乳腺癌患者的保乳手术和辅助放疗（BCSAR）适应症正在增加，同样，对于健康受试者的风险减少乳房切除术（RRM）的适应症也在增加。其中大部分病例采用硅壳乳房植入物（SSBI）进行重建。为了研究曾接受BCSAR的病人中进行RRM重建的硅壳乳房植入物（SSBI）的并发症，开展了一项前瞻性队列研究。研究组包括在同一侧乳房之前接受过BCSAR的病人中经SSBI重建的RRM病例。对照组包括患有高风险乳腺癌并接受RRM及即时SSBI重建但无前期BCSAR的病人。其中15.8％的病例有BCSAR历史。在即时RRM后首次使用的SSBI在51.5％的病例中被更换，其平均存活时间为24.04±28.48个月。BCSAR与第一次SSBI的病理性包囊收缩显著相关（P=0.00）（37.5％对5.9％）。在需要更换第一次SSBI的病例中，44.23％的病例出现第二次SSBI的失败，其平均存活时间为27.95±26.53个月。第二次SSBI中依次发生包囊收缩与之前的BCSAR历史之间没有显著关联（P=0.10）。在前期接受了BCSAR的RRM患者中使用SSBI进行重建与病理性包囊收缩明显增加相关。病人应被告知SSBI并发症和重建失败的高发率。聚氨酯涂层植入物在考虑使用异体重建的前期BCSAR患者中可以作为一种替代选择。© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Indications for breast-conserving surgery and adjuvant radiotherapy (BCSAR) in patients with breast carcinoma are increasing, as are indications for risk-reducing mastectomy (RRM) in healthy subjects. Most of these cases are reconstructed with silicone shell breast implants (SSBI).To study complications of silicone shell breast implants (SSBI) in breast reconstruction in patients undergoing RRM with previous BCSAR.A prospective-cohort study was designed. The study group includes cases of RRM reconstructed with SSBI in patients who had previously undergone BCSAR in the same breast. The control group consists of patients with high-risk breast cancer who have undergone RRM and immediate SSBI reconstruction without previous BCSAR.There was a history of BCSAR in 15.8% of cases. The first SSBI used in immediate reconstruction after RRM was replaced in 51.5% of cases with a mean survival of 24.04 ± 28.48 months. BCSAR was significantly associated to pathological capsular contracture (P=0.00) in this first SSBI (37.5% vs 5.9%). Of the cases requiring the replacement of the first SSBI, 44.23% suffered failure of the second SSBI, with a mean survival of 27.95 ± 26.53 months. No significant association was found between the consecutive development of capsular contracture in the second SSBI and previous history of BCSAR (P=0.10).BCSAR prior to RRM reconstructed using SSBI is associated with a significant increase in pathological capsular contracture. Patients should be warned of the high rate of SSBI complications and reconstruction failure. Polyurethane-coated implants may provide an alternative in cases in which alloplastic reconstruction is considered in patients with previous BCSAR.© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.