乳晕切口结合MRI治疗聚丙烯酰胺水凝胶隆乳术后并发症91例

目的:探讨乳晕切口结合MRI检查治疗聚丙烯酰胺水凝胶注射隆乳术后并发症的方法。方法:对91例聚丙烯酰胺水凝胶注射隆乳术后并发症的患者,应用MRI检查协助术前诊断,采用乳晕切口,于手术直视下取出加残腔灌洗以及病变组织去除术等综合治疗手段,分析聚丙烯酰胺水凝胶注射隆乳术后并发症的处理方法以及同时置入假体的适应证。结果:本组91例治疗效果基本满意,术前症状基本消失,MRI复查显示无明显的聚丙烯酰胺水凝胶残留,其中42例同时置入乳房假体进行隆胸,效果良好。结论:聚丙烯酰胺水凝胶注射隆乳术对受术者可造成后严重后果;核磁共振是目前最好的检查方法;乳晕切口直视下取出加残腔灌洗以及病变组织去除术是目前治疗此类并发症的最好方式;应严格掌握同时置入假体的适应证的尺度。     

高频彩超在隆乳术后并发症诊治中的应用分析

目的:探讨高频彩色多普勒血流显像(CDFI)超声在聚丙烯酰胺水凝胶注射隆乳、硅凝胶假体隆乳术后并发症诊治中的应用,以便提高临床疗效。方法:应用高频CDFI超声检查在本院及外院66例隆乳术后并发症的患者,观察不同充填物的超声表现,及时发现并发症,根据超声确定手术方式,并将超声检查结果与手术结果相对照。结果:66例隆乳术后并发症患者检查结果发现,聚丙烯酰胺水凝胶注射隆乳的17例(28只)患者乳房有变硬感,14例(21只)患者双侧乳房不对称,注射物有移位,22例(39只)患者乳房局部可扪及硬结。硅凝胶假体隆乳术的假体纤维囊性包膜挛缩9例,硅凝胶假体囊破裂2例,假体移位和位置不良2例。CDFI表现与临床表现及手术取出物所见相符。结论:高频彩色多普勒血流显像超声(CDFI)是诊治隆乳(聚丙烯酰胺水凝胶、硅凝胶假体)术后并发症简便有效的方法,为临床提供简便适用的诊治依据。     

3.0T MRI对硅凝胶乳房假体及假体破裂的诊断价值

目的探讨MRI各序列对显示硅凝胶乳房假体及假体破裂的诊断价值。方法回顾性分析自2016年3月至2018年6月采用3.0T MRI检查18例硅凝胶假体隆乳患者的影像学资料,并分析不同MRI扫描序列对显示和评价硅凝胶乳房假体的价值,特别在显示假体破裂方面的不同优势。结果全部36只假体中,20只良好,呈半球形,内部信号均匀,包膜完整,表面光滑;16只一般,其中8只假体完整,但其内部存在细小的短线和较长的弧形皱褶,并呈放射状延伸到假体外周,8只假体包膜不规整,存在不同程度的破裂和渗漏。T1WI、T2WI抑脂及DWI序列在评价硅凝胶乳房假体及假体破裂方面具有不同的优势,而3D T1WI增强序列具有薄层、可三维重建的优势,显示假体结构更加全面立体,对鉴别假体囊内破裂和假体较大的折叠方面具有优势;另外,假体破裂后周围组织强化的显示能够增加对假体破裂诊断的准确性。结论 MRI多序列联合扫描的方法可以更加全面地评价硅凝胶乳房假体,并准确显示假体破裂,特别是3D T1WI增强序列具有较高的应用价值。     

聚丙烯酰胺水凝胶注射隆乳取出术后同时置入假体适应证探讨

目的探讨聚丙烯酰胺水凝胶注射隆乳取出术后即时置入假体的适应证。方法对226例聚丙烯酰胺水凝胶注射隆乳术后发生并发症患者,行磁共振检查及症状和体征归纳总结,结合取出术中所见具体情况及患者意愿等判断即时置入假体的适应证,对于符合即时置入条件者共61例实行假体置入术。结果行单纯注射物取出术的165例,术后恢复良好,术前临床症状基本消失;即时置入假体的61例,术后乳房塑形满意,效果良好。结论对于聚丙烯酰胺水凝胶注射隆乳取出术者,根据磁共振以及物理检查,结合术中具体情况,以及患者有无置入假体要求等,符合者可以即时置入假体。     

