一种乳房体积测量器及其在隆乳术中应用

目的:设计一种乳房体积测量器,对其在隆乳术中的应用进行评价和探讨。方法:设计并自制乳房体积测量器,对隆乳的患者进行测量和计算,选择合适容积的乳房假体行隆乳术。结果:本组52例,41例乳房对称者,隆乳术后效果好;11例乳房不对称者,其中,8例术后乳房对称,效果好,2例有细小差异,1例因假体型号(直径和凸度)选择不当,术后乳房体积接近但直径和高度存在差别。结论:本乳房体积测量器准确合理、方便快捷,在隆乳术中对乳房假体容积的选择具有指导意义。     

An Uncommon Complication of Secondary Augmentation Mammoplasty:Bilaterally Massive Engorgement of Breasts After Pregnancy Attributable to Postinfection and Blockage of Mammary Ducts

Augmentation mammoplasty is one of the most frequently performed aesthetic operations. Galactorrhea and galactocele formation after augmentation mammoplasty, while the patient is experiencing the hormonal effects, is rarely seen. The cause remains unknown. However, postoperative fibrosis and blockage of the mammary ducts after augmentation mammoplasty is a probable cause of this formation in some patients. In the reported case, the patient described painful massive engorgement of both breasts during the last month of pregnancy and inability to breast-feed after delivery. In her history, she had undergone breast augmentation via the semicircular periareolar transglandular approach. She had experienced an infection at an early stage of her postoperative period and had needed to have both prostheses removed. A second breast augmentation mammoplasty was performed 1 year after the first operation via the same incision. She was content with the result of her second augmentation mammoplasty, up until her third pregnancy, at which time she reported inability to breast-feed after her delivery. At our examination, it was determined that there was massive painful breast engorgement, hyperemia, and inflammation of both breasts attributable to a bilateral galactocele formation. She refused to take any medication (bromocriptine), but approved antibiotic treatment. The patient responded to the antibiotics, and the prostheses therefore were left in place without further complications.     

双平面隆乳术在矫治小乳症并乳房下垂中的应用

目的：讨论双平面隆乳术在矫治小乳症并乳房下垂中的临床应用。方法：选择22例患者,4例哺乳后乳房萎缩并松垂行单纯双平面隆乳术,18例小乳症并乳房Ⅰ度至Ⅲ度下垂行双平面硅胶假体隆乳及乳房下垂矫正。结果：22例术后随访1个月至1年2个月,平均6．5个月。20例（40只）乳房形态良好,无假体移位、包膜挛缩及畸形。1例（2只）Ⅲ度乳房下垂者因悬吊不够,9个月随访时仍呈现Ⅰ度下垂。1例（1只）乳房硬化,为BakerⅢ。讨论“双平面”法隆乳术,即假体同时位于两个平面（部分位于乳腺下,部分位于胸大肌下）,此方法适用于各类乳房,能避免“双乳房”畸形,术后乳房下部形态美观。     

Galactorrhea After Aesthetic Breast Augmentation With Silicone Implants: Report of Two Cases and Management of Postoperative Galactorrhea

Galactorrhea is a rare event after breast augmentation. The physiopathologic bases of galactorrhea depend on the central secretion of prolactin. These physiopathologic bases must be clearly understood for the prevention and treatment of postoperative galactorrhea. This report describes two cases of a postoperative galactorrhea after aesthetic breast augmentation with silicone implants. The clinical appearance closely resembles a postoperative sepsis without hyperthermia. Bacteriologic samples are negative. Endocrinologic examination finds a characteristic hyperprolactinemia. The evolution is favorable under dopaminergic agonists.     

硅凝胶假体隆乳安全性的争议问题探讨

目的：探讨硅凝胶假体隆乳安全性的争议问题。方法：查阅近年来有关硅凝胶假体隆乳的可能并发症之研究文献,并作综合分析、评价。结果：硅凝胶假体隆乳术后存在乳房假体破裂或渗漏、硅胶肉芽肿、包膜挛缩、假体移位、感染、蒙道尔病等已明确的并发症以及继发乳腺癌、自身免疫性疾病、结缔组织病、硅胶及铂的乳汁污染等尚存争议的安全性问题。结论：目前的研究认为硅凝胶假体隆乳术是相对安全的,既要重视已明确的并发症,又要重视尚存争议的安全性问题,并于术前充分告知选用硅凝胶假体隆乳的就医者。     

