聚丙烯酰胺水凝胶在乳房纤维包膜挛缩病例中的应用(Ⅱ)

目的　介绍一种治疗硅胶囊假体隆乳术后纤维包膜挛缩的有效治疗方法和新材料。方法　从 1997年 10月至 2 0 0 0年 9月 ,用此方法治疗 16 7只因硅胶囊假体隆乳引起纤维包膜挛缩的乳房 ,根据包膜囊内有无出血分为Ⅰ期置换或Ⅱ期置换 ,对包膜严重挛缩或乳房下皱襞高低不一致的病例提出具体的矫正方法 ,对取出假体后能否Ⅰ期置换水凝胶和严重挛缩的包膜腔是否能在扩大分离后Ⅰ期置入水凝胶作了分析。结果　本组 16 7只乳房除 3例 4只乳房在术中分离扩大包膜腔和 1只乳房置换术后因外伤造成出血更换水凝胶外 ,均取得了满意的术后效果。乳房形态自然、质地柔软。结论　聚丙烯酰胺水凝胶置换硅胶囊假体 ,治疗因硅胶囊假体隆乳术后造成纤维包膜挛缩取得良好的治疗效果。从随访的结果看 ,这是解决这一顽症的有效方法     

聚丙烯酰胺水凝胶在乳房纤维 包膜挛缩病例中的应用（Ⅱ）

目的　介绍一种治疗硅胶囊假体隆乳术后纤维包膜挛缩的有效治疗方法和新材料。方法　从1997年10月至2000年9月,用此方法治疗167只因硅胶囊假体隆乳引起纤维包膜挛缩的乳房,根据包膜囊内有无出血分为Ⅰ期置换或Ⅱ期置换,对包膜严重挛缩或乳房下皱襞高低不一致的病例提出具体的矫正方法,对取出假体后能否Ⅰ期置换水凝胶和严重挛缩的包膜腔是否能在扩大分离后Ⅰ期置入水凝胶作了分析。结果　本组167只乳房除3例4只乳房在术中分离扩大包膜腔和1只乳房置换术后因外伤造成出血更换水凝胶外,均取得了满意的术后效果。乳房形态自然、质地柔软。结论　聚丙烯酰胺水凝胶置换硅胶囊假体,治疗因硅胶囊假体隆乳术后造成纤维包膜挛缩取得良好的治疗效果。从随访的结果看,这是解决这一顽症的有效方法。     

聚丙烯酰胺水凝胶在乳房纤维包膜挛缩病例中的应用（Ⅱ）

目的：介绍一种治疗硅胶囊假体隆乳术后纤维包膜挛缩的有效治疗方法和新材料。方法：从1997年10月至2000年9月,此方法治疗167只因硅胶囊假体隆乳引起纤维包膜挛缩的乳房,根据包膜囊内有无出血分为I期置换或II期置换,对包膜严重挛缩或乳房下皱襞高低不一致的病例提出具体的矫正方法,对取出假体后能否I期置换水凝胶和严重挛缩的包膜腔是否能在扩大分离后I期置入水凝胶作了分析。结果：本组167只乳房除3例4只乳房在术中分离扩大我膜腔和1只乳房换术后因外伤造成出血更换水凝胶外,均取得了满意的术后效果,乳房形态自然,质地柔软,结论：聚丙烯酰胺水凝胶置换硅胶囊假体,治疗因硅胶囊假体隆乳术后造成纤维包膜挛缩取得良好的治疗效果。从随访的结果看,这是解决这一顽症的有效方法。     

聚丙烯酰胺水凝胶隆乳取出后同期假体置入

目的 探讨聚丙烯酰胺水凝胶（polyacrylamide hydrogel,PAHG）注射隆乳取出术后,同期行假体置入的临床适应证与疗效.方法 对PAHG注射隆乳后发生并发症者,术前做乳腺超声、磁共振成像（MRI）检查,明确注射物分布层次和组织浸润情况,经乳晕切口行注射物及病变组织彻底清除后,根据组织浸润程度、包膜完整性、胸肌和乳腺变性情况,分别选择乳腺后、胸大肌后、双平面3种方式,同期行硅凝胶假体置入术.结果 56例切口均愈合良好,乳房对称、挺拔.术后随访6个月至3年,乳房外形良好,无瘢痕和假体疝出,无纤维包膜挛缩等并发症发生.结论 依据PAHG取出后乳房畸形特点,同期假体置入重塑乳房形态,既可改善乳房外观,又可缓解心理障碍,效果满意.     

