Dr Salgarello is an associate professor and plastic surgeon, Department of Plastic Surgery, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica-Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS-Università Cattolica del "Sacro Cuore" Rome, Italy.
Dr. Pino is a plastic surgeon, Department of Plastic Surgery, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica-Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS-Università Cattolica del "Sacro Cuore" Rome, Italy.
Aesthet Surg J. 2023 May 15;43(6):665-672. doi: 10.1093/asj/sjac261.
Secondary cosmetic breast surgery after primary augmentation with implant can be associated with an increased risk of adverse events. Partial/complete nipple-areola complex necrosis is particularly feared. In this preliminary study, the authors propose the utilization of indocyanine green (ICG) angiography to assess the blood supply of breast tissue after implant removal.
The main objective was to prevent skin and gland necrosis in revision breast surgery.
The authors performed a retrospective comparative analysis of 33 patients who underwent secondary breast surgery between 2018 and 2021 by a single surgeon (M.S.). Breast tissue perfusion was assessed in 16 patients by intraoperative ICG angiography at the end of implant removal and possible capsulectomy. Non-stained/non-fluorescent areas were judged to be low perfusion areas and were excised with short scar mastopexy.
In the ICG angiography group, 7 patients (44%) showed an area of poor perfusion along the inferior pole; all of these patients underwent subglandular breast augmentation. Resection of the poor perfusion areas allowed an uneventful postoperative course. In the non--- ICG angiography group (17 patients), 5 patients experienced vertical-scar dehiscence/necrosis. We found a statistically significant association between the non-ICG angiography group and vertical scar dehiscence/necrosis, and also between vertical scar dehiscence/necrosis and subglandular implant placement (P = 0.04).
Safer secondary surgery can be offered to patients undergoing secondary aesthetic breast procedures, especially when the first augmentation surgery is unknown-for example, implant plane, type of pedicle employed, if the implant is large and subglandular, and if capsulectomy is performed.
初次隆胸后进行二次美容乳房手术可能会增加不良事件的风险。部分/完全乳头乳晕复合体坏死尤其令人担忧。在这项初步研究中，作者提出使用吲哚菁绿（ICG）血管造影术来评估假体取出后乳房组织的血液供应。
主要目的是防止在修复性乳房手术中发生皮肤和腺体坏死。
作者对 2018 年至 2021 年间由同一位外科医生（M.S.）进行的 33 例二次乳房手术患者进行了回顾性对比分析。在假体取出和可能的包膜切除术结束时，通过术中 ICG 血管造影术评估 16 例患者的乳房组织灌注情况。无染色/无荧光区域被判断为低灌注区域，并通过短瘢痕乳房悬吊术切除。
在 ICG 血管造影组中，7 例（44%）患者下极有一处灌注不良区域；所有这些患者均行胸肌下乳房隆乳术。切除低灌注区域后，患者术后恢复顺利。在非 ICG 血管造影组（17 例）中，5 例患者出现垂直瘢痕裂开/坏死。我们发现非 ICG 血管造影组与垂直瘢痕裂开/坏死之间存在统计学显著关联，以及垂直瘢痕裂开/坏死与胸肌下植入物放置之间存在统计学显著关联（P=0.04）。
对于接受二次美容乳房手术的患者，可以提供更安全的二次手术，特别是当初次隆胸手术信息未知时，例如植入物的层次、使用的皮瓣类型、植入物是否较大且位于胸肌下、以及是否进行包膜切除术。
