乳癌根治术后同期假体置埋隆乳术

目的报告乳癌根治术后,应用硅凝胶乳房假体同期置埋隆乳.方法对手术的方法选择及实施,切除物体积与假体型号的关系,术后注意事项等问题进行探讨.结果随访感到手术后乳房多项外在指标均较满意.结论该方法比应用各种自体组织隆乳大为简化,并免除手术分期进行带来的问题.     

乳癌根治术同期假性置埋隆乳术

目的 报告乳癌根治术后，应用硅凝胶乳房假体同期置埋隆乳。方法 对手术的方法选择及实施，切除物体积与假体型号的关系，术后注意事项等问题进行探讨。结果 随访感到手术后乳房多项外在指标均较满意。结论 该方法比应用各种自体组织隆乳大为简化，并免除手术分期进行带来的问题。     

乳房假体隆乳术后再次手术的临床分析

目的　总结乳房假体隆乳术后并发症发生的原因 ,以探索最佳的防治方法。　方法　从切口位置、放置层次、假体类型等多方面综合分析了 40例乳房假体隆乳术后并发症发生的原因。　结果　假体包膜挛缩是再次手术的主要原因 ,手术适应证过宽 ,假体质量低劣是术后并发症发生的主要原因。　结论　选用高质量的假体 ,严格手术适应证 ,提高对隆乳术相关知识的理解和掌握以及由专科医师实施手术是减少并发症的关键。乳晕内切口是乳房假体隆乳术以及假体置换术的最佳选择     

国外美容医学最新研究与进展(七)——乳房重建

1Natrelle硅胶乳房假体置入的随诊研究:人类生态学、生活方式、手术特点50000例隆乳资料的分析;2应用局部肿胀麻醉行初次乳房腺体下假体隆乳术的结果;3在将假体置于乳腺组织后和胸肌后的隆乳术后,乳房腺体的体积及胸大肌体积改变的统计;4切除乳房后重建乳房皮瓣坏死的发生率:前瞻性研究;5乳房切除后即刻用脂肪移植进行的隆乳术,避免术后的乳房畸形。     

隆乳术后效果评价的改进及胸肌后与乳腺后假体置人隆乳术者的满意度调查

目的探讨既往评定假体隆乳术效果的不足,及胸大肌下与乳腺后层次的假体隆乳术效果的满意度调查。方法各选取10例胸大肌下和乳腺后层次放置假体的隆乳者,分别在立位和卧位下的手感、动感,以及乳房自身感受、配偶感受等方面进行满意度调查,从而对两种不同层次隆乳方法手术效果进行评价。结果乳腺后隆乳和胸大肌下隆乳相比,在立位和卧位时,前者手感更好,尤其是平卧时乳房能自然向两侧展开,且乳房可以随着不刊体位的变动而相应变动,配偶满意度远高于后者。结论作者制订的假体隆乳术后评价分级标准全面可靠。乳腺后问隙层次假体隆乳术后形态自然,尤其是卧位时动感逼真,符合实际生活中隆乳者及其配偶对手术效果的评价标准,优于胸大肌下假体隆乳术。     

经脐孔缘切口置人充注式生理盐水假体隆乳术

目的 探讨经脐孔缘切口行充注式生理盐水假体隆乳术的手术方法,为隆乳术提供新切口选择.方法 沿脐孔缘切口,采用特制专用器械分离皮下隧道至乳房下皱襞,然后穿进胸大肌后间隙,分离假体放置空间,先置人扩张器,充注生理盐水后,调整乳房形态以及扩张器位置.然后取出扩张器,更换为充注式生理盐水乳房假体而完成手术.结果 采用经脐孔缘切口行充注式生理盐水假体隆乳术者,均获得了良好的手术效果,无感染、血肿、假体渗水、Baker Ⅲ或Ⅳ级纤维囊挛缩等并发症发生.结论 采用生理盐水充注式乳房假体,经脐孔缘切口可以完成胸大肌下隆乳术,增加了隆乳手术切口的选择范围.     