隆乳术后乳房肿块14例诊疗体会

目的 探讨隆乳术后乳房肿块的诊断及治疗。方法 总结我院2001—2006年收治的14例隆乳术后出现乳房肿块患者的临床资料。结果 8例为凝胶性假瘤，4例为纤维腺瘤，2例为乳癌。4例行穿刺抽液，8例行肿块切除，2例行乳癌改良根治术。结论 影像学检查方式以X线与MRI同时进行为最好，手术方式在不影响治疗效果的前提下选择对乳房的外形影响最少为佳。     

Sepsis With Multiple Abscesses After Massive Autologous Fat Grafting for Augmentation Mammoplasty: A Case Report

Background  

Autologous fat grafting to the breast for breast reconstruction and cosmetic breast augmentation has gained much attention recently. However, its efficacy and the severities of its associated complications are of concern. The authors experienced one case of multiple breast abscesses after augmentation mammoplasty by autologous fat grafting.     

A Late Complication of Augmentation Mammoplasty by Polyacrylamide Hydrogel Injection: Ultrasound and Magnetic Resonance Imaging Findings of Huge Galactocele Formation in a Puerperal Woman with Pathological Correlation

Abstract: Polyacrylamide hydrogel (PAAG) was widely used for injection augmentation mammoplasty in Eastern Europe and China although uncommon in the western countries. However, the safety of this procedure remained controversial. Herein, we report a 30‐year‐old woman with a history of augmentation mammoplasty by PAAG injection developed galactoceles during her pregnancy. Ultrasound and magnetic resonance imaging showed huge cystic lesions in bilateral breasts; as a result, the normal breast tissue was almost completely replaced. On the basis of the imaging findings, the patient underwent mastectomy as well as immediate breast reconstruction with satisfactory outcome. It is important to be familiar with the imaging findings of this rare yet severe complication after augmentation mammoplasty in order to make an accurate diagnosis and a proper management.     

内窥镜辅助腋下切口隆乳术的应用体会

目的:探讨应用内窥镜辅助,在腋下切口假体隆乳术中的临床应用与操作体会。方法:自2010年10月~2012年10月应用内窥镜辅助隆乳20例,40侧。手术均行腋下切口,内窥镜辅助,胸大肌下分离置入假体或胸大肌筋膜间分离置入假体。结果:20例均随访1年以上,一例一侧包膜挛缩变硬,再次内窥镜辅助经腋下切口切开包膜组织,扩大腔隙,重新置入假体,,术后恢复好。其余术后乳房形态良好,外形及手感好,无血肿及感染等并发症发生。结论:采用内窥镜辅助下,手术在直视下进行,安全性高,手术创伤小,出血少,术后包膜挛缩发生率低,是值得推广的辅助技术。     

采用隆乳切口行乳房肿块切除术

目的：探讨乳房肿块切除手术中切口选择的美学问题。方法：根据乳房肿块的大小、部位，应用三种隆乳术皮肤小切口，乳腺内放射状切口行乳房肿块切除。结果：临床应用56例，全部取得良好效果，切口瘢痕隐蔽，保持了乳房的较好外形。结论：采用隆乳切口行乳房肿块切除术是较理想的手术方式，传统的乳房肿块切除手术切口应加以改进。     

The impact of preoperative breast implant size selection on the 3-year reoperation rate

Background

Revision surgery following primary augmentation mammoplasty is commonly performed. There are several long-term and short-term published studies on the incidence of revisionary surgery in primary mammoplasties. The current study is a single surgeon’s experience with reoperations following consecutively performed primary augmentation mammoplasties and an assessment of the role of the process of breast augmentation. A retrospective data analysis was performed to evaluate a single surgeon’s 3-year reoperation rate in primary augmentation mammoplasties.

Methods

A retrospective analysis of data using the Excel Spread was performed. Data of patients having had consecutive primary augmentation mammoplasties, performed between January 2008 and December 2010, were collected to evaluate the efficacy of a structured process of primary augmentation mammoplasties and its impact on a 3-year reoperation rate. Patients with asymmetrical breast or chest requiring different size implants were excluded. Patients presenting with ptosis requiring mastopexy in primary augmentation mammoplasty were also excluded from the study.

