A Nomogram for Predicting the Degree of Breast Augmentation According to Implant Size

Choosing the right implant size for a specific patient is a challenging aspect of breast augmentation. Bust circumference is obtained by measuring the chest circumference at the level of the nipple-areola complex. Pre- and postoperative bust circumference measurements obtained from 147 patients who underwent primary bilateral breast augmentation using round, textured, gel-filled implants were evaluated, and a practical reference list for future operations was developed. According to the results, each additional 100 ml in implant size yielded an approximate 2-cm increase in bust circumference. The authors believe these results gathered from systematic measurements may serve as a useful guide for choosing the right size implant for a satisfactory augmentation procedure.     

Augmentation/Mastopexy: How to Select and Perform the Proper Technique

During a period of 8 years, 384 female patients underwent simultaneous surgery for placement of implants and mastopexy. The surgical techniques used were selected according to the characteristics of each particular case. The determining variables in the selection were ptosis of the nipple–areola complex (NAC) and distance from the NAC to the inframammary fold. Only three surgical techniques were used: NAC lifting (n = 30), periareolar pexy (n = 196), and inverted T pexy (n = 158). The degree of general satisfaction with each of the techniques was 89%, 82%, and 92%, respectively. Round and anatomic implants were used, respectively, for 258 (67%) and 126 (33%) of the patients, with their use depending on the medical indications and each patient’s choice. All complications were minor, and their overall incidence was 18%. Factors such as proper choice of the surgical technique, type of implant, approach to placement of the implant, type of suture, and removal of tissue for the pexy are fundamental to obtaining a good result. With these factors kept in mind, it is possible to perform the combined procedure of mastopexy and implantation, to minimize the complications, and to obtain satisfactory results over the mid and long terms.     

联合筋膜鞘CFS在中重度上睑下垂术后的临床效果观察

目的 观察中重度上睑下垂治疗中联合筋膜鞘悬吊术的临床效果。方法 选取2020年12月-2021年8月广州紫馨整形外科医院整形外科中重度上睑下垂患者50例（50眼）,依据手术方式分为筋膜鞘悬吊术组、额肌瓣悬吊术组两组,各25例（25眼）。比较两组上睑下垂矫正情况、上睑回退情况、活动范围、MRD1、PFH、临床疗效、术后并发症发生情况、治疗满意度。结果 筋膜鞘悬吊术组上睑下垂正矫率高于额肌瓣悬吊术组,过矫率、欠矫率、复发率均低于额肌瓣悬吊术组,差异有统计学意义（P＜0.05）;术后1周、1个月、3个月,筋膜鞘悬吊术组上睑回退均小于额肌瓣悬吊术组,活动范围均大于额肌瓣悬吊术组,差异有统计学意义（P＜0.05）;筋膜鞘悬吊术组总有效率为88.00%,高于额肌瓣悬吊术组的64.00%,差异有统计学意义（P＜0.05）;筋膜鞘悬吊术组术后并发症发生率为8.00%,低于额肌瓣悬吊术组的32.00%,差异有统计学意义（P＜0.05）;筋膜鞘悬吊术组上视治疗满意度高于额肌瓣悬吊术组,平视治疗满意度高于额肌瓣悬吊术组,差异有统计学意义（P＜0.05）。结论 中重度上睑下垂治疗中联合筋膜鞘悬吊术的临床效果较额肌瓣悬吊术好,更能有效提升上睑下垂正矫率,降低过矫率、欠矫率、复发率,缩小上睑回退,扩大活动范围,降低术后并发症发生率,提升治疗满意度。     

Augmentation Mammaplasty for Mammarial Hypothrophy and Ptosis in a Patient with Ichthyosis

A 30-year-old female with mammarial hypothropy was diagnosed with non-bullous congenital ichthyosiform erythroderma (NBCIE) with dermatologic evaluation. Her mammarial hypotrophy and ptosis was corrected with a breast implant. Although there is a tendency to skin infections and increased skin fragility in the ichthyotic patients, breast augmentation with silicone prosthesis is well-tolerated by the patient.     

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。     

Correction of Congenital Severe Ptosis by Suspension of a Frontal Muscle Flap Overlapped with an Inferiorly Based Orbital Septum Flap

