假体隆乳术后严重包膜挛缩处理结合假体置入

目的探讨假体隆乳术后严重包膜挛缩的处理方法及乳房假体置入的适应征。方法 2006年6月至2014年3月,对45例假体隆乳术后严重包膜挛缩(双侧乳房均为Baker分类法Ⅳ级)进行治疗,并进行同期或二期乳房假体置入。手术均采用乳晕切口入路,并根据情况保留或去除包膜组织,在乳腺后间隙或胸大肌后间隙置入假体。结果 38例患者均一期置入乳房假体,7例于术后6个月行二期乳房假体置入。术后切口均一期愈合,39例获门诊随访,随访率86.7%,随访时间6~58个月(平均13.5个月)。1例术后4个月时仍出现包膜挛缩Ⅳ级,予以二期手术取出乳房假体,未再置入。其余患者乳房形态良好,触摸乳房手感较柔软。结论对于严重的假体隆乳术后包膜挛缩,对包膜进行有效处理,并根据情况置入假体,可以取得较好的术后乳房外观及手感。

Breast Prosthesis Implantation Combining with Correction for Capsular Contracture after Augmentation Mammoplasty

Objective To explore the correction for serious capsular contracture after augmentation mammoplasty and the indication of breast prosthesis implantation. Methods From June 2006 to March 2014, 45 cases with serious capsular contracture after breast augmentation (Bilateral, level Ⅳ of Baker classification method) were treated and received breast prosthesis implantation at the same period or at stage Ⅱ. Via breast areola approach, the capsular tissue was kept or removed based on the circumstances, retro-mammary space or posterior pectoralis major space was stripped for prosthesis placing. Results Among all the cases, 38 cases received breast prosthesis at stage I, other 7 cases proceeded the second period of breast prosthesis 6 months later. Postoperative incisions were healed by first intension. Thirty-nine cases were followed up for 6-58 months (mean 13.5 months) successfully and the follow-up rate was 87.9%. Level Ⅳ of capsular contracture was still observed in 7 cases 4 months after the surgery, then the breast prosthesis was removed with no implantation again. The breast shape of remaining cases was good with soft handfeel. Conclusion For serious breast capsular contracture after augmentation mammoplasty, effective processing of the envelope with prosthesis imbedding according to the situation could obtain a better postoperative breast appearance and feel.