Results

A total of 507 primary bilateral augmentation mammoplasties were performed by the author between January 2008 and December 2010. All patients had muscle splitting biplane technique and all had round silicone cohesive gel silicone implants during the study period. All implants were inserted using inframammary crease incision. Mean size of implant in primary augmentation mammoplasty was 346.9 cc (range 200–700). Data showed 10 (1.97 %) patients had a reoperation following primary augmentation mammoplasty.

Conclusions

This retrospective study showed a low 3-year reoperation rate. A clear understanding of the process of breast augmentation, good informed consent and careful selection of implant size in primary and revision augmentation mammoplasty can potentially reduce reoperations. Level of Evidence: Level IV, Prognostic/risk study.     

埋没导引缝合法矫正隆乳术后双侧乳房不对称

目的：介绍一种处理隆乳术后双侧乳房不对称的方法。方法：2009年3月～2009年12月笔者应用埋没导引缝合法处理6例假体置入后双侧乳房不对称患者。结果：经过术后3～6个月的随访,5例患者取得了满意的效果,且没有出现复发,1例患者调整无效后行小切口切开矫正。结论：埋没导引缝合法是处理隆乳术后双侧乳房不对称简单、可靠、值得推荐的方法。     

聚丙烯酰胺水凝胶在隆乳术中的应用

硅胶膜乳房假体 ,目前已不是理想的隆乳材料。本文总结我们应用可注射型聚丙烯酰胺水凝胶隆乳的经验。从 1997年 10月至 1998年 12月 ,采用此技术完成 83 3例隆乳术。该组 83 3例资料结果显示乳房外形良好 ,质地柔软。 12例出现可治愈的轻度并发症 ( 1.4 4% ) ,无 1例出现乳房纤维包膜挛缩。本组经近期随诊观察 ,效果显著 ,安全可靠 ,操作简单 ,痛苦小。我们认为这种可注射型聚丙烯酰胺水凝胶是目前隆乳较理想的填充材料。     

The role of mammography in detecting breast cancer in augmented breasts

Recent reports suggest that mammographic findings may be compromised in patients who have undergone augmentation mammoplasty. Therefore, early detection of breast cancer by mammography may be obscured. We reviewed records for our patients with breast cancer after augmentation mammoplasty to define further the role and accuracy of mammography. Six patients aged 34 to 52 years (mean, 42 years) had a diagnosis of breast carcinoma 4 to 14 years (mean, 7.2 years) after augmentation mammoplasty. Five patients had preoperative mammographic examinations. Suspicious lesions were seen in 4 patients, and microcalcifications were identified in the fifth. The sixth patient had a normal xeromammogram. Pathological diagnosis was infiltrating ductal carcinoma in 5 patients and intraductal carcinoma in 1. Findings for lymph nodes were negative in 3 patients; 2 others had positive findings in one lymph node, and 1 had positive results in four lymph nodes. Five patients had a suspicious mass that was palpated on self-examination or by the patient's plastic surgeon, and the sixth patient had a routine screening mammogram. Two of 3 patients with positive lymph nodes received adjuvant chemotherapy. This report confirms the role of mammography as a screening tool in making the diagnosis of breast cancer in women who have undergone augmentation mammoplasty. The importance of self-examination and follow-up by the plastic surgeon is stressed. The data suggest that mammography remains an accurate method for detecting breast lesions.     

自体脂肪颗粒移植在矫正硅凝胶假体隆乳术后缺陷中的临床应用

目的:探讨自体脂肪颗粒在矫正硅凝胶假体隆乳术后外形缺陷中的临床应用及操作要点。方法:对58例放置假体隆胸后存在外形缺陷或外形不满意患者术后采用自体脂肪颗粒移植行矫正修复后,分别在立位、仰卧位、侧卧位、俯卧位等不同体位下,对其形态、手感、满意度等进行调查,并进行评价。结果:58例患者的主客观外形缺陷均得到满意修复,未出现并发症。结论:自体脂肪颗粒移植可以作为一种常规手段,为假体隆乳术后患者解决外形、手感、动感、心理等诸方面问题。并且安全有效,简单易行。     

Innovative combination of therapeutic mammoplasty and expandable-implant breast augmentation for immediate partial breast reconstruction