BACKGROUND: This report introduces a new method for correction of congenital severe upper eyelid ptosis. METHODS: The poor levator-function upper eyelid ptosis of 22 patients was corrected using suspension of the frontal muscle flap overlapped with an inferiorly based orbital septum flap as a motor unit, which substituted for the function of the levator muscle. The frontal muscle flap and orbital septum flap were formed in the frontal part and upper eyelid, respectively. Two flaps were overlapped and sutured to suspend the upper eyelid and to correct the congenital severe upper eyelid ptosis. This technique avoids the need for the linking structure necessary with the standard frontalis sling approach and improves the direction of pull to mimic that of a normal levator more closely than that of frontalis muscle advancement. RESULTS: The follow-up period ranged from 6 to 20 months (mean, 12 months). A total of 4 patients had bilateral surgery, whereas 18 patients underwent unilateral surgery (26 eyelids). In 22 cases (26 eyes), congenital severe upper eyelid ptosis was treated using suspension of the frontal muscle flap overlapped with an inferiorly based orbital septum flap. After the operation, 17 cases (19 eyes) were followed up and analyzed retrospectively. The average follow-up period was about 12 months (range, 6-20 months). The 17 corrected eyes had a symmetric redundant fold of preseptal skin according to the marginal reflex distance-1 (MRD-1) measurement used to judge efficacy. Two eyes in this series required reoperation for undercorrection. Complications such as ectropion and corneal exposure were avoided. CONCLUSION: Use of a frontalis muscle lap overlapped with an inferior based orbital septum flap to manage severe congenital upper eyelid ptosis is a useful procedure that results in substantial cosmetic and functional improvement with few complications.     

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.     

骨增量技术在牙槽骨严重缺损患者再造复合种植修复中的应用

目的 探讨骨增量技术对牙槽骨严重缺损的重建修复效果。方法 选取我院口腔科门诊2018年 3月-2022年3月收治的49例牙槽骨严重缺损患者作为研究对象,根据全口曲面X线断层摄片和锥形束CT摄 片结果对牙槽骨缺损的类型进行确定,针对不同类型缺损实施对应的骨增量技术进行牙槽骨植骨修复治 疗。参照Enemark分级方法评估牙槽骨缺损的植骨修复效果,统计治疗后患者牙齿松动度的改善情况及患 者对修复效果的满意度。结果 49例患者牙槽骨严重缺损植骨存活率为97.96%,植骨成功率为91.84%;治 疗后生理松动占比高于治疗前,Ⅰ、Ⅱ、Ⅳ度松动占比低于治疗前（P ＜0.05）;患者满意度为95.92%。 结论 根据牙槽骨缺损的类型以对应骨增量技术对患者实施牙槽骨重建修复复合种植治疗可提高植骨的存 活率和成功率,缓解牙齿松动,改善牙齿功能,治疗效果理想,有较高的临床应用价值。     

自体脂肪颗粒移植隆胸与假体隆胸的塑形效果

探讨自体脂肪颗粒移植隆胸和假体隆胸的塑形效果。方法 选取2018年1月-2022年1月于 广州远东美容医院行隆胸手术的48例患者为研究对象,以随机数字表法分为对照组和研究组,每组 24例。对照组采用常规的假体隆胸手术,研究组采用自体脂肪颗粒移脂隆胸手术,比较两组入院时、术前 1 d、术后1 d、术后2 d的C-反应蛋白（CRP）水平变化情况、手术时间、胸围增加量、临床疗效、术后 并发症发生情况以及塑形效果满意度。结果 研究组术后1、2 d CRP水平低于对照组（P ＜0.05）;研究组 手术时间短于对照组,胸围增加量高于对照组（P ＜0.05）;研究组治疗总有效率为91.67%,高于对照组的 66.67%（P＜0.05）;研究组塑形效果满意度为91.67%,高于对照组的66.67%（P＜0.05）;研究组术后并发 症发生率为0,低于对照组的25.00%（P ＜0.05）。结论 自体脂肪颗粒移植隆胸手术的塑形效果优于假体隆 胸效果,不但能增加患者胸围,还能提升患者的临床疗效,强化患者对塑形效果的满意度,且术后并发症 较少,安全性较高。     

针对性系统护理对上睑下垂手术患者术后心理状态及外观满意度的影响

目的 探讨针对性系统护理对上睑下垂手术患者术后心理状态及外观满意度的影响。方法 选取 我院2018年1月1日-2023年11月16日收治的73例上睑下垂患者作为研究对象,依据收治时间的先后将其分 为对照组（2018年1月1月-2020年12月31日,n =32）和观察组（2021年1月1日-2023年11月16日,n =41）。 对照组予以常规术后护理,观察组予以针对性系统护理,比较两组眼睑美学效果、心理状态及外观满意 度。结果 观察组上睑轮廓、双眼睑宽度对称性、双眼睑高度对称性评分高于对照组,差异有统计学意义 （P ＜0.05）;观察组护理后GAD-7、PHQ-9评分均低于对照组,差异有统计学意义（P ＜0.05）;观察组 外观满意度为97.56%,高于对照组的78.13%,差异有统计学意义（P ＜0.05）。结论 在上睑下垂手术患者 术后实施针对性系统护理可以提高其眼睑美学效果,减轻其负面情绪,提升外观满意度。     

Combined Use of Hair and Fibrin Glue for Soft Tissue Augmentation: Experimental Study

