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1.
Martha Embrey Elizabeth E. Adams Bruce Cunningham Walter Peters V. Leroy Young George L. Carlo 《Aesthetic plastic surgery》1999,23(3):197-206
The etiology of capsular contracture is unclear and probably multifactorial. This review covers the literature on several
proposed contracture factors, including filler material, implant placement, surface texture, and bacterial infection. The
pilot study's goal was to test the feasibility of a data collection form, which could be used in a scaled-up study analyzing
multiple surgeon's records. The goal of the expanded version of this study will be to determine the efficacy of available
interventions for capsular contracture, including surveillance. The Breast Implant Public Health Project, LLC (BIPHP), piloted
a retrospective review of outcomes in women who had interventions to relieve capsular contracture or had chosen a wait-and-watch
approach. An evaluation of the efficacy of various treatments can help women decide if they want to pursue treatment at all
and, if so, which treatment might offer them the best solution. BIPHP researchers (E.E.A., M.E.) developed a data collection
form after reviewing records of three surgeons (B.C., W.P., V.L.Y.). During the data collection using the same records, we
tested a randomization process to identify women with capsular contracture who underwent various interventions, including
a wait-and-watch strategy, and those who had no mention of any intervention or waiting approach. Data were gathered on a total
of 90 breasts with capsular contracture (scored Baker I–IV or qualitatively), of which 45 underwent a total of 102 interventions
for capsular contracture. Interventions were classified as ``closed capsulotomy,' ``surgical,' or ``watchful waiting.'
Closed capsulotomy was performed most often (47%), followed by surgery (29%) and watchful waiting (21%). Presurgical Baker
scores averaged higher in breasts that underwent surgery (3.1) than for watchful waiting (2.5) or closed capsulotomy (2.3).
Though closed capsulotomies had 100% of outcomes scoring ``improved' or ``same,' 58% of the breasts underwent the procedure
more than once, suggesting that the favorable outcome was short-lived. The wait-and-watch approach resulted in scores of either
``same' or ``worse'; surgery (open capsulotomy, repsoitioning, or capsulectomy) resulted in 79% improved, 16% same, and
5% worse outcomes in breasts with outcomes listed. In all intervention procedure categories, outcomes were frequently unavailable;
they were noted only 60% of the time (52/87). The missing 40% may have resulted from the doctor's failure to note it in the
chart, satisfied patients not returning for additional treatment, or dissatisfied patients seeking treatment elsewhere. Generally,
the data collection forms and procedures were workable; however, we uncovered issues to address in the scale-up of this pilot
study: (1) the outcome report rate was 60%; (2) though Baker scores are commonly used to evaluate the degree of capsulaar
contracture, it seems that grade I may have different meanings for different surgeons, which would need to be clarified; (3)
participating surgeons will need to divulge standard-of-care items that they may not have included in medical records, but
routinely performed (e.g., patient massage, use of prophylactic antibiotics); and (4) records were initially separated by
``implant,' then researchers realized that a more useful collection would be by ``breast.' The latter approach captures
the history of the breast in one record, which may be more important to contracture than the differences in implants. With
the modifications discussed, the study can be scaled up to encompass as many records as necessary to achieve robust statistical
power. These data will add to the existing literature regarding factors associated with capsular contracture and identify
factors that affect the successful outcome of capsular contracture interventions. 相似文献
2.
Jorge Planas Emilia Migliano Jorge Wagenfuhr Jr. Sebastian Castillo 《Aesthetic plastic surgery》1997,21(6):395-397
The authors report their experience on the nonsurgical treatment of capsular contractures due to breast implant augmentation
mammaplasty. External ultrasonic repeated applications have been applied to 24 patients after closed capsulotomy procedures
in order to reduce the recurrency rate. The new ultrasonic device used was based on a 2-MHz generator with a timing adjustable
power emission connected to eight transducers designed for breast anatomy. The authors report significant improvement of the
closed capsulotomy technique demonstrating a persistent stability of the achieved results in 82% of the treated contractures,
even in severe cases (Baker's IV), after a minimum follow-up period of 12 months. Methods of application, technical features
of the ultrasonic device, experimental charts, and results obtained on 34 breast implant capsular contractures are reported
and discussed. 相似文献
3.