包膜外聚丙烯酰胺水凝胶注射隆乳材料取出同期双平面假体隆乳术

目的：探讨包膜外聚丙烯酰胺水凝胶注射隆乳材料取出同期双平面假体隆乳术的疗效。方法：在全麻＋局麻下,采用乳晕下缘弧形切口,在注射聚丙烯酰胺水凝胶隆乳的包膜外分离,然后完整取出聚丙烯酰胺水凝胶及其包膜。同时在胸大肌下分离,在乳房下皱襞处离断胸大肌起点,胸大肌下腔隙内放置引流管,并置入硅凝胶隆乳假体,调整乳房形态满意后逐层缝合乳腺组织、皮下组织及皮肤切口。结果：本组10例均一次性完整取出聚丙烯酰胺水凝胶及其包膜,假体隆乳术后形态满意。但由于包膜组织剥离范围较广,术后引流液较多,引流管放置时间较长,拔管时间为3～6天,平均4.5天。无一例发生伤口感染或愈合不良。结论：对于单腔包膜完整的注射聚丙烯酰胺水凝胶隆乳患者的再次手术,本方法简便易行,取出聚丙烯酰胺水凝胶完整,隆乳术后乳房形态满意,是一种较好的手术方式。     

聚丙烯酰胺水凝胶隆乳术后取出及乳房畸形修复方法

目的 探讨聚丙烯酰胺水凝胶（polyacrylamide hydrogels,PAHG）注射隆乳术后取出PAHG及修复术后乳房畸形的手术方法和时机.方法 经乳晕下缘1/2长切口,利用内镜辅助进行注射物清除术,根据注射物侵蚀范围确定是否行同期硅凝胶乳房假体（以下简称假体）置入术,利用生物修补膜固定假体并重塑乳房下皱襞.结果 46例中,39例注射物及其包膜被完全取出,7例取出游离PAHG,而包膜因广泛且单薄致有残留.14例同期置入乳房假体,其中5例应用生物修补膜;4例Ⅱ期置入假体;切口均Ⅰ期愈合,切口瘢痕不明显;1例伴发乳腺癌患者切除患侧乳房;1例同期置入假体及生物修补膜,术后3个月出现假体移位,再次手术重新固定;1例应用生物修补膜,术后出现注射物残腔积液,最终取出生物修补膜.结论 采用经乳晕下缘1/2长切口内镜辅助下行PAHG取出并完整去除包膜的手术,注射物取出彻底,可应用假体同期或延期修复取出术后乳房的畸形,必要时应用生物修补膜固定假体并重塑乳房下皱襞形态.     

超声检测乳房假体状况对隆乳术后包膜挛缩手术方式选择的临床意义

目的 评估在硅凝胶乳房假体置入后并发严重包膜挛缩时进行超声检查对手术方式选择的临床意义.方法 将51例(89侧)手术治疗的硅凝胶假体隆乳术后并发严重包膜挛缩(BakerⅢ～Ⅳ级)者,按术前是否接受超声检查分为超声组和非超声组.超声组25例(45侧)假体置入年限均≥5年的受术者,接受包膜顶部或全部切除术.非超声组26例(44侧)采用包膜切开松解术或包膜旷(留)置术,假体置入年限≥5年的占53.8%(14/26).结果 89个乳房假体手术中发现假体破裂或渗漏的55个,发生率为61.7%.超声组手术证实假体破裂或渗漏的达到86.7%(39/45),超声诊断手术符合率92.1%(35/38),术后6个月随访包膜挛缩复发率为5.3%(2/38).非超声组经手术证实的假体破裂或渗漏率为36.4%(16/44),术后6个月随访包膜挛缩复发率为25.9%(7/27).两组的假体破裂或渗漏的手术符合率和术后包膜挛缩复发率差别有统计学意义(P＜0.001和P＜0.05).结论 超声检查有助于包膜挛缩的评估、假体破裂或渗漏的诊断和手术治疗方式的选择.严重包膜挛缩者,置入5年以上的乳房假体破裂或渗漏率明显增加.建议在严重包膜挛缩者的超声诊断提示乳房假体破裂或渗漏时应用包膜切除术,以提高治疗效果和降低术后复发.     

