Shikhman Alexander, Erz Logan, Brown Meghan, Wagner Douglas
Division of Plastic Surgery, Department of Surgery, Summa Health Systems, Akron, OH.
Department of Surgery, Summa Health Systems, Akron, OH.
Plast Reconstr Surg Glob Open. 2022 Feb 22;10(2):e4132. doi: 10.1097/GOX.0000000000004132. eCollection 2022 Feb.
Implant-based breast reconstruction in postmastectomy patients is commonly performed in a submuscular plane. Following reconstruction, animation deformity can be a displeasing aesthetic result for patients. In addition, patients may experience more postoperative pain with a submuscular reconstruction. Prepectoral conversion of submuscular implant position is an option for addressing these concerns. We describe a detailed technique and review our results.
A retrospective review was conducted of all prepectoral conversions performed by the senior author (DSW) from 2017 to 2019 after IRB approval. All patients presented with animation deformity and another symptom such as asymmetry, pain, and/or capsular contracture. Patients underwent prepectoral conversion with smooth silicone gel implants. Demographic data, outcomes, and patient satisfaction were reviewed.
Prepectoral conversion was performed in 33 consecutive patients (57 breasts) with animation deformity. Twelve patients had capsular contracture, seven complained of pain, and five had ruptured implants. Postoperative complications included three infections requiring implant removal in two breasts, one implant exposure and one hematoma requiring implant replacement, five seromas requiring aspiration, and one capsular contracture. Seven patients had contour abnormalities addressed with secondary autologous fat grafting. Ultimately, all patients had elimination of animation deformity and were satisfied with the results of the conversion.
Unsatisfactory results of subpectoral implant reconstruction such as animation deformity and chronic pain have led the reconstructive surgeon to consider various techniques to address these issues. The conversion to a prepectoral plane will effectively eliminate animation deformity, resolve pain, and yield satisfactory results in these patients.
乳房切除术后患者的植入式乳房重建通常在胸大肌下平面进行。重建后，动态畸形对患者来说可能是不理想的美学结果。此外，胸大肌下重建的患者术后疼痛可能更明显。将胸大肌下植入位置转换为胸大肌前是解决这些问题的一种选择。我们描述一种详细技术并回顾我们的结果。
在获得机构审查委员会批准后，对资深作者（DSW）在2017年至2019年进行的所有胸大肌前转换进行回顾性研究。所有患者均表现为动态畸形以及其他症状，如不对称、疼痛和/或包膜挛缩。患者采用光滑硅胶凝胶植入物进行胸大肌前转换。回顾人口统计学数据、结果和患者满意度。
连续33例（57侧乳房）有动态畸形的患者进行了胸大肌前转换。12例患者有包膜挛缩，7例主诉疼痛，5例植入物破裂。术后并发症包括3例感染（2侧乳房需要取出植入物）、1例植入物外露和1例血肿（需要更换植入物）、5例血清肿需要抽吸，以及1例包膜挛缩。7例患者通过二期自体脂肪移植解决了轮廓异常问题。最终，所有患者的动态畸形均消除，对转换结果满意。
胸大肌下植入重建的不满意结果，如动态畸形和慢性疼痛，促使重建外科医生考虑各种技术来解决这些问题项。转换为胸大肌前平面将有效消除动态畸形、缓解疼痛，并在这些患者中产生满意的结果。