Breast Augmentation: Teaching Our Patients How Compression Can Help Prevent Capsular Contracture 总被引:2,自引:0,他引:2
If we insert a foreign body into a human being, physiologically, we get a capsular contracture because a periprosthetic scar
contracts to give the implant a spherical shape, the smallest surface area for a given volume. To antagonize this contracture,
one must stretch the periprosthetic scar and this can be accomplished with compression. 相似文献
4.
Late capsular hematoma after the implantation of silicone breast prostheses for augmentation mammaplasty is an extremely rare complication. The case of a patient in whom two late intracapsular hematomas occurred two times after augmentation mammaplasty with textured silicone implants is reported. Magnetic resonance imaging clearly showed fluid accumulated within the capsule. No identifiable etiology could be demonstrated, although the breakdown of an eroded capsular artery is suspected, caused by friction between the rough surface of the textured prosthesis and the fibrous capsule. Two hematomas in a single patient have not been described previously in the literature. 相似文献
5.
The authors report their experience in five years of treating breast implant capsular contractures with an external ultrasonic
device that facilitates the closed capsulotomy technique. A set of 52 patients have been treated with a 82.6% of improvement
at a year follow up. Methods of application and results are discussed. 相似文献
6.
In this experimental study on mice we try to prove that capsule formation around breast implants is considerably diminished
after topical application of Mitomycin-C (MMC). MMC solution is applied under the breast tissue or pectoralis major muscle,
in the pocket of the silicone implant and just before placing it. This is a morphological study of the connective tissue formed
around the implant, under light and electron microscope. Our results suggest that it is worthwhile working on a clinical study
trying to prevent the most common complication of breast implants, contracture of a capsule. 相似文献
7.
隆乳术后纤维包膜挛缩的手术治疗初步报告 总被引:5,自引:0,他引:5
目的:探讨胸大肌后间隙乳房假体置入术后,由纤维包膜挛缩所致各远期并发症的手术治疗原则及方法。方法:经乳晕切口行假体置换术,在充分保留原纤维包膜的原则下,针对手感较硬,乳房变表,乳头异位等并发症行相应的手术处理。结果:1995年以来治疗29例均取得满意的近期效果。结论:置换假体结合各对症处理可有效治疗隆乳术后纤维包膜挛缩所致各并发症,充分保留原纤维包膜可获得较好远期效果。 相似文献
8.
Carlos Augusto Carpaneda 《Aesthetic plastic surgery》1997,21(2):110-114
Histologic studies were performed on capsular tissue resected from 21 patients who were implanted with smooth silicone prostheses
filled with gel. The results disclosed a non-uniform response to the implants. The granulomatous reaction to the silicone
showed important variations along the same surface of the implants, between the plane and the concave surfaces, between equivalent
points at the right and left sides, and among the patients. Also, a significant difference was observed between reactions
and capsules in early and late stages. The author believes these variations of the capsular inflammatory reaction promote
different sites of contraction between cell-to-cell, or cell-to-collagen-to-cell. These adding forces result in vectors of
different intensities and directions around the implants which explains the various clinical grades of capsular contracture. 相似文献
9.
微小组合乳房假体与传统单一假体包膜挛缩的比较研究 总被引:2,自引:0,他引:2
目的 了解微小组合硅凝胶乳房假体置入肌层下的包膜挛缩特点,并与传统单一大假体进行比较.方法 30只大白兔,每只大白兔背部两侧肌层下分别置入10ml微小硅凝胶假体4个、40 ml传统硅凝胶乳房大假体1个.3个月时进行包膜挛缩Baker评级,压缩实验,包膜切开后裂开宽度,包膜厚度的比较,取包膜样本切片进行HE染色,镜下观察比较包膜特点.结果 微小组合假体Baker评级、包膜裂开最大宽度、包膜厚度均明显低于大假体组(P<0.01).假体压缩率明显高于大假体组(P<0.01).微小组合假体形成的包膜较传统假体包膜凸凹不平,胶原排列较屈曲且膜薄.结论 微小组合假体较传统假体有更低程度的包膜挛缩,有一定的隆乳术应用前景. 相似文献
10.
