From The Wall Center for Plastic Surgery.
Plast Reconstr Surg. 2023 Jun 1;151(6):918e-930e. doi: 10.1097/PRS.0000000000010129. Epub 2023 Jan 2.
Mastopexy augmentation is a challenging procedure, and a technique to create desirable, consistent, predictable results with a low rate of problems has not been well standardized. The inherent difficulty lies in competing surgical maneuvers. This study sought to evaluate the authors' experience and describe the key concepts and steps that allow safe, efficient, predictable results with low complication and long-term reoperation rates.
A 10-year retrospective review of all aesthetic breast operations between 2005 and 2015 was performed. Two senior surgeons (S.H.W. and H.C.W.) performed 1217 one-stage, superiorly based, short-scar mastopexy augmentation procedures. The data were evaluated in the context of other published series in the literature.
The overall revision rate was 4.8%. Patients who had undergone prior breast surgery were statistically more likely to require a revision compared with patients who had virgin breast tissue (10.4% versus 3.8%; P = 0.0005). Average follow-up was 39 months. Twenty-eight percent of revisions were performed more than 2 years after the original surgery; 16% were performed more than 6 years later. All revisions were included, regardless of procedure scope or timing. Of the 58 revision cases, 86% were purely implant or implant-pocket related; 7% were purely tissue related. There was one case of partial nipple necrosis. There were no cases of emergent reoperation, implant loss, implant exposure, or major wound dehiscence.
The authors' approach has been refined to maximize aesthetics, longevity, consistency, and surgical efficiency, and to minimize complications. This study demonstrates that safe and predictable results can be attained in one stage with low complication and reoperation rates. .
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
乳房上提隆乳术是一项具有挑战性的手术，目前尚未形成一种能够确保手术效果良好、稳定、可预测且并发症发生率低的标准化技术。该手术的难点在于各种手术操作之间相互矛盾。本研究旨在评估作者的经验，阐述实现安全、高效、稳定、并发症发生率和再次手术率低的关键理念和步骤。
对 2005 年至 2015 年间所有美容乳房手术进行了 10 年的回顾性研究。两位资深外科医生（S.H.W.和 H.C.W.）进行了 1217 例一期、基于上方、短瘢痕乳房上提隆乳术。将这些数据与文献中的其他发表系列进行了评估。
总体返修率为 4.8%。与初次乳房手术的患者相比，既往有乳房手术史的患者需要返修的几率更高（10.4%比 3.8%；P=0.0005）。平均随访 39 个月。28%的返修是在初次手术后 2 年以上进行的；16%的患者在 6 年以后进行了返修。所有的返修手术均包括在内，无论手术范围或时间如何。在 58 例返修病例中，86%与植入物或植入物袋有关；7%与组织有关。有 1 例出现部分乳头坏死。无紧急再次手术、植入物丢失、植入物暴露或严重伤口裂开的病例。
作者的方法已经得到了改进，以最大限度地提高美观度、持久性、一致性和手术效率，同时减少并发症。本研究表明，通过一期手术可以获得安全且可预测的效果，且并发症发生率和再次手术率较低。
临床问题/证据水平：治疗性，IV 级。