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。     

治疗硅凝胶假体破裂的十年临床经验总结

目的探讨硅凝胶假体破裂的临床表现及治疗效果。方法总结自2006年12月至2016年12月,10年间收治硅凝胶假体隆乳术后假体破裂的46例患者(硅凝胶假体破裂61只),其中单纯隆乳成形术37例,乳房再造9例;术中去除包膜,并采用庆大霉素盐水溶液、生理盐水及稀释的碘伏溶液反复冲洗创腔,术后留置负压引流管1枚。结果患者均一期愈合,术后无血肿、积液、感染等临床症状,并对治疗效果满意。结论经手术去除假体包膜,同时采用庆大霉素生理盐水等溶液大量冲洗对取出破裂硅凝胶假体的预后治疗,其效果安全、有效。     

聚丙烯酰胺水凝胶在乳房纤维包膜挛缩病例中的应用

乳房纤维包膜挛缩是隆乳术后最棘手的问题，尽管预防和治疗的方法颇多，但收效仍不理想，复发率很高，目前尚无可靠治疗方法。本组从１９９７ 年１０ 月至今应用聚丙烯酰胺水凝胶替代５０ 例因硅胶囊乳房假体隆乳引起的纤维包膜挛缩。根据挛缩程度，包膜腔内有无被污染和包膜腔在乳房的位置等因素分Ⅰ期替换或Ⅱ期替换两种方式。本组５０ 例替换结果显示，原僵硬的乳房变为柔软，Ｂ超证实挛缩的囊壁在３ ～６ 个月后有变薄现象。本组资料结果证实，用聚丙烯酰胺水凝胶替代硅胶囊乳房包膜挛缩的假体隆乳，对原已形成的纤维包膜挛缩有良好的近期（半年）治疗效果。     

The use of an integral tissue expander® for primary breast reconstruction

The authors emphasize the recent advances in breast reconstruction provided by use of the skin expander device. A Silastic percutaneous skin expander developed by the authors and the Dow Corning Corporation has been used by them in breast reconstruction for the past 7 years with satisfactory results. Important design differences in the device suggested by the authors include the use of a reinforced backing which consists of Dacron Silastic sheeting extending beyond the inflatable teardrop-shaped envelope for approximately 3/8 of an inch, thus adding strength and rigidity to the envelope and the rim, and making it possible for the rim of the expander implant to be sutured in an appropriate orientation.     

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。     

应用解剖型假体隆乳治疗轻中度乳房下垂

目的探讨应用解剖型假体隆乳术治疗小乳症伴轻中度乳房下垂的方法及效果。方法对15例患小乳症伴乳房轻中度下垂者应用解剖型ST-410假体行乳腺下隆乳术，根据术后患者满意度判断手术治疗效果。结果15例乳房轻中度下垂者通过此方法均获得很大改善，患者均感满意。结论应用解剖型假体行乳腺下隆乳术可明显改善轻中度乳腺下垂。     

乳晕切口法解剖型假体隆乳术治疗轻度乳房下垂

目的探讨应用解剖型假体(又称泪滴型假体)隆乳术矫正轻度乳房下垂的可行性及临床效果。方法术前依据原乳房三维形态,测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据,以确定所需采用的假体类型、容量及下垂乳房下皱襞距离,选用乳晕切口对36例轻度乳房下垂者应用麦格410解剖型假体行隆乳术。结果全部隆乳者术后乳房挺拔,下垂基本得到矫正,受术者均表满意。结论应用解剖型假体的隆乳术是目前矫正有增大乳房容积愿望的轻度乳房下垂者的最佳选择之一。     

乳癌术后的乳房再造

目的 探索乳癌根治术后3种不同乳房再造方法的最佳外观效果.方法 (1)乳癌切除Ⅱ期行扩大背阔肌肌皮瓣乳房再造.(2)乳癌切除即时腹直肌横行皮瓣乳房再造.(3)保留胸大肌乳癌切除,Ⅱ期乳房假体置入并行乳头、乳晕再造;对不保留胸大肌乳癌切除者,Ⅱ期皮肤扩张后乳房假体置入再造.结果 共计治疗12例,10例皮瓣全部成活,外观形态满意,优良率较高.2例不满意,其中1例扩张后,因局部皮肤皮下组织较薄,扩张程度不足,勉强置入140 ml乳房假体,外观形态明显偏小;另1例腹直肌肌皮瓣大部分坏死,经再次修复创面愈合,乳房再造失败.结论 乳房再造的方法选择得当,可使乳房形态更为自然.普通背阔肌皮瓣改用扩大的背阔肌皮瓣后,软组织量比前者增加1倍以上,使再造乳房与对侧相近.假体置入乳房成形后,Ⅱ期行单蒂乳头、乳晕再造,可给患者以心理和外观上的更多抚慰.     