Buckled Upper Pole Breast Style 410 Implant Presenting as a Manifestation of Capsular Contraction 总被引:2,自引:0,他引:2
Darryl James Hodgkinson 《Aesthetic plastic surgery》1999,23(4):279-281
Recent experience with the cohesive gel implant has shown an interesting variation of capsular contracture. Instead of spherical
contraction, the capsule formation around the 410 implant seems to cause a buckling of the superior pole of the implant. This
buckling has been observed in four implants and presented clinically in 2 of 50 patients with a superior pole mass. The capsular
contraction around the implant and the buckling are probably camouflaged by a subpectoral implantation and this presentation
should be recognized by the surgeon, especially when considering placement of the cohesive gel implant in a subglandular position.
Histological sections of a capsule around the implant show fragmented silicone, with a cellular reaction around the fragmented
silicone. 相似文献
11.
Rhinophyma is a rare disease that primarily affects Caucasian men in the fifth to seventh decades of life, characterized
by a progressive thickening of nasal skin, which produces a disfiguring soft-tissue hypertrophy of the nose. Severe cosmetic
deformity and impairment of breathing may coexist, making the surgical treatment necessary.
The authors are conscious that in literature there is not agreement about the ideal treatment of rhinophyma, nevertheless
they wish to give their contribution according to their experience with different treatment modalities such as the scalpel,
the electrocautery, the dermabrader, and the carbon dioxide laser. The authors believe the scalpel, in association with bipolar
electrocautery and local infiltration of dilute epinephrine to reduce bleeding, is the safest means to preserve the underlying
sebaceous gland fundi and permit a spontaneous re-epithelialization scarring-free. 相似文献
12.
Dr. Jiří Šmahel M.D. 《Aesthetic plastic surgery》1978,2(1):435-441
The capsule formed around an implant contracts and tends to become spherical, a tendency limited by the consistency of the implant. Another factor in this is the size of the implantation pocket. If the pocket fits too tightly, spherical development occurs earlier and becomes more marked. A dead space between the tissues and the implant, on the other hand, leads to proliferation in the wall of the pocket and hence a thickened capsule.The spherical form of the breast and its firmness need not necessarily be due to fibrotic thickening of the capsule, and the diagnosis of constrictive fibrosis does not always apply. The same symptoms may result from contraction of a thin capsule when the implantation pocket was made too small. 相似文献
13.
Capsular contracture after breast augmentation is a distressing, troublesome event both for the patient and the surgeon. Fibrosis
transforms the prosthesis into a hardened sphere, turning the initially satisfactory cosmetic result into a deformed mass.
Treatment for capsular contracture can be either surgical, consisting of capsulotomy or capsulectomy with implant replacement,
or pharmacologic, consisting of intracapsular instillation of steroids and antibiotics. The success rates for both types of
treatment vary. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment
of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have emerged recently as effective
prophylactic agents for reactive airway diseases. Anecdotal reports have indicated that zafirlukast and montelukast effectively
reverse capsular contracture. The authors investigated whether capsular contracture varies significantly over time after zafirlukast
therapy by studying 20 women who had breast prostheses implanted and then experienced the development of capsular contracture.
The results suggest that capsular contracture responds favorably to treatment with zafirlukast. The findings indicate that
zafirlukast may reduce pain and breast capsule distortion for patients with long-standing contracture who either are not surgical
candidates or do not wish to undergo surgery. 相似文献
14.
15.
我科自1990年以来共收治19例假体置入隆乳术后BakerⅢ、Ⅳ级纤维包膜挛缩者,采用局麻下乳晕切口部分切除挛缩包膜及重新置入假体法。术后乳房外观及手感良好,12例经6个月至两年半随访,纤维包膜收缩均限于BakerⅠ级。我们就如何选择手术切口、切除挛缩包膜及预防包膜挛缩的发生进行了探讨。 相似文献
16.
