乳房植入后导致手术的并发症。

Complications leading to surgery after breast implantation.

作者信息

Gabriel S E, Woods J E, O'Fallon W M, Beard C M, Kurland L T, Melton L J

机构信息

Division of Rheumatology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.

出版信息

N Engl J Med. 1997 Mar 6;336(10):677-82. doi: 10.1056/NEJM199703063361001.

DOI:10.1056/NEJM199703063361001

PMID:9041097

Abstract

BACKGROUND

Local complications that require additional surgical procedures are an important problem for women with breast implants.

METHODS

We studied 749 women who lived in Olmsted County, Minnesota, and received a first breast implant at the Mayo Clinic between 1964 and 1991. We identified complications that occurred after the initial procedure and after any subsequent implantation. A complication was defined as a surgical procedure performed for any of the following reasons: capsular contracture; rupture of the implant; hematoma or bleeding; infection or seroma of the wound; chronic pain; extrusion, leakage, or sweating of the implant; necrosis of the nipple, areola, or flap; malfunction of the filler port of a tissue expander; and wound dehiscence.

RESULTS

During follow-up (mean, 7.8 years; range, 0 to 25.8), 208 (27.8 percent) of the women underwent 450 additional implant-related surgical procedures. Ninety-one (20.2 percent) were anticipated, staged procedures or were done because the patient requested a size change or aesthetic improvement, and 359 procedures (79.8 percent) had at least one clinical indication (thus constituting a complication). Complications occurred in 178 (23.8 percent) of the 749 women and involved 274 (18.8 percent) of the 1454 breasts with implants and 321 (18.8 percent) of the 1703 implants. The most frequent problem was capsular contraction (272 cases), followed by rupture of the implant (60), hematoma (55), and wound infection (23). The rate of complications was significantly lower (P<0.001) among women with cosmetic implants (6.5 percent at one year, 12 percent at five years) than among women who underwent implantation after mastectomy for breast cancer (21.8 percent at one year, 34 percent at five years) or prophylactic mastectomy (17.3 percent at one year, 30.4 percent at five years).

CONCLUSIONS

Women who have had breast implantation frequently experience local complications during the subsequent five years. Complications were significantly less frequent among patients who received implants for cosmetic reasons than among those who received implants after mastectomy for cancer or for cancer prophylaxis.

摘要

背景

对于接受乳房植入物的女性而言，需要额外进行外科手术的局部并发症是一个重要问题。

方法

我们研究了居住在明尼苏达州奥尔姆斯特德县、于1964年至1991年期间在梅奥诊所接受首次乳房植入的749名女性。我们确定了初次手术后以及任何后续植入后发生的并发症。并发症定义为因以下任何原因进行的外科手术：包膜挛缩；植入物破裂；血肿或出血；伤口感染或血清肿；慢性疼痛；植入物挤出、渗漏或出汗；乳头、乳晕或皮瓣坏死；组织扩张器填充端口故障；以及伤口裂开。

结果

在随访期间（平均7.8年；范围0至25.8年），208名（27.8%）女性接受了450次与植入物相关的额外外科手术。91次（20.2%）是预期的分期手术，或者是因为患者要求改变尺寸或改善美观而进行的手术，359次手术（79.8%）至少有一项临床指征（因此构成并发症）。749名女性中有178名（23.8%）出现并发症，涉及1454个有植入物的乳房中的274个（18.8%）以及1703个植入物中的321个（18.8%）。最常见的问题是包膜挛缩（272例），其次是植入物破裂（60例）、血肿（55例）和伤口感染（23例）。接受美容植入物的女性并发症发生率（一年时为6.5%，五年时为12%）显著低于因乳腺癌行乳房切除术后植入（一年时为21.8%，五年时为34%）或预防性乳房切除术后植入（一年时为17.3%，五年时为30.4%）的女性（P<0.001）。