Psychological effects of aesthetic surgical breast procedures

Summary This research program is concerned with the psychological effect of the mammary reduction and augmentation, both on cosmetic indications. 31 reduction patients and 25 augmentation patients were interviewed with a biographic questionnaire, a personality questionnaire and an attitude measurement scale. Except for the biographic questionnaire these instruments were administered twice: before and after the operation. The resulting data were compared with those of two control groups. It is concluded that women who want to be operated on their breasts on cosmetic indications are normal persons. Not being happy with the shape of their breasts is their only psychosocial characteristic. This unhappiness is eliminated after the operation.This paper was read at the third Congress of the European Section of the International Plastic and Reconstructive Society on May 25, 1977 in the Hague.The author wishes to thank Prof. Dr. A.J.C. Huffstadt, Groningen for his kind cooperation.     

A convenient,effective mammary sizer

In augmentation mammaplasty cases it has been impossible for the patient to relate to the doctor preoperatively exactly how large they want their new breasts to be. Many of these patients are uncomfortable because they are not given a realistic impression of how large they will be postaugmentation. We have devised a mammary sizer which gives the patient a better idea of how large she will be postaugmentation. It gives the doctor a better impression of what size implant to use to achieve the desired size.     

隆乳术后27例取除假体者原因分析

通过对隆乳术后27例取除假体者的原因进行分析,进一步揭示了目前隆乳术中仍存在的某些不足,发现术后感染、疼痛、假体破裂或外露、包膜挛缩、病人心态失衡等都是造成假体取出的直接原因。认为采取高质量的假体胸大肌下间隙隆乳是降低并发症提高隆乳术质量的关键。     

隆乳术后27例取除假体者原因分析

通过对隆乳术后２７例取除假体者的原因进行分析，进一步揭示了目前隆乳术中仍存在的某些不足，发现术后感染、疼痛、假体破裂或外露、包膜挛缩、病人心态失衡等都是造成假体取出的直接原因。认为采取高质量的假体胸大肌下间隙隆乳是降低并发症提高隆乳术质量的关键。     

关于隆乳术麻醉方法有效性的思考

目的　探讨隆乳术有效的麻醉方式。方法　总结 3 83例患者以各种麻醉方式隆乳的临床经验。分析隆乳术疼痛产生的机制和隆乳术的应用神经解剖。结果　硬膜外麻醉和肋间神经阻滞技术不是胸大肌下间隙隆乳术理想的麻醉方式。局部肿胀麻醉只适用于乳房下间隙隆乳术和肌肉不发达的部分胸大肌下间隙隆乳术的患者。全身麻醉对任何术式均有效。结论　隆乳术中应根据不同情况采用不同的麻醉方式     

隆乳术后并发感染的病因分析及治疗

目的探讨隆乳术后并发感染的病因、诊断、治疗方法及可能的预防措施。方法对比分析我们收治的17例利用不同手术方法隆乳术后并发感染的临床表现并进行相应的治疗。结果术后所有病例均在短时间内治愈,无感染复发。结论隆乳术后并发感染根据部位及性质,采取及时的手术治疗可获得良好的控制感染效果,但存在不同程度的乳房萎缩。     

The advantages of a lower central breast segment in reduction mammaplasty

A method is described, which achieves reduction in the size of the breast and allows determination of breast shape, without the distortion of breast tissue and the production of unfavorable postoperative connective tissue tensions, inherent in most currently used techniques. Aesthetically pleasing breasts can be produced more consistently by a sculptural rather than an origami-like approach.     

