Wickman M
Department of Plastic and Reconstructive Surgery, Karolinska Hospital, Stockholm, Sweden.
Plast Reconstr Surg. 1993 Apr;91(4):663-70; discussion 671-2.
Fifty women scheduled for breast reconstruction surgery with tissue expansion were randomly divided into two groups. In the first group the tissue was expanded rapidly, i.e., once a day, starting 1 week postoperatively, and in the other group it was expanded slowly, i.e., once a week, starting after 2 weeks. The expansion periods were 14 and 41 days, respectively. In both groups the expansion volume was about 200% of the final breast prosthesis. The expanders were replaced by textured, gel-filled implants after 3 months. Follow-up examinations were made after 6 and 12 months to evaluate breast softness. A subjective method, Breast Augmentation Classification, and an objective method, applanation tonometry, were used and showed good correlation. Subjectively, the capsular contraction rate after 1 year was 33.5% in the whole series: 40% in the rapid expansion group and 27% in the slow expansion group. Objectively, the capsular contraction rate was 50.5% in all patients: 60% in the rapid group and 41.5% in the slow group. There was no statistically significant difference between the two groups at any time with either method. Irradiated patients included in the study did not show poorer results. The results obtained after 6 months remained stable up to 12 months after the implantation of the permanent prosthesis. The importance of objective evaluation to compare different series is discussed.
五十名计划接受组织扩张乳房重建手术的女性被随机分为两组。第一组组织扩张迅速，即术后1周开始每天扩张一次；另一组扩张缓慢，即术后2周开始每周扩张一次。扩张期分别为14天和41天。两组的扩张量均约为最终乳房假体的200%。3个月后，将扩张器更换为带纹理的凝胶填充植入物。在6个月和12个月后进行随访检查，以评估乳房柔软度。采用了主观方法（隆乳分类法）和客观方法（压平眼压测量法），二者显示出良好的相关性。主观上，整个系列中1年后的包膜挛缩率为33.5%：快速扩张组为40%，缓慢扩张组为27%。客观上，所有患者的包膜挛缩率为50.5%：快速组为60%，缓慢组为41.5%。两种方法在任何时候两组之间均无统计学上的显著差异。纳入研究的接受过放疗的患者并未表现出较差的结果。植入永久性假体后6个月获得的结果在12个月时保持稳定。讨论了客观评估在比较不同系列中的重要性。