直视下处理注射隆乳并发症同期假体隆乳体会

目的：探讨经直视下处理聚丙烯酰胺水凝胶注射隆乳术后并发症并同期行假体隆乳的适应证。方法：通过对接受注射者症状、体征归纳总结,分别行MRI检查,并采用手术直视下取出加残腔灌洗以及病变组织去除术等综合治疗手段,分析63例聚丙烯酰胺水凝胶注射隆乳术后并发症的处理方法以及同期置入假体的适应证。结果：本组63例治疗效果基本满意。MRI复查显示无明显的聚丙烯酰胺水凝胶残留,其中41例同期置入假体,效果良好。结论：聚丙烯酰胺水凝胶注射隆乳术对受术者可造成后严重后果;MRI是目前最好的检查方法;手术直视下取出加残腔灌洗以及病变组织去除术是目前治疗并发症的最好方式;严格把握同期置入假体的适应证。     

聚丙烯酰胺水凝胶注射隆乳术后并发症的处理

目的:探讨聚丙烯酰胺水凝胶注射隆乳术后并发症处理方法.方法:对226例聚丙烯酰胺水凝胶注射隆乳术后并发症的患者行核磁共振检查和病理检查,并采用手术直视下取出加残腔灌洗以及病变组织去除术等综合治疗手段,通过对接受注射者症状,体征归纳总结,分析聚丙烯酰胺水凝胶注射隆乳术后并发症的处理方法以及同时置入假体的适应证.结果:本组226例治疗效果基本满意.MRI复查显示无明显的聚丙烯酰胺水凝胶残留,其中61例同时置入假体,效果良好.结论:聚丙烯酰胺水凝胶注射隆乳术对受术者可造成后严重后果;核磁共振是目前最好的检查方法;手术直视下取出加残腔灌洗以及病变组织去除术是目前治疗此类并发症的最好方式;注意把握同时置入假体的适应证的尺度.     

彩色超声在聚丙烯酰胺水凝胶注射隆乳术后的应用

目的:分析聚丙烯酰胺水凝胶注射隆乳术后的乳腺彩色超声表现,提高对隆胸后乳腺变异的认识及诊断水平,分析其并发症的发生率。方法:2009年6月～2012年6月181例在外院行聚丙烯酰胺水凝胶注射隆乳术,术后来我院进行彩色超声检查,显示乳腺结构及其充填物的形态,有无并发症。结果:检查结果未见明显异常135例,异常46例,出现不适后取出28例(56个乳房)。结论:乳腺彩色超声在聚丙烯酰胺水凝胶注射隆乳术后并发症的检测中有较大的应用价值。     

经乳晕切口处理注射隆乳并发症结合假体植入42例

目的:探讨经乳晕切口处理聚丙烯酰胺水凝胶注射隆乳术后并发症结合置入乳房假体的适应症.方法:通过对接受注射者症状、体征归纳总结,分别行MRI检查,并采用手术直视下取出加残腔灌洗以及病变组织去除术等综合治疗手段,分析其术后并发症的处理方法以及同时置入假体的适应症.结果:本组42饲治疗效果基本满意.MRI复查显示无明显水凝胶残留,其中26例同时王八假体,效果良好.结论:聚丙烯酰胺水凝肢注射隆乳术手术直视下取出加残腔灌洗以及病变组织去除术是目前治疗并发症的最好方式;严格把握同时王入假体的适应症.     

