乳房体积测量器在乳房整形中的应用

目的　使两侧体积不等的乳房在行乳房整形术后获得对称、满意的效果。方法　使用自制的乳房体积测量器 ,应用计算乳房标准体积的方法 ,对隆乳和缩乳的患者进行测量并计算 ,从而选择不同容积的置入假体和切除不同体积的乳房组织。结果　本组 32例患者 ,经过 3个月至 2年的随访 ,其中有 2例单侧隆乳患者因原乳腺组织局部缺损 ,术后外形欠佳 ,其余患者术后两侧乳房的体积基本对称 ,效果较为理想。结论　术前只有较准确地测量出乳房体积 ,计算出既符合美学要求又能满足患者愿望的乳房体积 ,并选择适当容积的隆乳假体或切除适当体积的乳房组织 ,才能保证术后两侧乳房体积的对称 ,使手术效果更加理想     

乳房体积测量器在乳房整形中的应用

目的使两侧体积不等的乳房在行乳房整形术后获得对称、满意的效果.方法使用自制的乳房体积测量器,应用计算乳房标准体积的方法,对隆乳和缩乳的患者进行测量并计算,从而选择不同容积的置入假体和切除不同体积的乳房组织.结果本组32例患者,经过3个月至2年的随访,其中有2例单侧隆乳患者因原乳腺组织局部缺损,术后外形欠佳,其余患者术后两侧乳房的体积基本对称,效果较为理想.结论术前只有较准确地测量出乳房体积,计算出既符合美学要求又能满足患者愿望的乳房体积,并选择适当容积的隆乳假体或切除适当体积的乳房组织,才能保证术后两侧乳房体积的对称,使手术效果更加理想.     

乳房体积测量器在乳房整形中的应用

目的 使两侧体积不等的乳房在行乳房整形术后获得对称、满意的效果。方法 使用自制的乳房体积测量器，应用计算乳房标准体积的方法，对隆乳和缩乳的患者进行测量并计算。从而选择不同容积的置入假体和切除不同体积的乳房组织。结果 本组32例患者，经过3个月至2年的随访．其中有2例单侧隆乳患者因原乳腺组织局部缺损，术后外形欠佳。其余患者术后两侧乳房的体积基本对称。效果较为理想。结论 术前只有较准确地测量出乳房体积，计算出既符合美学要求又能满足患者愿望的乳房体积，并选择适当容积的隆乳假体或切除适当体积的乳房组织。才能保证术后两侧乳房体积的对称。使手术效果更加理想。     

术前数字化分析在不对称乳房隆乳术中的应用

目的探讨应用三维扫描仪精确测量乳房体积对选择隆乳假体型号的指导意义。方法对拟行假体隆乳且目测有乳房不对称的患者术前行三维扫描和精确体积计算,并根据测量结果选择假体型号。结果本组共20例患者。其中13例双侧乳房体积差为10~20 ml,双侧乳房选择了相同型号的假体隆乳;7例双侧乳房体积差为37~110 ml,选择了不同型号的假体;术前、术后双侧乳房体积差绝对值分别为(27.4±3.7)ml和(12.7±4.7)ml,差异具有统计学意义(P0.05)。结论术前应用数字化成像系统测量乳房体积可以为假体选择提供客观依据,从而提高假体隆乳术的手术效果和患者的满意度。     

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。     

超声自动乳腺全容积成像测量技术在乳房重建中的应用

目的:探讨应用超声自动乳腺全容积成像(Automated Breast Volume Scanning,ABVS)测量技术测量全乳及乳房假体体积的方法,及其在乳房整形中的应用前景。方法:将入选的30例病案随机分为AB两组。A组依据传统经验与简易测量手段进行乳房重建术前的设计工作;B组根据ABVS得到DICOM5.0的原始数据,导入mimics 10.01以及Magic RP软件进行两侧乳房体积差和假体体积的选择。手术后,定期进行回访与术后满意度及乳房相关径线的测量。最终将AB两组的术后效果进行统计学分析,得出结论。结果:B组在乳房对称性方面患者的满意率要高于A组,其余的并无统计学差异。结论:本方法可以准确测量双侧乳房体积差,提供较为准确的乳房整形术前信息,在测量乳房和乳房假体体积方面具有实际的应用价值。     