双平面法隆乳术治疗聚丙烯酰胺水凝胶注射隆乳术后并发症

目的探索治疗聚丙烯酰胺水凝胶注射隆乳术后并发症的最佳方法。方法对15例水凝胶注射隆乳术后出现严重并发症者，于注射物取出及残腔灌洗后，应用乳腺下平面与胸肌下平面双平面隆乳术进行治疗。结果随访12例术后患者，随访时间3个月-1年，平均6．8个月，无假体移位及畸形出现，10例（20只）乳房形态良好，2例（3只乳房）可触及假体边缘，1例（1只）乳房轻度硬化达BakerⅡ级。结论双平面隆乳术是治疗水凝胶注射隆乳术后并发症切实有效的方法。     

Refinements of Vertical Scar Mammaplasty: Circumvertical Skin Excision Design With Limited Inferior Pole Subdermal Undermining and Liposculpture of the Inframammary Crease

Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skepticism, vertical reduction mammaplasty is becoming increasingly popular in recent years because it best incorporates the two concepts of minimal scarring and a satisfactory breast shape. At the moment, vertical scar techniques seem to be more popular in Europe than in the United States. A recent survey, however, has demonstrated that even in the United States, it has surpassed the rate of inverted T-scar breast reductions. The technique, however, is not without major drawbacks, such as long vertical scars extending below the inframammary crease and excessive skin gathering and “dog-ear” at the lower end of the scar that may require long periods for resolution, causing extreme distress to patients and surgeons alike. Efforts are being made to minimize these complications and make the procedure more user-friendly either by modifying it or by replacing it with an alternative that retains the same advantages. Although conceptually opposed to the standard vertical design, the circumvertical modification probably is the most important maneuver for shortening vertical scars. Residual dog-ears often are excised, resulting in a short transverse scar (inverted T- or L-scar). The authors describe limited subdermal undermining of the skin at the inferior edge of the vertical incisions with liposculpture of the inframammary crease, avoiding scar extension altogether. Simplified circumvertical drawing that uses the familiar Wise pattern also is described.     

Late Recurrent Capsular Hematoma After Augmentation Mammaplasty: Case Report

Late capsular hematoma after the implantation of silicone breast prostheses for augmentation mammaplasty is an extremely rare complication. The case of a patient in whom two late intracapsular hematomas occurred two times after augmentation mammaplasty with textured silicone implants is reported. Magnetic resonance imaging clearly showed fluid accumulated within the capsule. No identifiable etiology could be demonstrated, although the breakdown of an eroded capsular artery is suspected, caused by friction between the rough surface of the textured prosthesis and the fibrous capsule. Two hematomas in a single patient have not been described previously in the literature.     

Surgical treatment of mammary hyperplasia during pregnancy

Reduction mammaplasty is an effective procedure and the treatment of choice for symptomatic breast hypertrophy. Two unusual cases of reduction mammaplasty are reported. After uneventful immediate postoperative courses, two unusual wound complications occurred requiring further treatment. It was discovered retrospectively that the two women (21 and 24 years old) were pregnant. There was no other cause to explain the skin problems which were encountered. It is suggested that a pregnancy test may be needed before undertaking reduction mammaplasty. Received: 25 May 1999 / Accepted: 10 August 1999     

双环中央蒂乳房缩小成形术的加网或外侧附加切口技术并发症的特点和适应证

目的 比较双环中央蒂乳房缩小成形术中加网和外侧附加切口的并发症，分析其产生的原因，以避免或减少并发症的发生。方法 回顾2003年8月至2006年5月收治的58例乳房缩小成形术，比较两种方法发生的并发症，包括：感染、血肿、脂肪液化、乳头乳晕血运障碍、皮肤坏死、切口愈合不良、切口瘢痕明显、网片折叠、双侧乳房不对称、缩小程度不足等。结果 加网组19例，发生并发症者6例，其中4例早期并发症患者平均切除腺体重276g；无网也无外侧附加切口3例，无并发症。附加切口组36例，发生并发症者7例（19．4％），其中5例早期并发症患者平均切除腺体重1008g。结论 加网组的并发症主要与网片有关，而附加切口组的并发症与乳房过大、切除腺体多、影响保留的腺体血供有关，改进网片材质和编织工艺、调整网片张力、避免用于表面皮肤过薄的患者，可以减少加网组的并发症。巨大乳房不宜选用双环中央蒂乳房缩小成形术的附加切口法或双环法。     