A vast variety of alloplastic materials together with autogenous grafts have been used for the correction of contour deformities related to aesthetic and reconstructive purposes. Despite a number of well-tolerated materials, the ideal has not yet been reached, although well-tolerated autogenous grafts have higher rates of resorption and distortion. The limited volume of autogenous grafts and concerns about donor-site morbidity may obligate the surgeon to use implantation materials. Covering almost every property of an ideal implantation material, hair, an organic autogenous nonvital tissue, was used for soft tissue augmentation in this experimental study. Hair pellets of 10 New Zealand rabbits were prepared and shaped as 1 × 1 × 1-cm cubes with the help of fibrin sealant, then inserted subcutaneously. The materials were evaluated 4 months later. No complications such as infection or extrusion were seen. The materials were intact, with no signs of resorption, but the shapes were distorted due to the pressure of the surrounding tissues. Histopathologic findings also demonstrated that the hair was well tolerated by the adjacent tissues. Different processes may enable hair to be used as a filler material in clinical practice. Well-tolerated, nonresorbable injectable materials or shaped implants may be obtained at low cost using hair.     

Effect of Price Capitation on Implant Selection for Primary Total Hip and Knee Arthroplasty

While price capitation strategies may help to control total hip (THA) and knee arthroplasty (TKA) implant costs, its effect on premium implant selection is unclear. Primary THA and TKA cases 6 months before and after capitated pricing implementation were retrospectively identified. After exclusions, 716 THA and 981 TKA from a large academic hospital and 2 midsize private practice community hospitals were reviewed. Academic hospital surgeons increased premium THA implant usage (66.5% to 70.6%; P = 0.28), while community surgeons selected fewer premium implants (36.4%) compared to academic surgeons, with no practice change (P = 0.95). Conversely, premium TKA implant usage significantly increased (73.4% to 89.4%; P < 0.001) for academic surgeons. Community surgeons used premium TKA implants at greater rates in both periods, with all cases having ≥ 1 premium criterion.     

水动力辅助吸脂对自体脂肪移植隆乳患者手术效果和脂肪移植成活率的影响

目的:探讨水动力辅助吸脂对自体脂肪移植隆乳患者手术效果、脂肪移植成活率及并发症的影响。方法:选取2015年8月-2018年8月在笔者医院行自体脂肪移植隆乳术的202例患者为研究对象,其中98例接受常规隆乳患者为对照组,104例接受水动力辅助吸脂进行隆乳患者为研究组,记录患者治疗有效率和并发症发生情况。结果:研究组总有效率为100.00%高于对照组的79.59%,差异有统计学意义(χ^2=22.423,P=0.000)。研究组吸脂时间少于对照组,乳房体积增大量、移植脂肪成活率高于对照组,差异有统计学意义(P<0.05)。研究组术后并发症总发生率为1.92%低于对照组的10.20%,差异有统计学意义(χ^2=26.751,P=0.000)。结论:水动力辅助吸脂可降低自体脂肪移植隆乳患者并发症发生率,提高脂肪移植成活率和治疗效果,可在临床推广应用。     

Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation

An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lack experimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months.Host defense mechanisms react differently to the various filler materials, but all substances—resorbable or nonresorbable—appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances. Presented at the 33rd Annual Meeting of the Association of German Plastic Surgeons in Heidelberg, Germany, September 21, 2002     

The Eurasian Nose: Aesthetic Principles and Techniques for Augmentation of the Asian Nose with Autogenous Grafting

Nasal augmentation is a highly popular technique used among Asian patients to change the characteristic flat Asian nose to a more prominent nose. The extent of augmentation is determined by the aesthetic desires of the patient, and the method of augmentation is provided by the surgeon, who takes into account the technical limitations of his or her preferred technique and the proposed surgical result. Although a silicone prosthesis is the most common implant used to improve the nasal appearance, the author prefers an autogenous approach with the olecranon bone used as a dorsal implant and conchal cartilages used to improve nasal tip projection because of the long-term stable results. A series of 31 cases over 15 years is reviewed. The technique varies little from that described for saddle nose by Hodgkinson in 1992 [5]. The procedure is a variation of the ulnar donor site originally described by Antia et al. [1].     

髓芯减压、空心钛钉植入治疗股骨头坏死

目的研究自体红骨髓组织工程复合物联合髓芯减压、空心钛钉植入治疗早期股骨头坏死临床应用的疗效。方法本组12例,男性9例,女性3例,双侧股骨头3例,右单侧7例,左单侧2例。术前均行X线摄片、CT、MRI检查,ARCO分期,Ⅰ期4髋,Ⅱ期11髋;C型臂X线透视下行股骨头坏死区和囊性变区定位、髓芯减压,关节镜监视下刮除坏死骨,送病理;植入由自体红骨髓与骨诱导活性材料复合成的非细胞型组织工程骨,空心钛钉支撑股骨头软骨下骨质。结果本组12例均获得随访,随访时间12～24个月,平均18个月。采用12分法评分系统评定,优8髋,良5髋,可2髋,差0髋,优良率为86．66％。结论髓芯减压、自体红骨髓非细胞型组织工程骨植入、空心钛钉支撑治疗早期股骨头坏死在减轻疼痛、改善关节功能、防止股骨头塌陷方面具有较好的作用。