组织扩张后行假体乳房再造的对称性处理

目的探讨组织扩张后使用假体进行乳房再造过程中,可使两侧乳房对称的方法。方法 2006年6月至2014年6月,对48例患者行组织扩张后假体乳房再造,在再造过程中采用对称性处理,方法包括:1选择直径与健侧乳房基底直径相近的扩张器,对称位置埋置,下极位置低于对称下皱襞2~3 cm,超量注水扩张;2依据扩张器注水容积,模拟假体容量及健侧乳房的三维摄像数据选择大小、形态适合的假体;3采用包括患侧的自体颗粒脂肪注射移植、背阔肌肌瓣移植、乳头乳晕移位,健侧乳房缩小、假体置入增大、上提固定等对称性修整手术。结果本组患者术后随访6~48个月,平均11.9个月。术后双侧乳房均达到基本对称,患者对再造效果满意。结论对乳房准确的测量,选择合适的扩张器,置入恰当的假体,结合两侧适当的修整,可以获得对称的再造效果。     

乳房再造术中的假体选择策略

目的 探讨乳房再造术中的假体选择策略。方法 回顾分析2006年8月至2021年8月,在我院行乳腺癌切除术后单侧假体乳房再造的217例患者的相关资料,总结围手术期各环节针对最终假体型号选择的经验,包括利用三维体表成像技术对健侧乳房进行测量、乳癌术中记录切除组织体积、在扩张器/假体两阶段再造方法中记录双侧乳房体积相近时的注水体积量、术中利用假体试模完成假体置入前的形态和体积验证等。术后从乳房下皱襞位置、乳房突度以及乳房容量三方面评价再造乳房的美学效果。结果 本组中,行即刻乳房再造164例,延期再造53例;行术后即刻假体置入41例,行扩张器/假体两阶段再造176例。组织扩张中位周期为7.0(5.5,10.4)个月。应用解剖形假体189例,圆形假体28例,假体体积中位数为225(200,270) mL。术后随访中位周期为7.0(5.0,12.0)个月。再造乳房美学评价为“优”者占75.1%(163/217),绝大部分患者假体包膜挛缩分级为Ⅰ级或Ⅱ级（168/217,77.4%）。结论 围手术期各环节均能够为最终假体型号的选择提供重要的参考信息,正确选择假体可使再造乳房达到和健侧乳房较为对称的体...     

隆乳术乳房假体容积的测算

以往隆乳术选择植入假体容积，常常仅凭经验、目测作粗略估算。为使手术效果既符合公认的美学要求，又能满足病人期望，希望找到一种较精确的计算乳房假体容积的方法。将近年来接受隆乳术病人的术前、术后乳房体表相关测量指标、乳房体积及假体容积等有关数据，经ＧＲＡＦＴＯＯＬ软件进行处理、分析，获得隆乳术病人术前、术后身高与胸围的关系曲线；术后胸围与术后双侧乳房总体积的关系曲线及回归方程。根据回归方程计算，再结合病人的身高、术前的胸围、乳房体积以及自己对术后乳房大小的要求，即可较精确地测算出植入假体的容积。这一计算方法，通过大量临床病例的验证，获得了满意的效果。     

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。     

Infection following breast reconstruction

Of 33 patients who underwent 49 breast implantations for reconstructive surgery, 8 (24%) patients developed implant infections. All 8 of these patients were among a subgroup of 15 having immediate breast reconstructions with tissue expander implants after simple or modified radical mastectomy (a 53% infection rate). The infection rate increased substantially when bilateral procedures involving implants were performed as opposed to unilateral implants. Nine implants were removed (an overall implant loss rate of 18%). Patients who underwent other breast reconstruction techniques (i.e., including immediate reconstruction with permanent implants or delayed reconstruction with or without tissue expanders) did not develop infection unless they had had simultaneous immediate reconstruction with a tissue expander in the contralateral breast. The most frequently isolated organism was the coagulase-negative staphylococcus. The study concludes that neither the tissue expander nor immediate reconstruction is a risk factor, but the combination may lead to an unacceptable infection rate, especially in the face of bilateral breast procedures.     