The Feasibility of Sentinel Lymph Node Detection in Patients with Previous Transaxillary Implant Breast Augmentation: Preliminary Results

Background: Transaxillary breast augmentation has gained popularity because of the good aesthetic results and scar placement in a less visible position. As breast-augmented patients age, an increasing number of breast cancer cases can be expected. Sentinel lymph node detection (SLND) is a well-established technique in breast cancer. To date, no information is available regarding the feasibility of SLND for patients with previous transaxillary implants.Methods: A 28-year-old women with bilateral breast hypoplasia underwent a bilateral breast augmentation by the transaxillary approach. One week earlier, SLND was accomplished through two periareolar injections of 0.1 mCi 99m-technetium-labeled fitate and lymphoscintigraphy. A 3.5-cm-long axillary incision was performed, and the dissection continued through the subfascial plane to create the implant’s pocket. A silicone gel implant (215 g round, low-profile, textured Silimed) was inserted.Results: A satisfactory aesthetic result was obtained. Two postoperative lymphoscintigraphies were performed (15 days and 7 months after surgery) with satisfactory SLND. No complication was noted.Conclusion: The initial data show that SLND in the setting of prior breast implant augmentation through the transaxillary approach is feasible. Additional prospective studies and larger clinical series are necessary to analyze the accuracy of SLND for patients with previous breast implants.     

Correction of breast contour deformities using polyurethane breast implant capsule in revisional breast surgery

Surgeons are commonly confronted with breast contour deformities and defects that result from previous surgical interventions. These soft tissue deformities can be corrected by conventional reconstructive flap surgery using autologous tissue, but there can be donor site morbidity. Smaller volume replacement is possible using temporary fillers such as hyaluronic acid or polylactic acid, or by using 'permanent' fillers such as autologous fat, but large defects are notoriously difficult to fill and often the fillers resorb or migrate. The patient described in this case report had an exchange of polyurethane implant (PU) in the left breast and correction of a contralateral breast contour filling deformity. A left breast partial capsulectomy was performed after implant removal and the capsule graft was inserted into a predissected pocket where soft tissue augmentation was required. A biopsy from the PU capsule was reported to show a foreign body type giant cell reaction to PU material in a fibrous capsule, lined by synovial metaplasia. The post-operative result showed satisfactory soft tissue revolumisation. PU breast implant structured capsule has thus been used as filler to correct breast soft tissue deformity and contour defects. Clearly it may have a use in other anatomical sites.     

Left Unilateral Breast Autoinflation and Intraprosthetic Collection of Sterile Pus: An Unusual Operative Finding of Silicone Gel Bleed with Silicone Lymphadenitis

Implant rupture is a known complication after augmentation mammoplasty. Saline implant failure may present with few diagnosable problems due to the loss of volume. On the other hand, intracapsular silicone gel implant rupture or failure can be silent, asymptomatic, and difficult to diagnose in the absence of loss of breast volume. Silicone leak and migration to regional nodes has been reported but is uncommon and lymph node enlargement can be nonspecific in patients with intact prostheses. Causes, timing, and diagnosis of implant failure sites and mechanisms have been extensively studied and reported in the literature. Implant failure resulting in lymphadenopathy is uncommon. In this article autoinflation of the left breast with regional lymphadenopathy is presented. Upon exploration, the prosthesis was found to be filled with sterile pus, showing an inward movement of a thick creamy material in an otherwise macroscopically intact prosthesis.     

A Case Report of Prefilled Polysaccharide Hydrogel Breast Implant Rupture: Clinical,MRI, and Pathologic Findings

A case of a ruptured prefilled polysaccharide hydrogel breast implant with its radiologic and pathologic findings is presented. Usually, hydrogel spreads out in tissues with swelling and edema after rupture of an implant. However, in this case, a small amount of hydrogel leakage was misdiagnosed with ultrasonography as a benign breast mass. Therefore, it is advisable to evaluate a breast mass after augmentation with a hydrogel breast implant using magnetic resonance imaging to differentiate it from the hydrogel itself.