改良乳晕切口隆乳术及假体置放技巧

为了更好地开展乳晕切口隆乳术，我科自１９９４年以来，对７例患者采用改良的乳晕内上或内下弧形切口，及单指置放假体的技巧，在胸大肌下间隙置放硅凝胶假体，术后乳房形态满意，随访３个月至１年无乳头乳晕感觉减退，感觉异常及纤维挛缩等并发症。本方法通过小切口置放大容量假体，手术操作简便易行，避免了神经损伤，使切口隐蔽的乳晕切口隆乳术具有更高的实用价值。     

改良乳晕切口隆乳术及假体置放技巧

为了更好地开展乳晕切口隆乳术，我科自１９９４年以来，对７例患者采用改良的乳晕内上或内下弧形切口，及单指置放假体的技巧，在胸大肌下间隙置放硅凝胶假体，术后乳房形态满意，随访３个月至１年无乳头乳晕感觉减退，感觉异常及纤维挛缩等并发症。     

乳房外下皱襞切口皮下腺体切除后假体植入术

目的：改善乳房残缺造成的不良外形和心理障碍，对因原位癌等疾病需作乳房皮下切除的患者探索一种既便于腺体完整切除和胸大肌后植入乳房假体，瘢痕又比较隐蔽，术后并发症较少的手术方法。方法：取乳房外下皱襞切口切除乳房腺体，经胸大肌外下缘进入胸大肌后间隙分离假体腔，植八注入式盐水乳房假体。结果：本方法切除接近腋窝的腺体尾部较下皱襞切口方便，比经胸大肌进入胸大肌后间隙的方法损伤少。用此方法切除腺体并隆乳50余侧，随访33侧隆乳术后2-7年的乳房，无一例发现腺体残留而发生乳腺疾病，假体植入后无一例发生血肿、乳房硬化等并发症，仅有一侧乳房假体轻度活动性移位：结论：乳房皮下腺体切除后同时重建乳房，能保持患者乳房良好的外形和曲线美，避免乳房残缺造成的心理障碍；本组患者大多为中年女性，重建后的乳房不宜过于丰满挺立，以免日后产生新的心理问题；外下皱襞切口较常用的下皱襞切口更能完整切除腺体，方便胸大肌后植入乳房假体，且并发症少。     

硅凝胶乳房假体隆乳的临床应用体会

目的：探讨硅凝胶乳房假体置入隆乳术的临床疗效。方法：依据测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据确定选用的假体类型、容量;采用腋窝切口或乳晕切口,将假体置于胸大肌深面或浅面。结果：统计我科自2010年5月至2011年12月采用国产硅凝胶毛面假体隆乳术122例,其中置于胸大肌深面68例、置于浅面54例,术后随访3个月至1年,所有患者乳房外形逼真,手感真实柔软,出现轻度包膜挛缩1例,未见感染、血肿及假体扭曲等并发症。结论：硅凝胶乳房假体与身体组织相容性好,适当的手术方法及术后处理可明显降低包膜挛缩率。     

乳晕内切口隆乳或假体置换术

自１９９７年１月以来，我们采用乳晕切口行隆乳术及乳房假体置换术，即经乳晕内的半圆形切口，将乳房假体置入胸大肌深面。共２２例的临床实践表明：经乳晕内切口行隆乳术，不仅可以不损伤乳腺组织，而且可以将乳房假体置入胸大肌深面，经乳晕内切口行乳房假体置换术，不...     

胸大肌下间隙隆乳术后硅胶囊假体外露2例

胸大肌下间隙隆乳术后硅胶囊假体外露２例作者单位：５１０５１５第一军医大学南方医院整形外科时安平罗盛康罗力生假体外露是隆乳术后一种少见的并发症，已往报道多见乳腺后间隙隆乳。我们在临床实践中曾遇见２例经乳晕切口胸大肌下间隙隆乳术后假体外露，现报告如下。１...     

双平面隆乳术86例分析

目的 探讨双平面(即部分胸大肌后间隙和部分乳腺后间隙)置人隆乳术的可行性及可靠性.方法 自2004年5月至2008年4月,共行双平面隆乳术86例,其中乳晕切口62例,乳房下皱襞切口24例.结果 对53例患者术后随访3个月至2年,除2例双侧乳房轻度不对称、1例包膜挛缩外,其余各例乳房外形良好,未见假体扭曲、血肿、感染等并发症发生,假体边缘不明显.结论 双平面隆乳术,改变了假体表面软组织覆盖及其生理力学关系,整合了乳腺下平面及胸大肌下平面的优势,是扬长避短的术式.     