Mastectomy with breast reconstruction in previously augmented patients: indications for implant removal

Surgeons performing breast reconstruction in previously augmented patients can either leave the preexisting implant in place and incorporate the implant into the reconstruction, or remove the implant, usually performing an implant exchange. The focus of this study is to identify indications for implant removal in previously augmented patients undergoing mastectomy with breast reconstruction. We performed a retrospective chart review of patients who underwent breast reconstruction from 1997-2007 at University of Alabama, Birmingham Medical Center. Of these patients, 54 had previous augmentation with silicone or saline implants. Twenty-two of these underwent bilateral breast reconstruction, making a total of 76 reconstructed breasts. Patients were followed for a mean of 2.1 years (range 0.1-5.1 years). The mean body mass index was 23.0 (range 18-30). Implants were explanted in all but one patient. Reasons for implant removal or exchange included subglandular position (n = 39), aged silicone implant (n = 50), rupture or leak (n = 24), implant exposure (n = 1), and infection (n = 1). Some patients had more than one reason for explantation. We recommend removal of preexisting implants for patients who have implants in a subglandular position, ruptures or leaks, site infections, implant exposures, capsular contractures, pain, indolent seromas, aged silicone implants, poor cosmesis, plans for or history of radiotherapy, and close proximity of tumor to implant. We also remove implants to respect patient preferences and to achieve symmetry in our reconstruction. Consequently, we find in our practice that most of previously augmented patients who undergo breast reconstruction will also undergo implant removal.     

乳腺癌术后乳房即刻再造152例报告

目的探讨乳癌根治术后即时应用单纯假体植入、可调式双囊假体植入和自体组织移植乳房再造术的适应证及疗效。方法101例在保留皮肤的乳腺癌改良根治术基础上于胸大肌下方植入Mentor假体再造乳房，39例在胸大肌下方植入Becker可调式假体再造乳房，10例用单蒂下腹部横行腹直肌肌皮瓣移植至乳房缺损区再造乳房。2例采用扩大的背阔肌肌皮瓣移植再造乳房。结果随访152例3—65个月，中位时间28个月，2例13个月后肿瘤局部复发，取出假体。术后乳房外观评价优良率达94％。结论单纯假体植入适用于乳房较小的患者，可调式假体植入乳房再造适用于乳房较大，或根治术时皮肤缺损较多的患者。     

乳房再造术的临床研究

目的 回顾总结了乳癌根治术后应用单纯假体植入、Becker可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣(TRAM)移植、扩大的背阔肌肌皮瓣(ELDF)移植乳房再造术的经验,探讨手术的适应征、方法和效果.方法 16例行保留皮肤的乳癌根治术一期假体植入乳房再造;13例行Becker可扩张假体植入一期乳房再造;4例行单蒂下腹部横形腹直肌肌皮瓣(TRAM)移植乳房再造手术,其中2例为一期再造,另2例为二期再造.应用Becker可扩张假体行二期乳房再造1例.扩大背阔肌肌皮瓣(ELDF)移植二期乳房再造1例.结果 手术效果满意,优良率超过90%.3例病人出现轻微并发症,其中1例皮瓣局灶坏死,一例出现保留的乳头乳晕部分坏死,1例出现血清肿.结论 单纯假体植入适用于瘦小病人,对侧乳房小且没有明显下垂.优点是不增加额外瘢痕,术后恢复快;可扩张假体植入乳房再造适用于乳房大或改良乳癌根治术的患者,此法结合了单纯假体植入法和组织扩张术乳房再造术的优点;TRAM和ELDF皮瓣移植乳房再造的优点是自体组织移植,安全、手术效果好.     

Tolerance, reliability and efficiency of inflatable breast implants after breast reconstruction. Retrospective study of 101 consecutive cases

A long-term retrospective study of breast reconstruction with inflatable implants is presented. One hundred and one patients were studied, with a median follow-up of 44 months. Prosthetic implants used were round McGhan implants, model 168. Median volume was 215 mL. Twenty-two patients had contralateral symmetrisation, an average of five months after implant. The advantages of this sort of reconstruction are ease, speed and homogenously good results. Drawbacks include the appearance of prosthetic leaks (7%), waves and folds (13%), stage III and IV capsular contractures (26%), asymmetry and incorrect placement of the implant (25%). Breast reconstruction with implants alone gives good results for specific indications: immediate reconstructions, bilateral reconstructions, no history of radiotherapy, and good quality chest wall tissues.     