不同乳房假体材料的磁共振成像特征

目的:通过对不同乳房假体材料的磁共振成像检查,探讨MRI检查对不同材料乳房假体植入后效果的评价。方法:选取硅凝胶假体、盐水假体、自体脂肪假体填充植入者各5例10只乳房,然后进行MRI检查,总结不同假体材料患者的磁共振成像表现差异。结果:正常硅凝胶假体T1WI为均质等信号,T2WI为均质高信号,STIR为高信号。其中1只乳房假体出现T1WI低信号、T2WI高信号、STIR高信号,发现此为漏出硅凝胶颗粒循内侧胸壁扩散所致。自体脂肪植入假体的MRI表现与人体正常脂肪信号基本一致,其中1只乳房假体出现脂肪纤维包块形成及脂肪液化、1只乳房假体出现脂液平面,说明脂肪纤维包块转化为脂肪液化。盐水填充假体表现为T1WI低信号、T2WI高信号,其包膜表现为周围菲薄的低信号,MRI能清晰显示生理盐水填充范围及所在层次,并能准确找到乳房皮下或腋下有无游离注射物等。结论:MRI能直观显示乳房假体植入后的形态、部位、分布范围,并清晰显示周围乳房腺体及软组织情况,对软组织分辨率高,因此,MRI是评价乳房假体植入术后情况的理想方法。     

假体隆乳术后并发症医疗原因分析

目的:结合临床16例硅凝胶假体隆乳术后并发症患者,分析并发症产生的原因。方法:180例小乳症患者,采用腋窝切口、乳晕切口、乳房下皱襞切口三种手术方式,硅凝胶乳房假体放置在乳房后隙或胸大肌下间隙,术后随访1年,其中16例出现了假体外露、假体破裂、纤维包膜挛缩等并发症。综合分析其产生的医源性原因。结果:180例隆乳术出现16例明显并发症,其中假体位置不佳7例;纤维包膜挛缩4例;假体外露、假体破裂、异常泌乳、切口瘢痕、血肿各1例。结论:硅凝胶假体隆乳术后并发症产生的原因是多样的,与术前设计、术中止血、腔隙剥离的范围、手术操作规范性、术后包扎固定、预防感染等因素有关系。隆乳术后并发症产生的原因有些是可以避免的。     

超声定位引导下注射隆乳充填物抽吸术

目的：处理聚丙烯酰胺水凝胶注射隆乳术并发症的根本方法是取出异物，为能准确、比较彻底地取出异物，同时对组织损伤小、较好地保存好乳房的形态，寻求一种定位准确、直接引导穿刺抽吸方向、动态监测抽吸效果的方法。方法：用超声探查注射隆乳术并发症患者的乳房情况，对异物定位，引导穿刺抽吸方向，动态监测抽吸状况。结果：2002年6月至2004年6月笔者用超声定位引导穿刺抽吸方向、动态观测异物抽吸情况l7例，即时取出异物，乳房硬结消失，术后随访，效果良好。结论：超声定位引导、动态监测负压抽吸注射隆乳术后异物，能够达到抽吸部位准确、异物去除彻底的目的，对乳房损伤小、效果好。     

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 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.     

Treatment algorithm of galactorrhea after augmentation mammoplasty

Galactorrhea is a known complication of breast surgery, particularly reduction mammoplasty. However, in augmentation mammoplasty, it is a rare event. There are only a few case reports concerning galactorrhea after augmentation mammoplasty. In this report, we present a case of galactorrhea that occurred at 2 weeks postoperatively in a 34-year-old woman who had undergone augmentation mammoplasty with silicone implants via a transaxillary approach. Endocrinologic tests including serum prolactin level, routine blood work, and breast ultrasonography were all normal. The authors decided to manage conservatively with close observation. After 1 month, the symptom resolved without sequelae, and no recurrence has been reported.     

隆乳术后假体取出29例临床分析

目的　探讨隆乳术后假体取出原因。方法　对 1 990年以来收治的 2 9例隆乳术后假体取出病例进行回顾性分析。结果　假体渗漏是导致术后假体取出的主要原因。其中术中证实属假体质量问题的有 2 5例 / 4 3只 ,表现为脱胶、砂眼、破裂。硅凝胶假体所致并发症主要表现为硅凝胶漏出引起的局部组织反应和后期的硬变。结论　假体质量问题应引起整形界的高度重视 ,严格手术适应证、正确地手术操作以及选择高质量的假体是减少并发症的关键     

The management of severe capsular contractures following breast augmentation

Several patients with severe capsular contracture following conventional augmentation mammoplasty with subcutaneously placed implants have had substantial improvement by replacing the implants in a submuscular position.     

