观察A型肉毒毒素肌注胸大肌对硅凝胶假体隆乳术后包膜挛缩形成的影响

目的:本研究旨在观察A型肉毒毒素对假体隆乳患者术后常见并发症包膜挛缩形成的影响。方法:对40例小乳症患者行硅胶囊乳房假体隆乳术。对照组20例患者直接采用假体隆乳,实验组20例患者于胸大肌下极注射A型肉毒毒素后放置假体,术后随访采用Baker分级进行临床评估患者包膜挛缩情况。结果:两组挛缩率的比较P0.05,有统计学意义。结论:A型肉毒毒素对隆乳术后的防止包膜挛缩有一定的积极作用。     

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。     

双平面法假体再置入在隆乳术后包膜挛缩治疗中的应用

目的 探索假体隆乳术后并发包膜挛缩的有效治疗方法.方法 选取自2007-2009年在我科就诊的25例胸大肌下假体隆乳术后并发包膜挛缩的患者,在完整切除挛缩的包膜后应用双平面法置入乳房假体.结果 对25例患者随访3 ～ 12个月,其中2例乳房变硬,为BakerⅡ级,经保守治疗后痊愈;术后乳房柔软,更富弹性,形态美观,无乳房下垂及假体上移等并发症发生.结论 双平面法隆乳术是治疗假体隆乳术后并发包膜挛缩的有效方法.     

Scleroderma and silicone gel breast prostheses — the Sydney study revisited

Background: Silicone augmentation mammoplasty has been postulated as a cause of environmentally-induced scleroderma. While representing a small proportion of all alleged causes of scleroderma, the issue has huge social, ethical and medicolegal ramifications. The hypothesis, however, has been recently questioned in results of comparative studies. We have previously reported no association between augmentation mammoplasty and scleroderma. However, all information was self-reported including augmentation mammoplasty status, and the prosthesis type was not identified. In addition, data were not available from untraceable cases. The current study addresses these issues. Aims: To validate self-reported augmentation mammoplasty status, re-analyse rates of exposure to silicone gel breast prostheses in 556 scleroderma patients and 289 general practice controls and evaluate whether silicone gel breast prostheses are causally linked to scleroderma. Methods: Study design - population-based case-control study; Cases - scleroderma patients resident in Sydney for at least six consecutive months between 1974–1988; Controls -patients from 29 randomly selected Sydney general practices, age- and gender-group-matched with cases. Validation of augmentation mammoplasty exposure was ascertained from the general medical practitioner of each interviewed case and control, or from the medical records of each deceased or untraceable case. Validation of the date of surgery and prosthesis type was from the relevant plastic surgeon. For each augmentation mammoplasty-positive case, validation of both the date and nature of the scleroderma onset was from the patient's medical records. Controls were given a ‘control date’ for disease onset to adjust for duration of potential exposure. Results: Validation of augmentation mammoplasty status was possible in 252 (87.2%) living controls, and 532 (95.7%) cases, of whom 287 were living. Self-reported augmentation mammoplasty status was highly reliable in living non-senile cases (kappa=l), and living validated controls (kappa=0.86). No association was identified between silicone gel augmentation mammoplasty and scleroderma with unadjusted odds ratios of 1.33 (95% CI:0.26–6.71), and 1.00 (95% CI:=0.16–6.16) following adjustment for potential confounders of age, socioeconomic status and ethnicity. Conclusions: This validates the self-reported augmentation mammoplasty status previously reported and does not support the hypothesis that silicone gel augmentation mammoplasty is an environmental inducer of scleroderma in females.     

高频超声诊断隆乳术后并发症的价值

探讨高频超声诊断隆乳术后并发症的种类与程度的价值.方法:选取隆乳术后患者50例,术后1天至36个月进行超声检查.其中硅胶假体隆乳46例,脂肪充填隆乳4例.按有无合并症分为正常组(10组)与异常组(40例).结果:置入假体呈无回声区,与周围组织界限分明.隆乳手术后合并的血肿、感染、位置偏移、假体破裂及包膜硬化均有较特异的声像图表现.结论:高频超声检查可清晰显示置入假体的部位、形态及毗邻关系,是发现隆乳术后合并症的可靠检查手段,可作为追踪观察的常规项目.     

乳晕双环切口多区段乳腺切除缩乳术

目的：探索一种巨乳缩小后乳房形态和功能俱佳的手术方法。方法：设计乳晕周围双环切口,采用乳腺基底蒂方法,对乳腺组织作放射状桔瓣样多区段切除进行缩乳整形术。结果：施术10例术后疤痕不明显,保存乳头乳晕的感觉,保留哺乳功能,并获得满意的美学形态。结论：本术式行巨乳缩小塑形效果可靠,方法简便实用。     

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     

聚丙烯酰胺水凝胶注射隆乳术后常见并发症及处理

目的　探讨聚丙烯酰胺水凝胶注射隆乳术后并发症产生的相关因素及其处理方法。方法　回顾 1432例注射聚丙烯酰胺水凝胶隆乳术资料 ,对并发症统计、分类 ,针对不同情况进行的相应处理。结果　发生各类并发症2 6 2例 ,占 18.30 %。其中散在性结节 182例 ;血肿 2 1例 ;硬结 19例 ;创伤性无菌性炎症 18例 ;胸大肌炎 13例 ;其它9例。经对症治疗、理疗、抽吸、软化处理后 ,多数患者获得满意疗效。结论　聚丙烯酰胺水凝胶注射隆乳术后并发症是多种因素共同作用的结果 ,及时正确地处理多能够获得较满意的疗效。     

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。     

乳房缩小术的并发症分析及适应证选择

目的：为预防乳房缩小术后并发症以及为临床选择手术适应证提供依据。方法：结合乳房美学、临床特征对乳房缩小术早期、晚期并发症进行分析。结果：早期并发症为血肿,乳头乳晕坏死,切口裂开、感染,乳汁瘘等;晚期并发症为增生疤痕,乳房塑形不满意,乳头乳晕变形,心理上不平衡。结论：针对不同程度的乳房肥大下垂特征、临床表现及不同年龄,提出手术绝对和相对适应证。