IntroductionTherapeutic mammoplasty is used in the treatment of suitably-sized and appropriately-located breast cancers to achieve adequate cancer excision, resulting in well-shaped but smaller breasts. In patients wishing to maintain or increase their breast size, simultaneous augmentation will be required.Presentation of caseA 48-year-old female underwent an “augmentation-therapeutic mastopexy”. She required mastectomy for a multifocal cancer of the right breast and breast conservation for a unifocal localised cancer in the upper part of the left breast. She requested right immediate breast reconstruction and hoped for larger breasts than she had. Due to complications during neoadjuvant chemotherapy, the right reconstruction plan was changed from a deep inferior epigastric perforator (DIEP) flap to an implant-based technique. On the left, an extended superomedial pedicle therapeutic mammoplasty was combined with a subpectoral augmentation using an expandable-implant.DiscussionThe use of expandable-implants for reconstruction of partial mastectomy defects in combination with therapeutic mammoplasty has not been reported. This case report shows that such “augmentation-therapeutic mastopexy” is feasible.ConclusionA “novel” oncoplastic technique herein termed “augmentation-therapeutic mastopexy” is described for partial breast reconstruction during the treatment of a patient with bilateral breast cancer. It enabled adequate treatment of her cancer while reshaping the breast and achieving the desired larger breast size. It should be considered in selected breast-conservation patients who wish to maintain or increase their breast size.     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的　一次性完成隆乳并矫正乳房轻度下垂。方法　经乳晕上切口切除半月形皮肤 ,不切开乳腺置入乳房假体 ,将乳腺组织上移悬吊固定于胸大肌深筋膜。结果　 2 3例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好 ,乳晕切口瘢痕不明显 ,乳头感觉及勃起正常。结论　该方法隆乳同时矫正下垂乳房效果可靠稳定 ,创伤小 ,止血彻底 ,瘢痕不明显。     

硅凝胶假体隆乳术后的随访观察

目的：随访硅凝胶假体隆乳术后病例,观察和总结术后效果及并发症发生情况,以指导临床工作的正确开展。方法：对228例硅凝胶假体隆乳者进行随访,通过术后留观、来院拆线、定期检查、电话随访、发生不适时前来就诊、再次接受其它美容治疗时的咨询和观察,判断隆乳术后效果,统计并发症情况,探讨并发症的正确处理。结果：228例中发生术后并发症的25例,其中术后血肿3例,感染3例,假体移位5例,假体破裂1例,纤维包膜挛缩10例,感觉异常1例,心理障碍2例。并发症经及时、正确处理后,效果满意。结论：硅凝胶假体隆乳整体而言效果良好,有一定并发症发生,经及时正确处理,可获得满意效果。     

Submuscular Periareolar Approach to Augmentation Mammoplasty in Korean Women

Augmentation mammoplasty can be approached by various methods according to the type of implant and implantation site depending on the status of the patient or surgeon's preference. The advantage for submuscular placement is based on problems associated with subglandular placement, especially capsular contracture and sensory changes in the nipple, and interference with the interpretation of mammograms is avoided. There are fewer complications such as hematoma, infection, and extrusion of the implant with submuscular dissection and relatively avascular, minimal sensory changes in the nipple compared with subglandular approach. The submuscular periareolar approach to augmentation mammoplasty was first described in the 1970s. This approach provides easy access to both the subglandular and subpectoral planes. It also provides a central point of access for creation of the implant pocket, which allows for easier and more accurate dissection in all diameters. The resultant periareolar scar is usually minimal with less injury to breast parenchyme and eventual biopsy or mastectomy incision to be performed through or around the areola. During the period of March 1999 to January 2000, 19 cases of who received submuscular periareolar augmentation mammoplasty under general anesthesia resulted in favorable scars with accurate access to pocket margin, easier dissection, and less bleeding compared with submuscular transaxillary augmentation mammoplasty. In our experience with the submuscular periareolar approach to breast augmentation it was highly versatile, safe, and less painful; postoperative hematoma incidence was greatly reduced and breast tissue injury was minimized.     

Mass lesion of the breast after augmentation mammoplasty.

Examination of the breast after augmentation mammoplasty may be relatively easy, but the evaluation of a mass lesion presents particular possibilities and problems. Closed compression capsulotomy occasionally results in rupture of the gel prosthesis, and when silicone contacts the surrounding breast tissue, a firm granuloma can result. A patient after augmentation mammoplasty had a mass lesion of the breast following trauma. At operation, the gel prosthesis was found to have ruptured and resulted in a silicone granuloma. A history of closed compression capsulotomy or trauma is important in the preoperative evaluation of such patients, and both the surgeon and the patient should be prepared to procede with replacement of the implant at the time of biopsy.