di Summa Pietro G, Osinga Rik, Sapino Gianluca, Glen Katie, Higgins Gillian, Tay Sherylin, Weiler-Mithoff Eva
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK.
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Gland Surg. 2021 Jun;10(6):1920-1930. doi: 10.21037/gs-21-91.
Breast asymmetry can result from congenital or traumatic aetiologies. Breast implants, autologous fat grafting, or a combination of both of these techniques are commonly used to achieve symmetry. This study adds critical evaluation of long-term patient outcomes in a large study group, to evaluate pearls and pitfalls of these treatment modalities.
A prospectively maintained database of a single surgeon experience in breast asymmetry treatment over a 13-year period (2006-2018) was retrospectively analysed. Breast implant surgery and fat grafting to treat asymmetry were compared in terms of number of operations to achieve symmetry, complications, and overall patient satisfaction.
Thirty-five patients underwent breast implant surgery, requiring an average 2.1±1.6 operations to achieve symmetry, with a major complication rate (requiring secondary procedures) of 26% (n=9). Again, 26% (n=9) were converted to lipofilling due to either implant removal or unsatisfactory results. Thirty (86%) patients underwent fat transfer monotherapy to achieve symmetry and no major complications were recorded. Nine percent (n=3) of these patients preceded to have additional implant surgery.
Although implant-based reconstruction seemingly offers a quick single stage procedure, it is associated with significantly more revision procedures as a result of complications including capsular contracture, implant rupture and breast distortion. Fat grafting, despite requiring sequential operations to achieve initial symmetry, ultimately offers a more durable result and is associated with significantly fewer and more minor complications, while not increasing the total number of procedures required to achieve symmetry in the long term.
乳房不对称可由先天性或创伤性病因引起。乳房植入物、自体脂肪移植或这两种技术的联合应用常用于实现乳房对称。本研究在一个大型研究组中对患者的长期预后进行了批判性评估，以评估这些治疗方式的要点和缺陷。
回顾性分析了一个前瞻性维护的数据库，该数据库记录了一位外科医生在13年期间（2006 - 2018年）治疗乳房不对称的经验。比较了乳房植入手术和脂肪移植治疗不对称在实现对称所需的手术次数、并发症及患者总体满意度方面的情况。
35例患者接受了乳房植入手术，平均需要2.1±1.6次手术才能实现对称，主要并发症发生率（需要二次手术）为26%（n = 9）。此外，26%（n = 9）的患者因植入物取出或效果不满意而转为脂肪填充。30例（86%）患者接受了脂肪移植单一疗法以实现对称，未记录到重大并发症。这些患者中有9%（n = 3）随后又进行了额外的植入手术。
尽管基于植入物的重建似乎提供了一种快速的单阶段手术，但由于包括包膜挛缩、植入物破裂和乳房变形在内的并发症，其相关的翻修手术要多得多。脂肪移植尽管需要连续手术以实现初始对称，但最终能提供更持久的效果，且相关的并发症明显更少、更轻微，同时从长期来看不会增加实现对称所需的手术总数。