Review of implant sizes in 146 consecutive asymmetrical augmentation mammoplasties

Background

Breast and chest asymmetries have been reported with varying incidences in patients requesting augmentation mammoplasty. However, there is a paucity of information regarding the sizes of different implants used, their relative distribution on either side, complications and revision rates in this cohort when compared with primary augmentation mammoplasty using similar size implants.

Methods

A retrospective data using the Excel spreadsheet was performed. All patients had muscle splitting technique for augmentation mammoplasty in asymmetrical breasts. Patients requiring augmentation with mastopexy, sternal notch to nipple areolar complex level discrepancy of more than 1 cm, and patients having same size implants were excluded from the analysis. Insignificant asymmetries, not noticed by patients, were not chosen for two different size implants. Patients, who chose two different size implants for mammoplasty, were divided into three groups based on the relative difference in the size of different implants used.

Results

A total of 164 patients had primary augmentation mammoplasty between 2005 and 2011, using two different size implants for augmentation mammoplasty in asymmetrical breasts. Mean age of the patients (n?=?164) was 29.2?±?7.79 years (range 18–50), and 46 (28.0 %) were smokers. Complete data on differential implant sizes used was available in 146 patients. Mean size of the implant on the right (n?=?146) was 346.27?±?70.581 cc (range 220–605). The mean size of the implant on the left (n?=?146) was 333.46?±?74.419 cc (range 200–655). Out of these 146 patients, 46 (31.5 %) patients had larger implants on the left as compared to 100 (68.5 %) patients on the right. Mean volume difference between the two sides when larger implants were used on left side was 55.76?±?37.785 cc as compared to 44.35?±?26.166 cc when larger implants were used on the right side. Low profile combination was used in 2.73 %, moderate size implant combination was used in 9.58 %, mixed profile combination was used in 3.42 % and high profile combination was used in 84.24 % of the patients. Overall revision surgery was performed in three patients (1.8 %), and out of these three revisions, only one (0.6 %) patient needed surgery for volume correction.

Conclusions

Primary augmentation mammoplasty in asymmetrical breasts using differential size implants is a procedure with low revision rates, provided that strict exclusion criteria are used along with adequate informed consent in this group. Level of Evidence: Level IV, risk/prognostic study.     

经腋下切口硅胶置入隆乳术的围手术期护理

目的:探讨我院行经腋下切口硅胶置入隆乳术的围手术期护理。方法:选择我院2008年12月～2011年10月在我院行硅胶置入隆乳术的患者24例,分别采取术前、术中以及术后护理,观察围手术期护理对隆乳术患者的临床护理作用;结果:24例行经腋下切口硅胶置入隆乳术的女性经手术后,均成功置入,置入后乳型丰满对称,无变性、炎症等不良反应,手术成功率100%;结论:完善的围手术期护理可以帮助患者今早的恢复,有助于患者的康复。     

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。     

Liposuction fat-fillant implant for breast augmentation and reconstruction

The perfect breast implant fillant material would have higher viscosity than water and would be autologous and harmless. We describe the confinement of liposuction fat in implants using the Lipovacutainer during a routine liposuction procedure. This collected fat is prepared inside the Lipovacutainer and is reinjected through a Lipomedia filling cannula into a leaf valve implant as the fillant in place of saline. The implants are used for bilateral augmentation mammoplasty and breast reconstruction procedures. Our six clinical cases have been monitored closely using mammography and MRI. These cases showed slow liquefaction without interference with mammography studies. We obtained excellent overall body contours. All complications were correctable and non-life-threatening and there was no capsule formation.Presented at the Lipoplasty Society of North America, New Orleans, Louisiana, USA, 17–19 September 1993