From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S509-S514. doi: 10.1097/SAP.0000000000003515. Epub 2023 Mar 17.
Implant-based reconstruction remains the most common form of postmastectomy breast reconstruction. With ever-evolving device characteristics, including the advent of high-profile, cohesive, fifth-generation implants, the incidence of anterior-posterior flipping of implants is presenting a new challenge. Patient and device characteristics associated with this phenomenon have yet to be fully elucidated.
Patients who underwent nipple- or skin-sparing mastectomy with subsequent 2-stage or direct-to-implant reconstruction with smooth implants between 2015 and 2021 were retrospectively identified and stratified by incidence of implant flipping. Patient, procedural, and device characteristics were evaluated.
Within 165 patients (255 reconstructed breasts), 14 cases of implant flipping were identified (flip rate 5.5%). All flips occurred in patients with cohesive implants (odds ratio [OR], 87.0; P = 0.002). On univariate analysis, extra full implant profile (OR, 11.2; P < 0.001) and use of a smooth tissue expander for 2-stage reconstruction (OR, 4.1; P = 0.03) were associated with flipping. Implants that flipped were larger than those that did not (652.5 ± 117.8 vs 540.1 ± 171.0 mL, P = 0.0004). Prepectoral implant placement (OR, 2.7; P = 0.08) and direct-to-implant method (OR, 3.17; P = 0.07) trended toward association, but this effect was not significant. Patient BMI, weight fluctuation during the reconstructive course, mastectomy weight, AlloDerm use, and history of seroma or periprosthetic infection were not associated with flipping.
Patients who receive a highly cohesive, high profile, larger implant are at increased risk for implant flipping. In addition, patients who receive a smooth tissue expander are more likely to experience flipping of their subsequent implant, compared with those who had textured tissue expanders. These characteristics warrant consideration during device selection to minimize discomfort, aesthetic deformity, and the need for reoperation.
基于植入物的重建仍然是乳房切除术后重建的最常见形式。随着器械特征的不断发展，包括高凸度、黏附性、第五代植入物的出现，植入物前后翻转的发生率呈现出新的挑战。与这种现象相关的患者和器械特征尚未完全阐明。
回顾性地确定了 2015 年至 2021 年间接受乳头或皮肤保留乳房切除术，随后进行 2 期或直接植入平滑植入物的患者，并按植入物翻转的发生率进行分层。评估患者、手术和器械特征。
在 165 名患者（255 例重建乳房）中，发现 14 例植入物翻转（翻转率为 5.5%）。所有翻转均发生在黏附性植入物的患者中（优势比 [OR]，87.0；P = 0.002）。在单因素分析中，额外的全植入物轮廓（OR，11.2；P < 0.001）和使用平滑组织扩张器进行 2 期重建（OR，4.1；P = 0.03）与翻转有关。翻转的植入物比未翻转的植入物更大（652.5 ± 117.8 与 540.1 ± 171.0 mL，P = 0.0004）。胸肌下植入物放置（OR，2.7；P = 0.08）和直接植入物方法（OR，3.17；P = 0.07）呈关联趋势，但无统计学意义。患者 BMI、重建过程中的体重波动、乳房切除术重量、AlloDerm 使用情况以及血清肿或假体周围感染史与翻转无关。
接受高黏附性、高凸度、较大植入物的患者发生植入物翻转的风险增加。此外，与接受有纹理组织扩张器的患者相比，接受平滑组织扩张器的患者更有可能经历随后植入物的翻转。在选择器械时，这些特征需要考虑，以尽量减少不适、美容畸形和再次手术的需要。