垂直乳晕切口假体隆乳术应用探讨

目的:探讨一种安全、并发症少、便于手术操作、无明显痕迹的隆乳手术方法。方法:笔者在2006年2月～2009年3月间采用垂直乳晕绕乳头基底部内侧切口,将乳房假体置入乳腺后间隙或胸大肌后间隙,行假体隆乳手术。结果:126例行隆乳手术就医者,术后乳房解剖形态自然、逼真、无明显瘢痕,乳头乳晕感觉无异常,未见明显并发症。结论:用该方法进行假体隆乳手术具有安全、损伤小、手术部位直观、假体便于置入、并发症少等优点,该方法不适合乳晕小的就医者。     

术前数字化分析在不对称乳房隆乳术中的应用

目的探讨应用三维扫描仪精确测量乳房体积对选择隆乳假体型号的指导意义。方法对拟行假体隆乳且目测有乳房不对称的患者术前行三维扫描和精确体积计算,并根据测量结果选择假体型号。结果本组共20例患者。其中13例双侧乳房体积差为10~20 ml,双侧乳房选择了相同型号的假体隆乳;7例双侧乳房体积差为37~110 ml,选择了不同型号的假体;术前、术后双侧乳房体积差绝对值分别为(27.4±3.7)ml和(12.7±4.7)ml,差异具有统计学意义(P0.05)。结论术前应用数字化成像系统测量乳房体积可以为假体选择提供客观依据,从而提高假体隆乳术的手术效果和患者的满意度。     

隆乳术后纤维包膜囊挛缩与成纤维细胞的关系

隆乳术后纤维包膜囊挛缩与成纤维细胞的关系黄金井＊隆乳术是近代整形外科施行较多的手术之一。９０年代前，隆乳术应用最广的方法是硅胶囊乳房假体植入。目前普遍使用的硅胶囊假体是Ｃｒｏｎｉｎ和Ｇｅｒｏｗ于１９６３年首先报道的。我国也有不少厂家生产硅胶囊乳房假体...     

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。     

不同类型乳房假体隆乳术后并发症的临床分析

目的 统计不同类型的乳房假体置人人体后，远期并发症发生的几率，并分析其原因。方法 总结1993年至2002年间假体隆乳573例，随访到手术方法相同、假体放置位置相同、同一医生组手术的隆乳妇女427例共852只乳房，使用4种不同类型乳房假体：毛面硅凝胶、光面硅凝胶、毛面生理盐水充注式、光面生理盐水充注式乳房假体。出现的远期并发症有纤维包膜挛缩、假体破裂渗漏、疼痛移位等，对各种假体并发症发生率进行统计分析，比较各类假体的优劣。结果 427例852只中803只效果满意，无明显并发症，占94．24％。发生并发症者42例49只乳房，占5．76％。并发症中乳房硬化属Baker‘s分级Ⅲ～Ⅳ级的有26只，缩小变形24只，移位疼痛10只，经手术取出发现假体破裂渗漏的有30只。其中纤维包膜挛缩引起乳房硬化多发生于硅凝胶假体，假体渗漏引起乳房缩小变形多发生于生理盐水充注式假体；假体在体内放置时间越长，发生并发症的几率越高。结论 经统计学处理发现，光面生理盐水假体并发症明显少于光面硅凝胶假体，毛面硅凝胶假体和毛面生理盐水假体并发症发生率没有明显差异。49只有不同并发症的乳房假体中有30只假体破裂渗漏，占61．22％，假体破裂渗漏后又容易引发其它并发症，说明假体质量的提高是减少并发症的关键，长期留置体内假体的老化是目前的难题。     

Predictability in breast augmentation

Plastic surgery literature does not teach us much about the size of breast prostheses required to get the cup size the patient wants in breast augmentation. The purpose of this study is to allow predictability of the increase in cup size using a series of measurements and to correlate them with volume changes and the required volume of implants to achieve the desired change in bra cup size.     

Massive heterotopic ossification in breast implant capsules

A patient is presented with massive heterotopic ossification of breast implant capsules, 17 years after surgical implantation of Silastic prostheses. The patient has been receiving oral calcium supplements for the past 3 years. This condition developed diffusely throughout the breast capsules. The capsules were 1.2 to 2.2 cm thick and demonstrated a layered structure. The calcified material was demonstrated radiologically and histologically to be true ossification.     

