Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom.
São Paulo State University - UNESP, Brazil.
J Plast Reconstr Aesthet Surg. 2024 Nov;98:131-143. doi: 10.1016/j.bjps.2024.08.057. Epub 2024 Aug 17.
Capsular contracture after implant-based breast reconstruction is not an uncommon problem and affects reconstruction outcomes. It can be influenced by various factors, such as the plane of implant placement, implant surface and implant type. This systematic review and meta-analysis aimed to evaluate how the abovementioned risk factors can affect capsular contracture rates.
A systematic review and meta-analysis was performed. PubMed MEDLINE, EMBASE (OvidSP) and Cochrane Library were searched. Comparison groups included subpectoral versus prepectoral implant placement, smooth versus textured implants and saline versus silicone implants. Odds ratios (ORs) were calculated for capsular contracture for each group. The level of evidence was evaluated using the Oxford Centre for Evidence-Based Medicine.
Twenty-three studies met the inclusion criteria. Sixteen studies compared subpectoral versus prepectoral implant placement, with no statistically significant differences in capsular contracture rates [OR, 1.21; 95% confidence interval (95% CI), 0.75-1.95; P = 0.44]. Five studies compared smooth versus textured implants, with no statistically significant differences in capsular contracture rates (OR, 0.99; 95% CI, 0.50-1.93; P = 0.97). Two studies compared saline versus silicone implants for capsular contracture. Patients receiving saline implants had significantly lower capsular contracture rates than silicone implants (OR, 0.19; 95% CI, 0.08-0.43; P < 0.0001).
Implant-based breast reconstruction using saline implants demonstrated reduced capsular contracture rates compared to silicone implants. However, no significant differences were observed in capsular contracture rates between subpectoral versus prepectoral implant placement and smooth versus textured implants.
基于植入物的乳房重建后发生包膜挛缩并非罕见问题，会影响重建效果。它可能受到多种因素的影响，如植入物放置平面、植入物表面和植入物类型。本系统评价和荟萃分析旨在评估上述危险因素如何影响包膜挛缩发生率。
进行了系统评价和荟萃分析。检索了 PubMed MEDLINE、EMBASE（OvidSP）和 Cochrane 图书馆。比较组包括胸肌下与胸肌前植入物放置、光滑与纹理植入物以及盐水与硅胶植入物。为每组包膜挛缩计算了比值比（OR）。使用牛津循证医学中心评估证据水平。
23 项研究符合纳入标准。16 项研究比较了胸肌下与胸肌前植入物放置，包膜挛缩发生率无统计学差异[OR，1.21；95%置信区间（95%CI），0.75-1.95；P=0.44]。5 项研究比较了光滑与纹理植入物，包膜挛缩发生率无统计学差异（OR，0.99；95%CI，0.50-1.93；P=0.97）。有 2 项研究比较了盐水与硅胶植入物用于包膜挛缩。接受盐水植入物的患者包膜挛缩发生率明显低于硅胶植入物（OR，0.19；95%CI，0.08-0.43；P<0.0001）。
与硅胶植入物相比，盐水植入物的基于植入物的乳房重建显示出降低的包膜挛缩发生率。然而，在胸肌下与胸肌前植入物放置和光滑与纹理植入物之间，包膜挛缩发生率没有观察到显著差异。
