Jakob Vivian L, Keck Maike, Lohmeyer Jörn A
Department of Plastic, Reconstructive and Aesthetic Surgery, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany.
Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Plast Reconstr Surg Glob Open. 2023 Mar 10;11(3):e4872. doi: 10.1097/GOX.0000000000004872. eCollection 2023 Mar.
Although breast implants of the current generation can, in principle, remain in the body for life, follow-up operations of the augmented or reconstructed breasts are regularly necessary. Capsular contracture is the leading cause for revisional surgery. The aim of this study was to evaluate indications and changes in time intervals between consecutive implant replacements with a focus on capsular contracture.
In the period from 2012 to 2017, all patients with breast implant replacements or removals at our institution were identified. From the medical file, the time of the first implantation and earlier replacements were analyzed for indication and timing of surgery.
A total of 498 operations for implant replacement or removal were analyzed in 323 patients. Including prior operations, 717 procedures could be evaluated. If capsular contracture was the indication, revision surgery was performed on average 14.3 years or 8.4 years in aesthetic or reconstructive cases, respectively. In patients with more than one implant removal or replacement, we saw a reduction in the time interval between the first, second, and third follow-up operation.
The main indication to perform implant replacements or removals was capsular contracture recurring at increasingly shorter intervals. Patients must be informed about this possible progression when changing implants, but also before the first operation. If capsular contracture occurs after a rather short time period in reconstructive cases, the opportunity of an alternative approach (eg, autologous reconstruction) instead of a renewed implant change should be discussed with the patient.
虽然目前一代的乳房植入物原则上可以终身留存体内，但对隆乳或乳房重建后的乳房进行后续手术仍是常规所需。包膜挛缩是翻修手术的主要原因。本研究的目的是评估连续更换植入物的指征及时间间隔变化，重点关注包膜挛缩。
在2012年至2017年期间，确定了在我们机构进行乳房植入物更换或取出的所有患者。从病历中分析首次植入时间和更早的更换情况，以了解手术指征和时间安排。
对323例患者的498例植入物更换或取出手术进行了分析。包括之前的手术，共可评估717例手术。如果指征是包膜挛缩，在美容或重建病例中，翻修手术平均分别在14.3年或8.4年后进行。在进行过一次以上植入物取出或更换的患者中，我们发现第一次、第二次和第三次随访手术之间的时间间隔缩短。
进行植入物更换或取出的主要指征是包膜挛缩复发且间隔时间越来越短。在更换植入物时，以及在首次手术前，都必须告知患者这种可能的进展情况。如果在重建病例中包膜挛缩在较短时间内发生，应与患者讨论采用替代方法（如自体重建）而非再次更换植入物的可能性。