去炎舒松用于预防隆乳术后包膜挛缩的实验研究 总被引:3,自引:1,他引:3
目的 探讨去炎舒松用于抑制假体隆乳后包膜挛缩的方法.方法 20只新西兰大白兔,平均分为2组,每组将10ml硅凝胶假体1个随机置入兔背部肌肉下,将有许多侧孔远端为盲端的扩张器导管跨越假体顶部,与导管相连的注射壶置于皮下.分别在假体置入1、2、3个月时,向对照组经注射壶注入3 ml生理盐水,向实验组注入去炎舒松10 mg/3 ml.在6个月时观察测量记录包膜挛缩情况,Baker评分,压缩实验,包膜切开后裂开最大宽度的测定,包膜厚度的比较,取包膜样本切片进行HE染色和天狼猩红染色,镜下观察比较包膜特点.结果 生理盐水组Baker评分、包膜裂开最大宽度、包膜厚度明显高于去炎舒松组(P<0.01).生理盐水组假体压缩率明显低于去炎舒松组(P<0.01).去炎舒松组包膜较生理盐水组薄,胶原排列规则、疏松.结论 去炎舒松通过特制的导管给药能有效地降低隆乳术后包膜挛缩. 相似文献
17.
18.
乳房假体隆乳术后并发症12例分析 总被引:5,自引:0,他引:5
目的 减少隆乳术并发症的发生,提高隆乳术的远期效果。方法 对12例乳房假体隆乳术后1~13年间出现并发症患者的临床表现及包膜病理变化进行分析讨论。结果 12例15侧乳房中,单侧9例并发1种并发症者4例,并发2种者4例,并发3种者1例;双侧3例,并发同一种并发症者2例,并发3种并发症者1例。各种并发症有其特有的包膜病理及临床特点。结论 严格执行无菌操作、熟练掌握该术技能、造反优质假体、首选胸大肌下置 相似文献
19.
Choupina M Malheiro E Pinho C Ferreira A Pinto A Cardoso A Reis J Amarante J 《Aesthetic plastic surgery》2002,26(1):50-53
Since the presentation of the tuberous breast deformity by Rees and Aston in 1976, many surgical procedures have been developed, but the correction of such a deformity still remains a surgical challenge. The authors report the last cases treated in the Department of Plastic and Reconstructive Surgery of S?o Jo?o Hospital-Porto and discuss about the ideal procedure which should be used according to the type of deformity. They emphasize the periareolar approach and the good results obtained by the Liacyr Ribeiro technique. 相似文献
20.
X. Li M. Takahashi K. Kushida S. Koyama H. Hoshino K. Kawana K. Horiuchi T. Inoue 《Calcified tissue international》1996,59(4):271-276
The effects of tamoxifen (TAM) treatment on bone metabolism and skeletal growth were studied in sexually mature intact or
ovariectomized (OVX) rats. Experiment 1 was designed to observe the effects of TAM on bone metabolism and skeletal growth
in intact rats and included two groups: (1) intact plus vehicle and (2) intact plus TAM. Experiment 2 was designed to investigate
the effects of TAM on OVX rats and included the other two groups: (3) OVX plus vehicle and (4) OVX plus TAM. Serum calcium
osteocalcin and urinary pyridinoline (Pyr) and deoxypyridinoline (Dpyr) were measured serially before and after TAM treatment
for 6 weeks in order to monitor bone turnover. Bone mineral density (BMD) and bone mineral content (BMC) of excised right
femora and lumbar vertebrae were determined by dual energy X-ray absorptiometry (DXA). To examine the effect of TAM on skeletal
growth, the conventional parameters of femora and the histology of right tibiae were also measured. TAM did not induce significant
change in the biochemical markers in intact rats during the 6-week experiment. Bone mass and skeletal growth were not changed
by TAM treatment in intact rats. However, TAM treatment reduced the increase in serum osteocalcin and urinary pyridinium cross-links
from 1 week to 6 weeks postovariectomy in the OVX rats. TAM inhibited the skeletal growth in OVX rats, because TAM treatment
shortened femoral length and decreased the cell number in the growth plate in OVX rats in this study. Our findings indicate
that TAM exerts an effect of estrogen agonist on bone metabolism and skeletal growth in OVX rats, however, it does not affect
them in intact rats.
Received: 1 September 1995 / Accepted: 20 February 1996 相似文献