中国乳腺癌术后假体乳房重建补片材料应用现状

假体为基础的乳房重建（IBBR）可以减少或避免自体组织乳房重建手术供区的损伤和瘢痕,近十年来逐渐成为了乳腺癌术后主要的乳房重建方式,同时随着材料学的进步和乳腺外科的发展,补片材料辅助技术已经广泛应用于IBBR手术。特别是对于需要植入较大假体的病例,借助人工材料联合胸肌,起到“延伸”肌肉组织、无张力覆盖假体的作用,使重建乳房下皱襞更为饱满、自然,进一步降低手术创伤的同时也增加了重建乳房的美学效果。近期在国内进行的补片材料应用情况调查显示：我国区域经济发达状况和患者的经济条件是选择乳房重建和人工补片应用的主要因素。此外,由于中国女性乳房的形态特点不同于欧美女性,对于乳房体积较小的假体乳房重建,较少应用人工补片,因此,国内重建补片材料的应用更具个体化和区域性。     

Diagnosis of breast tumors after breast reduction

We conducted a retrospective study to evaluate the diagnosability of breast tumors after breast reductions as this is a frequent surgical procedure. The data should shed light on the hypothesis that routine screening methods concerning the diagnosis of breast tumors prove more difficult after breast operations. All women who had undergone breast reduction at our department between January 1989 and December 1994 were examined. During this period we counted 166 patients; the majority of them (n = 144) had undergone a bilateral breast reduction and the rest of them (n = 22) a unilateral breast reduction for various reasons. After the operation, all patients were checked in standardized intervals. Those who developed any kind of breast mass (n = 6) were recorded and examined by ultrasound and mammography, and occasionally by an additional fine-needle biopsy. In case any doubt about the dignity had remained, an excisional biopsy was carried out. In none of our patients was it possible to get a precise diagnosis of an ill-defined mass with ultrasound. With mammography, some of the existing masses, which were really scars, mimicked different kinds of tumors, and once a carcinoma was initially interpreted as scar tissue with oil cysts. The diagnosis of breast masses after breast reductions with routinely used screening methods has proved to be more difficult as breast reductions lead to architectural alterations of the remaining breast parenchyma. Such alterations can and should be documented shortly after the operation so that later occurring tumors are distinguished more easily. Therefore, a basic mammography 3 months after each breast reduction has to be claimed in order to facilitate further breast tumor diagnosis.     

Penetrating injury to a breast implant

Summary Eight years following bilateral augmentation mammaplasty, a penetrating glass injury resulted in perforation of one of the patient's breast prostheses. The case is described.     

经乳晕切口处理聚丙烯酰胺水凝胶注射隆乳术后并发症

目的 分析30例聚丙烯酰胺水凝胶隆乳术后并发症发生原因及处理措施.方法根据并发症表现的不同加以分类.所有并发症者均采用经乳晕切口的显露刮吸、部分腺体及肌肉切除,只有1例同时通过腋窝切口行即刻乳房硅凝胶假体置入,5例半年后行乳房硅凝胶假体置入.结果 所有病例的术前症状基本消失.结论 聚丙烯酰胺水凝胶用于隆乳应非常慎重,目前必须进行严格的双盲随机病例对照研究,采用经乳晕切口的方法可以最大程度取出聚丙烯酰胺水凝胶.     

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

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目的 用微小介入的方法针取乳房组织进行活检，医师不开刀手术就能取得足量乳房组织进行确定诊断。方法 Mammotone微创活检系统在乳房肿块活检诊断系统进行取材，将探讨单次置入乳房的病灶中利用该系统的真空抽吸辅助装置和特殊的旋转设计，将病灶吸附于管腔内，再用传送装置将管状刀送入管腔内，将病灶取出，结果 88例病人，102处病灶中，恶性31处，良性71处，其中纤维腺瘤28处，乳腺增生或增生性腺瘤43处，34处小于2cm病灶被完全取除，其余68处病灶均经手术切除并复送病理，与活检符合率为97.1%。结论 经皮微创穿刺乳房肿块活检是目前定性诊断乳腺病变的理想方法。在临床实际工作中应根据具体条件和需要与传统方法选择应用。     

早期乳腺癌保留乳房手术62例疗效评价

目的探讨早期乳腺癌保留乳房手术治疗疗效。方法回顾性分析1996～2004年经治的62例早期乳腺癌实施保乳手术治疗疗效。结果全部病人手术过程顺利,近期乳房外形保持良好。术后随访1～8年(平均2年),无局部复发、远处转移和死亡病例。无放疗后合并症。结论保乳手术治疗早期乳癌的近、远期疗效满意。术前严格掌握手术适应证,术后规范的综合治疗,是保乳手术获得良好疗效的保证。