Ishii Naohiro
Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.
Department of Plastic and Reconstructive Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan.
Gland Surg. 2023 Dec 26;12(12):1786-1793. doi: 10.21037/gs-23-221. Epub 2023 Dec 22.
Breast reconstruction using silicone breast implants (SBIs) has been performed for many patients in Japan under the initiative of the Japan Oncoplastic Breast Surgery Society (JOBSS) since SBIs were first covered by insurance in 2013. A change in the lineup of available SBIs owing to the Allergan crisis caused a decrease in the availability of SBIs appropriate to Japanese breast contours. Recently, the number of immediate implant-based breast reconstructions (IBRs) was approximately 4,000 in one year and was slightly decreasing. The SBI is generally placed under the pectoralis major muscle. Because the number of patients with one-stage, implant-based operative indications is small, an acellular dermal matrix is not available in Japan, and the complication rate in one-stage, IBR is high, most immediate, IBRs are performed in two stages. The prevalence of immediate, one-stage, IBRs is approximately 10%. Fat grafting by injection using Coleman's technique is performed in many hospitals under the JOBSS initiative as a surgery combined with SBI insertion. Complications after SBI placement may be less common in Japan than those in other countries. Japanese breast reconstructive surgeons undertake preventive measures to lessen these complications according to guidelines and experts' opinions, which may contribute to the low complication rate after SBI placement. The total reported number of patients with breast implant-associated anaplastic large cell lymphoma is four, and no patients have died because of this disease. In Japan, procuring informed consent and diagnosing and treating this disease are performed according to the JOBSS guidelines.
自2013年硅凝胶乳房植入物（SBI）首次纳入保险范围以来，在日本乳房整形外科学会（JOBSS）的倡议下，许多患者接受了使用SBI的乳房重建手术。由于艾尔建危机，可用SBI的产品阵容发生了变化，导致适合日本乳房轮廓的SBI供应减少。最近，每年基于植入物的即刻乳房重建（IBR）数量约为4000例，且略有下降。SBI通常放置在胸大肌下方。由于一期基于植入物的手术适应症患者数量较少，日本无法获得脱细胞真皮基质，且一期IBR的并发症发生率较高，因此大多数即刻IBR分两期进行。即刻一期IBR的患病率约为10%。在JOBSS的倡议下，许多医院采用科尔曼技术进行注射脂肪移植，作为一种与SBI植入相结合的手术。在日本，SBI植入后并发症可能比其他国家少见。日本乳房重建外科医生根据指南和专家意见采取预防措施以减少这些并发症，这可能有助于降低SBI植入后的并发症发生率。报告的乳房植入物相关间变性大细胞淋巴瘤患者总数为4例，且无患者因该病死亡。在日本，根据JOBSS指南获取知情同意并对该病进行诊断和治疗。