乳房下皱襞切口隆乳术的体会

1990年以来,我院在局麻下行经乳房下皱襞切口硅胶乳房假体胸大肌下间隙隆乳术32例,有26例经3个月～3年的随访,其中疗效优23例,占88.5％,乳房外形美观,大小适中,手感柔软,切口瘢痕不明显(附图)。另3例受术者本人满意,但外形及对称欠佳,有较明显切口瘢痕。现谈几点体会。     

微小组合假体隆乳术的初步报告

目的通过使用微小组合假体隆乳术，观察是否可较好地解决减小切口长度，减少包膜挛缩的发生率及硅胶渗漏．使隆乳术后的双侧乳房大小更加理想。方法切口可位于乳晕外缘周、乳房下皱褶或腋窝。在胸大肌后剥离腔穴，然后将10ml微小硅凝胶假体逐一置入，堆积塑形。结果已行5例10侧隆乳术，术后随访最长6年，最短3个月，无论外形手感，医生与隆乳者双方均感满意。结论微小组合假体隆乳术较传统单一大假体隆乳术有切口小、容易获得理想的乳房体积、便于双侧调节对称、外观自然、假体渗漏相对较少、包膜挛缩率低等优点。该法适用于隆乳术或乳房再造，尤其适用于乳房部分缺损的修复。     

内窥镜辅助隆乳术

目的 养活常规隆乳术盲视下操作分离假体置入腔隙而赞成的创伤,提高隆乳术效果,探讨内镜在隆乳术中的应用。方法 自1996年5月起在内窥镜辅助下行胸大肌下置入腔隙的分离,止血及肌肉,筋膜的剥离,切割,17例置入假体34个,其中经腋切口7例,乳晕旁切口9例,乳房下皱臂切口1例。结果 应用内间辅助进行隆乳术可以减少组织损伤,经乳晕旁切口可以更直接和准确地分离和切割胸大肌内下份起点,腹直肌前鞘和腹外斜肌筋膜,形成分离彻底的置入腔隙和良好的乳房下皱襞形态,防止乳房假体上移及位置不正,术后无出血,感染等并发症,10例术后经随访3－12月,均无包膜挛缩,外形及手感良好,结论 内窥镜 乳术对置入腔分离,止血彻底,可减少血肿,感染等并发症,降低包膜挛缩的发生率,有助于获得良好的手术效果。     

Submuscular Periareolar Approach to Augmentation Mammoplasty in Korean Women

Augmentation mammoplasty can be approached by various methods according to the type of implant and implantation site depending on the status of the patient or surgeon's preference. The advantage for submuscular placement is based on problems associated with subglandular placement, especially capsular contracture and sensory changes in the nipple, and interference with the interpretation of mammograms is avoided. There are fewer complications such as hematoma, infection, and extrusion of the implant with submuscular dissection and relatively avascular, minimal sensory changes in the nipple compared with subglandular approach. The submuscular periareolar approach to augmentation mammoplasty was first described in the 1970s. This approach provides easy access to both the subglandular and subpectoral planes. It also provides a central point of access for creation of the implant pocket, which allows for easier and more accurate dissection in all diameters. The resultant periareolar scar is usually minimal with less injury to breast parenchyme and eventual biopsy or mastectomy incision to be performed through or around the areola. During the period of March 1999 to January 2000, 19 cases of who received submuscular periareolar augmentation mammoplasty under general anesthesia resulted in favorable scars with accurate access to pocket margin, easier dissection, and less bleeding compared with submuscular transaxillary augmentation mammoplasty. In our experience with the submuscular periareolar approach to breast augmentation it was highly versatile, safe, and less painful; postoperative hematoma incidence was greatly reduced and breast tissue injury was minimized.     

Relationship of Incision Choice to Capsular Contracture

Background Capsular contracture can be an ongoing problem in breast augmentation even with good surgical technique. In the author’s practice, a higher incidence of capsular contracture was observed with the use of a periareolar incision than with an inframammary incision. Methods A review of breast augmentations performed from November 2004 through June 2006 was conducted. This analysis included the incision used, the procedure performed, and the development of capsular contracture. Results The incidence of contracture was 0.59% in the inframammary group and 9.5% in the periareolar group. This increase in capsular contracture with a periareolar incision was statistically significant. Capsular contracture occurring with augmentation performed at the time of a periareolar mastopexy was 8%, which was statistically significant compared with the inframammary group. The difference in contracture rates between a periareolar incision alone and a periareolar mastopexy was not statistically significant. Conclusions Breast augmentation through a periareolar incision has a higher incidence of capsular contracture than observed with an inframammary incision. This most likely occurs due to an increase in contamination of the breast pocket with intraductal material colonized by bacteria. The periareolar incision is, and will remain, a standard of care. Therefore, this information can help clinicians make a more informed decision regarding incision placement for breast augmentation. Presented at the annual meeting of the Texas Society of Plastic Surgeons, September 30, 2007.     

