Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy.
Breast J. 2024 Feb 27;2024:9097040. doi: 10.1155/2024/9097040. eCollection 2024.
BACKGROUND: Breast cancer with about 2.3 million diagnoses and 685,000 deaths globally is the most frequent malignancy in the female population. Continuous research has led to oncological and reconstructive advances in the management of breast cancer, thus improving outcomes and decreasing patient morbidity. Nowadays, the submuscular expander and prosthesis (E/P) implant-based breast reconstruction (IBR) accounts for 73% of all reconstructions. Despite its widely accepted efficacy, the technique is not free from complications and up to 28% of cases require revision surgery for mechanical complications such as capsular contracture, implant displacement/rotation, and implant rupture. With this study, the authors report their experience in the management of E/P IBR revision surgery through the technique of Selective Capsulotomies (SCs) and Partial Capsulectomy (PC). METHODS: A retrospective study was conducted on patients who had previously undergone E/P IBR and presented for revision reconstruction between January 2013 and May 2023 at the Department of Plastic Surgery of the University of Siena, Italy. Reasons for revision included capsular contracture, implant displacement/rotation, and implant rupture. Revision reconstructions involved SC and PC with implant replacement. Fat grafting was also considered. The complication rate was evaluated by analysis of patients' medical records. Patients' satisfaction with the treatment was assessed through a specific questionnaire. RESULTS: 32 patients underwent revision surgeries. No early complication occurred. Recurrence rate was assessed at 19% with average follow-up of 59 months (range: 13-114 months). The average time between revision surgery and recurrence was 3 years (range: 1-6 years). 23 patients answered the questionnaire and were overall satisfied with the treatments (8.29/10). CONCLUSIONS: SC possibly associated to PC is a valuable option for E/P IBR revision surgery with minimal complications, reduced surgical trauma, short operating time, and relatively low recurrence risk. In addition, treated patients are overall satisfied with the results over time.
背景：乳腺癌在全球范围内的诊断病例约为 230 万例，死亡病例约为 68.5 万例，是女性中最常见的恶性肿瘤。不断的研究导致了乳腺癌治疗的肿瘤学和重建学方面的进步，从而改善了结果并降低了患者的发病率。如今，胸肌下扩张器和假体（E/P）植入物乳房重建（IBR）占所有重建的 73%。尽管该技术被广泛认可，但它并非没有并发症，高达 28%的病例因机械并发症（如包膜挛缩、植入物移位/旋转和植入物破裂）需要进行修复手术。在这项研究中，作者报告了他们通过选择性囊切开术（SCs）和部分囊切除术（PC）对 E/P IBR 修复手术的管理经验。
方法：对 2013 年 1 月至 2023 年 5 月在意大利锡耶纳大学整形外科就诊的既往接受过 E/P IBR 并进行修复重建的患者进行回顾性研究。修复的原因包括包膜挛缩、植入物移位/旋转和植入物破裂。修复重建包括植入物更换的 SC 和 PC，同时也考虑了脂肪移植。通过分析患者的病历评估并发症发生率。通过特定的问卷评估患者对治疗的满意度。
结果：32 例患者接受了修复手术，没有早期并发症发生。复发率为 19%，平均随访时间为 59 个月（范围：13-114 个月）。复发的平均时间为修复手术后 3 年（范围：1-6 年）。23 例患者回答了问卷，总体对治疗效果满意（8.29/10）。
结论：SC 可能与 PC 联合使用是 E/P IBR 修复手术的一种有价值的选择，具有最小的并发症、减少手术创伤、较短的手术时间和相对较低的复发风险。此外，随着时间的推移，接受治疗的患者对结果总体上是满意的。
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