经乳晕切口综合处理假体隆乳术后包膜挛缩

Combined treatment with areola approach for capsular contracture after breast augmentation with implants

目的探讨经乳晕切口采用多种方法综合处理假体隆乳术后包膜挛缩的效果。方法2005年2月至2011年6月，对94例168侧假体隆乳术后包膜挛缩进行治疗并置人假体，其挛缩程度均为Baker分类法Ⅲ、Ⅳ级。94例均采用乳晕切口，根据原假体置入腔隙及乳腺、胸大肌厚度等条件，采取重新剥离腔隙、去除或不去除包膜组织，甚至二期手术，于胸大肌或乳腺后间隙置人假体等方法综合处理，术中严格止血。结果术后94例中46例获得门诊随访，其余病例均获得电话随访，时间6～37个月，平均9．9个月，术后包膜挛缩复发Ⅲ级者2例、Ⅳ级者1例，其余病例乳房外观均丰满、挺拔，柔软度较好，电话随访病例均对乳房塑形效果满意。本组病例均无血肿、感染、乳房假体破裂、乳房下垂及上移等并发症发生。结论应用乳晕切口对假体隆乳术后包膜挛缩进行综合而有效地处理，术后包膜挛缩复发率较低，可以获得较满意的乳房塑形效果。

Objective To investigate the combined treatment with areola approach for capsular contracture after breast augmentation with implants. Methods From Feb. 2005 to Jun. 2011, 94 cases （ 168 sides） with Baker Ⅲ and Ⅳ capsular contracture after breast augmentation with implants were treated with areola approach. The implants cavity was recreated, with or without removal of capsule. The implants were reimplanted behind pectoralis major or breast at the second stage in some patients. Results 46 cases were followed up by clinic visit and the others were followed up by telephone for 6-37 months, with an average of 9.9 months. The capsular contracture was relapsed in 2 cases as Baker Ⅲ and 1 case as Baker Ⅳ. All the other breasts got a good appearance with good soft texture and feeling. No hematoma, infection, implants rupture, breast ptosis or implant displacement happened. Conclusions Combined treatment with areola approach has a good therapeutic effect for capsular contracture after breast augmentation with implants. The breast appearance is satisfactory with low occurrence of capsular contracture.