CT数据三维重建乳房体积测量方法的建立及人为影响因素分析

目的建立三维重建技术测量乳房体积及乳房假体体积的方法。分析利用CT数据三维重建技术进行乳房体积测量的人为影响因素对最终测量结果产生误差的影响。方法将胸部CT二维数据导入计算机，获得三维立体模型，再应用软件对三维模型进行合理分割，求得单侧乳房体积、乳房假体体积、两侧胸廓体积差、两侧乳房体积差。对上述方法进行可重复性检验，并对坐标位置、旋转角度、选取范围等人为影响因素对体积测量结果产生误差的影响进行统计分析。结果在给定坐标系中和选取范围内的可重复性检验显示本方法误差范围均不大于4．08ml。双侧乳房体积差在给定影响因素前后的差值为坐标沿X轴移动±4mm时，其平均差值分别为10．339ml和7．73ml；沿Z轴旋转±2°时，其平均差值分别为8．654ml和7．971ml，而增大和缩小选取半径4mm时，其平均差值分别为6．764ml和4．267ml。结论利用CT数据三维重建技术进行乳房体积测量的方法，应用于乳房体积测量具有准确性和可靠性。     

几种乳房再造术的临床应用体会

目的：探讨乳腺癌根治术后应用单纯假体植入、可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造的适应证、手术方法、手术效果。方法：本组共24例病例。14例乳腺癌患者行保留皮肤的乳腺癌根治术，Ⅰ期行假体植入乳房再造；6例采用改良乳腺癌根治可扩张假体植入Ⅰ期乳房再造；4例接受单蒂下腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造手术，其中2例为Ⅰ期再造，另2例为Ⅱ期乳房再造。结果：手术效果较满意，2例出现轻微并发症，其中1例皮瓣局灶坏死，另1例出现乳头乳晕部分坏死。结论：单纯假体植入适用于乳房小，没有明显下垂的瘦小病人。优点是不增加额外瘢痕，术后恢复快；可扩张假体植入乳房再造适用于乳房大或改良乳腺癌根治术的患者，此法结合了单纯假体植入法和组织扩张的优点：TRAM皮瓣移植乳房再造的优点是自体组织移植，安全、手术效果好。     

Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings

To shorten the reconstructive process, improve results, and provide additional options for women seeking mastectomy, we used an acellular cryopreserved dermal matrix (AlloDerm) sling to reestablish the lower pole of the pectoralis major muscle. This technique creates a subpectoral-sub-AlloDerm pocket that completely encloses the breast implant. By tailoring the width of the AlloDerm, we can precisely control the degree of lower-pole fullness. This technique shortens or eliminates the need for tissue expansion and provides an additional option for single-stage breast reconstruction with implants. We have selectively used this technique as a reconstructive option for 10 women undergoing bilateral mastectomy (20 breasts).     

乳癌术后不同乳房再造术式的临床应用

目的探讨适合乳癌术后各种乳房再造术式的适应证。方法对我院2003至2005年收治的44例、45只乳癌术后乳房再造的患者,根据不同情况分别采用扩张器/假体置入(5只)、背阔肌肌皮瓣 假体置入(13只)、背阔肌肌皮瓣(3只)、DIEP皮瓣(6只)、单蒂TRAM瓣(10只)及劈开的双蒂TRAM瓣(8只)等方法进行乳房再造,分析各手术方法的适应证。结果应用皮瓣乳房再造40只,皮瓣全部成活;1只应用扩张器/假体乳房再造术后,注射壶部表皮坏死;1只应用背阔肌 假体乳房再造术后半年出现假体破裂伴局部感染;1只应用DIEP乳房再造术后,出现皮瓣下积液;2只部分皮瓣坏死。术后随访3个月至半年,医生及患者对乳房形态均较满意。所有应用腹部皮瓣的患者均无腹壁疝发生。结论6种乳房再造技术基本满足了我国女性乳癌术后各个时期各种条件再造乳房的要求,整形外科技术的改进以及新材料的应用扩大了乳房再造的适应证。     

Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift

Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast. This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed. Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients. Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast.