房下垂矫正术的血肿发生率可能低于单纯隆乳术（II 级）。血肿可能会增加包膜挛缩的风险（III 级）。在乳房缩小术中，血肿发生率为 1.0%至 9.3%。切口选择与血肿发生率之间的关联证据尚无定论（III 级）。使用含肾上腺素溶液、蒂选择和切除重量似乎不会影响血肿发生率（V 级、II 级和 II 级）。术后引流和酮咯酸的使用并不影响血肿的发生率（I 级和 III 级）。术中低血压可能会增加乳房缩小术后血肿的风险（III 级）。
乳房血肿是常见的并发症。目前的文献缺乏非肿瘤性乳房手术后血肿危险因素的充分证据，需要进一步进行高影响力的研究。
证据水平 III：本杂志要求作者为每篇文章分配一个证据水平。有关这些循证医学等级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
