Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reason...Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.展开更多
Aim:Permanent expanders allow for breast reconstruction as a single stage.These prostheses are more expensive than conventional tissue expanders,but this excess cost is markedly offset as only one operation is require...Aim:Permanent expanders allow for breast reconstruction as a single stage.These prostheses are more expensive than conventional tissue expanders,but this excess cost is markedly offset as only one operation is required.However,if the revision rate is sufficiently high,then this effect is negated.We aim to compare costs of one-stage vs.two-stage reconstruction at a single center,taking into account explantation and unexpected admissions following complications.Methods:A retrospective review was carried out on all patients who underwent one-stage and two-stage reconstruction over a 5-year period by a single surgeon.A cost analysis was performed taking into account,explantation and additional admissions.Results:One hundred and forty-three one-stage and 45 two-stage procedures were included.The explantation rate for one-stage procedures is 36%,at a mean of 12.9 months postimplantation,the majority of which were exchanged for silicone implants to improve cosmesis.Four(9%)of the two-stage procedures were explanted a mean of 18 months postreconstruction.Overall,one-stage reconstructions were significantly more expensive than the two-stage group(P=0.016).Conclusion:There are many benefits of one-stage breast reconstruction.However,it does not appear to be cost-effective when additional admissions for explantation surgery are taken into account.展开更多
文摘Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.
文摘Aim:Permanent expanders allow for breast reconstruction as a single stage.These prostheses are more expensive than conventional tissue expanders,but this excess cost is markedly offset as only one operation is required.However,if the revision rate is sufficiently high,then this effect is negated.We aim to compare costs of one-stage vs.two-stage reconstruction at a single center,taking into account explantation and unexpected admissions following complications.Methods:A retrospective review was carried out on all patients who underwent one-stage and two-stage reconstruction over a 5-year period by a single surgeon.A cost analysis was performed taking into account,explantation and additional admissions.Results:One hundred and forty-three one-stage and 45 two-stage procedures were included.The explantation rate for one-stage procedures is 36%,at a mean of 12.9 months postimplantation,the majority of which were exchanged for silicone implants to improve cosmesis.Four(9%)of the two-stage procedures were explanted a mean of 18 months postreconstruction.Overall,one-stage reconstructions were significantly more expensive than the two-stage group(P=0.016).Conclusion:There are many benefits of one-stage breast reconstruction.However,it does not appear to be cost-effective when additional admissions for explantation surgery are taken into account.