Anatomy of pectoral fascia in relation to subfascial mammary augmentation

The aim of this study is to elucidate the anatomic details of the pectoral fascia in relation to subfascial breast augmentation.Thirty-two breasts of Korean cadavers were dissected and studied grossly and microscopically.The superficial pectoral fascia (SPF) was easily undermined and separated with an Agris-Dingman dissector. A gentle pushing force by the dissector could stretch the SPF and extend the subfascial pocket further at the lateral border of pectoralis major muscle (PM). The dissector head stayed inside the pocket, not perforating through the fascia. Near the inferior border of PM at the level of the sixth intercostal space, the dissection was hard to advance down beyond rectus abdominis muscle (RA). Yet a continuous vigorous dissection led into the subcutaneous layer of the abdominal wall over RA. The SPF is thick and continues to superficial axillary fascia at the lateral end of the muscle. At the inferior border of the PM (sixth intercostal space), however, the pectoral fascia became thin and feeble.The subfascial implants should be placed under the SPF, laterally beyond the lateral border of PM and inferiorly under the glandular tissue of the breast below the sixth intercostal space.     

Importance of the periareolar approach in the augmentation of the ptotic breast

This is a retrospective review of 66 patients with grade II breast ptosis who underwent augmentation mammaplasty from January 1996 to January 2001. Of these 66 patients, 17 were augmented using a periareolar approach, and 49 were augmented using an inframammary approach. All patients had textured saline implants, and 64 of 66 patients had the implants placed in a submuscular position. Mean photographic follow-up was 4.8 months (range, 6 weeks-1 year). When compared with an inframammary approach in the presence of grade II ptosis, a periareolar approach results in improved fill of the lower pole of the breast, improved centralization of the nipple on the breast mound, and lessening or elimination of undesirable upper pole fullness.     

Submuscular augmentation mammaplasty using a perinipple incision

The periareolar approach for submuscular augmentation mammaplasty sometimes shows a widened or hypertrophic scar and distorts the shape of the areolar-skin junction. The authors describe submuscular augmentation mammaplasty using a perinipple incision and muscle preservation techniques. The perinipple incision can be extended using a backcut within the areola according to the thickness of the index finger of the operator. The authors could reach the lateral edge of the pectoralis major and lift it while preserving anatomic continuity. The folded, smooth saline implant was introduced with a no-touch or minimal-touch technique. Implant volumes ranged from 175 to 325 mL. Ten to 25-mL volume was overfilled (within the recommended amount), particularly large volume was overfilled in patients who had a thin envelope to reduce the palpation of the edge of the implant. From August 2000 to December 2002, 306 patients underwent subpectoral augmentation mammaplasty via the perinipple approach. Eleven patients complained of rippling or a visible fold. There were 7 patients who required a partial capsulectomy through the perinipple incision again. The scar was well hidden but scar revision was needed in 17 patients as a result of skin slough on the areola flap. Of these cases, some were camouflaged using a medical tattooing procedure as well. Pain was reduced markedly compared with the axillary approach. In conclusion, the perinipple incision has a less visible scar in patients who have an ill-demarcated skin-areolar junction and provides a similar operative field compared with the periareolar incision. In addition, preservation of the normal skin-areola junction is cosmetically successful.     

经腹外斜肌入路隆乳术

为降低假体置入隆乳术后的纤维包膜挛缩的发生率，自１９９０年以来要用经乳房下腹外斜肌入路行隆乳术９６例，术后随访半年以上者７２例，其中６７例（９３．１％）乳房外观挺拔自然，手感柔软，２例（２．８％）发生单侧乳房硬化，此术式可提供一个完整的肌腔隙将假体完全覆盖，从而可以明显降低纤维包膜挛缩的发生率。     

Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor

Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.     

不同入路行假体隆乳术的效果比较

目的:比较不同入路下假体隆乳术的术后效果。方法:2016年1月至2018年1月,长沙雅美医疗美容医院美容外科收治隆乳患者211例(年龄18~52岁,平均)。根据手术入路将患者分为腋窝入路组、乳晕入路组、乳房下皱襞入路组,对3个组患者术后疼痛、切口瘢痕、引流量及其他并发症进行观察。结果:乳晕入路组与乳房下皱襞入路组患者术...