隆乳术后纤维包膜挛缩的手术治疗初步报告

目的：探讨胸大肌后间隙乳房假体置入术后,由纤维包膜挛缩所致各远期并发症的手术治疗原则及方法。方法：经乳晕切口行假体置换术,在充分保留原纤维包膜的原则下,针对手感较硬,乳房变表,乳头异位等并发症行相应的手术处理。结果：1995年以来治疗29例均取得满意的近期效果。结论：置换假体结合各对症处理可有效治疗隆乳术后纤维包膜挛缩所致各并发症,充分保留原纤维包膜可获得较好远期效果。     

负压引流在隆乳术中的应用

旨在通过术后引流量的观察，对负压引流在隆乳术中的应用作一评价。取乳晕切口，胸大肌深面分离假体腔隙，在乳房假体未放入前，于乳房下皱襞另戳一小口，将引流管置入腔隙内，引流管外口连接负压引流器。术后，有数量不等的引流量，少者小于１０ｍｌ，最多为５０ｍｌ，平均每侧引流量为２０ｍｌ。负压引流是预防和治疗隆乳术后出血及血肿形成的有效措施；假体腔隙内维持负压，还有利于乳房塑形，使乳房外形更逼真；具有操作简单、创伤小、术后瘢痕不明显及不增加病人痛苦等优点     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上,设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过10例20只乳房的临床应用,取得了满意效果。     

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。     

聚丙烯酰胺水凝胶注射隆乳术后并发症的处理

目的　探讨处理聚丙烯酰胺水凝胶注射隆乳术后并发症的最佳方法。方法　分析 4 8例行聚丙烯酰胺水凝胶注射隆乳术者术后出现的多种并发症 ,采取手术取出加残腔灌洗以及病变组织切除术等综合治疗手段。结果　本组 4 8例术后效果均感满意 ,辅助检查显示无肉眼可见的聚丙烯酰胺水凝胶残留。结论　手术取出加残腔灌洗以及病变组织切除术是处理聚丙烯酰胺水凝胶注射隆乳术后并发症的一种切实有效的可行方法。     

Subcutaneous mastectomy with immediate reconstruction and maximal vascular protection

A combined reconstructive-reductive procedure after glandular resection in the breast has proved to be a highly practical and successful approach for subcutaneous mastectomy. A prosthesis may also be inserted at the time of the initial operation. The method requires that the incision be small, to protect blood supply, that there be a double-layer covering for the prosthesis, and that an L-shaped suture line be used for good aesthetic results.FMH Plastic and Reconstructive Surgery.     

聚丙烯酰胺水凝胶注射隆乳术后并发症处理临床分析

目的探讨聚丙烯酰胺水凝胶注射隆乳术后并发症的处理方法。方法本组病例12例,注射聚丙烯酰胺水凝胶隆乳术后14～51个月,出现乳腺感染脓肿2例,多发性硬结形成或移位8例,有恐惧心理要求取出水凝胶2例。所有患者术前均行彩超或MRI检查定位。经乳晕切口取出9例,其中3例行一期硅胶假体隆乳术,2例乳腺脓肿感染经乳房下皱襞切口切开引流。结果随访3～12个月,患者均对取出术效果满意,乳房外形对称,无明显硬结扪及,无感染复发。术后B超检查仍可见少量水凝胶存在于乳腺组织中。结论水凝胶取出术采用乳晕切口直视下手术较为合理,对于乳腺脓肿选择乳房下皱襞切口。是否一期硅胶假体隆乳取决于胸大肌组织受累程度、患者的要求和术者的经验。水凝胶注射隆乳术后假体很难彻底清除,应加强对患者的术后随访和心理疏导。     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术。方法用双环形切口，保留乳头乳晕深动脉和乳房下限的组织，对肥大的乳房进行缩小和重新塑形。结果23例惠者的乳头乳晕均无坏死，感觉良好，乳房形态自然。结论本手术设计简单，操作容易，术后瘢痕隐蔽，效果稳定，是修复各种肥大或下垂乳房的较好方法。