Ingrown Hairs Under an Augmentation Mammoplasty Incision Scar - A Case Report

隆乳手術後腋下切口毛髮往內生長之－案例報告

王仁鐸(Jen-To Wang) ； 謝式洲(Shyh-Jou Shieh)

《臺灣整形外科醫學會雜誌》 26卷2期 (2017/06) Pp. 247-253

摘要

Background: Augmentation mammoplasty is one of the most frequently performed aesthetic operations. Complications such as capsule contracture, wound dehiscence, wound infection, seroma formation, etc., have been described in many case series. Aim and Objectives: We report a rare complication case: the ingrown hair under the axillary incision scar after breast augmentation surgery. Materials and Methods: A 24-year-old woman had a bilateral breast augmentation via the transaxillary approach. A dimpling scar with a protruding mass developed progressively in the right axillary region after surgery. An epidermal inclusion cyst was suspected, we excised the cyst and revised the scar. We found a cluster of ingrown hairs with intact hair follicles. We excised all of the hair follicles with the overlying skin and ingrown hairs, and then repaired the wound edge-to-edge in layers. Results: A histopathological analysis showed that the follicular infundibulum contained lamellated keratin in the hair bulbs of the hair follicles. At the 6-month follow-up, the wound had healed with a fine scar, and the patient was satisfied with the result. Conclusion: To prevent this rare and embarrassing complication, we conclude that the transaxillary wound for breast augmentation should be delicately repaired layer by layer and appropriate using skin hook, so that the wound edge not be inverted or hair follicles not be invaginated.

關鍵字

ingrown hair ； breast augmentation

並列摘要

背景：隆乳手術是最常施行的美容手術之一；較常見的術後併發症例如傷口感染，傷口癒合不良，被膜攣縮等等，已經廣被在各個期刊中發表。目的及目標：我們提供一例罕見的隆乳術後併發症，在隆乳手術的腋下切口凹陷疤痕內發現一群往內生長的毛髮。材料及方法：一位24歲女性接受過雙側腋下切口的隆乳手術，術後感覺右側切口疤痕有一凹陷相當明顯，並可以在疤痕旁邊摸到一個隆起腫塊。我們經理學檢查後，術前懷疑是一個常見的因手術引起的表皮包涵性囊腫(epidermal inclusion cyst)，因此幫她安排了囊腫切除手術以及疤痕修整手術。但是手術時在傷口裡面發現一群毛囊以及整叢成束完整的毛髮，這是與一般的表皮包涵性囊腫不一樣的。我們把毛囊、毛髮叢束以及疤痕周邊組織切除之後，小心的將傷口一層一層對齊縫合。結果：切下來的檢體在組織學上可以看到往內生長被包埋之毛髮叢束之毛囊根部構造。病患傷口術後癒合良好，在6個月後的追蹤，在腋下只留下細微不明顯的疤痕，病患相當滿意這樣的結果。在此報告的討論中，我們並舉一例「非隆乳手術」的其他手術所造成的表皮包涵性囊腫，以玆比較。結 論：腋下是豐富生長毛髮的地方，我們建議隆乳手術的經腋下切口必須要精確的對齊縫合，包括一層接著一層的縫合以及傷口邊緣必須對齊，讓傷口邊緣不致往內凹陷；並且小心皮鉤之使用，不要將毛囊不慎鉤陷入皮下。這麼做才能避免腋毛往內生長這個罕見而且尷尬的併發症。