From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine.
Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine.
Plast Reconstr Surg. 2024 Jan 1;153(1):7-22. doi: 10.1097/PRS.0000000000010573. Epub 2023 Apr 20.
Breast implants are the most commonly used medical devices in plastic surgery, and capsular contracture (CC) is one of the most common complications. However, our assessment of CC is based largely on Baker grade, which is problematically subjective and affords only four possible values.
The authors performed a systematic review concluding in September of 2021 in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It identified 19 articles that propose approaches to measuring CC.
In addition to Baker grade, the authors identified several modalities reported to measure CC. These included magnetic resonance imaging, ultrasonography, sonoelastography, mammacompliance measuring devices, applanation tonometry, histologic evaluation, and serology. Capsule thickness and other measures of CC inconsistently correlated with Baker grade, whereas the presence of synovial metaplasia was consistently associated with Baker grade I and II, but not III and IV capsules.
There remains no particular method to reliably and specifically measure the contracture of capsules that form around breast implants. As such, we would recommend that research investigators use more than one modality to measure CC. Other variables that can impact breast implant stiffness and associated discomfort beyond CC need to be considered when evaluating patient outcomes. Given the value placed on CC outcomes in assessing breast implant safety, and the prevalence of breast implants overall, the need for a more reliable approach to measuring this outcome persists.
乳房植入物是整形手术中最常用的医疗器械之一，包膜挛缩（CC）是最常见的并发症之一。然而，我们对 CC 的评估在很大程度上基于 Baker 分级，该分级存在问题，主观性强，只能提供四种可能的值。
作者进行了一项系统评价，于 2021 年 9 月完成，符合系统评价和荟萃分析报告的首选项目。它确定了 19 篇提出测量 CC 方法的文章。
除了 Baker 分级，作者还确定了几种被报道用于测量 CC 的方法。这些方法包括磁共振成像、超声、超声弹性成像、乳房顺应性测量设备、压平眼压计、组织学评估和血清学。包膜厚度和 CC 的其他测量值与 Baker 分级不一致相关，而滑膜化生的存在与 Baker 分级 I 和 II 一致，但与 III 和 IV 级包膜不一致。
目前仍然没有特别的方法可以可靠和专门地测量形成乳房植入物周围的包膜的挛缩程度。因此，我们建议研究人员使用多种方法来测量 CC。在评估患者结果时，需要考虑除 CC 之外影响乳房植入物硬度和相关不适的其他变量。鉴于 CC 结果在评估乳房植入物安全性方面的重要性，以及乳房植入物的普遍存在，因此仍然需要一种更可靠的方法来测量这一结果。
