假体隆乳术后形态不佳的矫治

目的探讨假体置入隆乳术后形态不佳的原因和矫治方法。方法根据临床表现将乳房不佳分为5种类型：圆球型、上部膨隆型、下坠型、单侧双乳型及不规则型。通过松解纤维囊、纤维囊折叠缝合、重新分离隆乳腔隙、更换假体、乳房悬吊术等方法，进行矫治再次隆乳术。结果经过至少6个月随访观察，本组106例均获得了满意的手术效果。结论隆乳术后乳房形态不佳主要与假体体积过大、腔隙分离不到位、假体移位、乳房下皱襞过度分离、纤维囊挛缩及引流、包扎位置不当等因素有关，针对不同原因实施相应的手术方法矫治，能够获得满意的手术效果。     

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.     

双平面法隆乳术切口与入路的改进

目的:探讨双平面法隆乳术手术切口及入路的选择。方法:由2008年1月～2009年6月期间应用经乳晕中线垂直切口行双平面法双侧隆乳术28例,术中于乳腺上极垂直切开乳腺腺体,沿胸大肌肌纤维方向分离并部分离断胸大肌起点,将假体下半部分置于乳腺后间隙,上半部分置于胸大肌后间隙。结果:28例患者随访3～6个月,术后恢复良好,切口愈合好,瘢痕隐蔽。结论:应用乳晕中线切口,纵行剖开乳腺腺体上极并沿胸大肌方向分离并离断部分胸大肌进行双平面法硅凝胶假体植入隆乳术,术野清晰,解剖层次显露好。为一种较好的手术方法。     

Complications with homologous fat grafts in breast augmentation surgery

The most common complications in breast augmentation surgery with homologous fat grafts obtained from fresh cadavers are presented, showing subsequent surgical procedures to reconstruct the breasts of such patients through use of silicone prostheses and muscle flaps from the latissimus dorsi.     

隆乳术乳房假体容积的测算

以往隆乳术选择植入假体容积，常常仅凭经验、目测作粗略估算。为使手术效果既符合公认的美学要求，又能满足病人期望，希望找到一种较精确的计算乳房假体容积的方法。将近年来接受隆乳术病人的术前、术后乳房体表相关测量指标、乳房体积及假体容积等有关数据，经ＧＲＡＦＴＯＯＬ软件进行处理、分析，获得隆乳术病人术前、术后身高与胸围的关系曲线；术后胸围与术后双侧乳房总体积的关系曲线及回归方程。根据回归方程计算，再结合病人的身高、术前的胸围、乳房体积以及自己对术后乳房大小的要求，即可较精确地测算出植入假体的容积。这一计算方法，通过大量临床病例的验证，获得了满意的效果。     

A critical look at capsule contracture in subglandular versus subpectoral mammary augmentation

A critical comparison of the contracture rate in subglandular versus subpectoral augmentations was done in a personal series (senior author's) of 100 consecutive augmentation patients, 50 with subglandular augmentation and 50 with subpectoral augmentation. The average followup for the series was 27 months. Baker's classification of capsule contracture was utilized. Overall contracture rate in the subglandular group was 58% (29 of 50 patients) while in the subpectoral group it was 22% (11 of 50 patients),p<0.0002. Considering only the more severe contractures (Baker III & IV), the subglandular patients had 48% (24/50) while the subpectoral patients had 14% (7/50),p<0.0002. Comparing the more severe contractures in individual breasts, the subglandular group had 41% and the subpectoral group had 8%,p<0.0001. We conclude that in this personal series of patients, subpectoral placement of the prosthesis has significantly reduced but not eliminated the occurrence of capsule contracture without sacrificing a normal breast appearance.Presented at the American Association of Plastic Surgeons 65th Annual Meeting May 7, 1986, Washington, D.C.     

PAHG注射隆乳术前评估

目的　探讨PAHG注射隆乳术前乳房局部条件的评估指标 ,严格掌握适应证和提高术后效果的预见性。方法　回顾 1432例注射PAHG隆乳术患者术前乳房局部检查结果 ,着重从腺体、基质、脂肪和皮肤等方面进行综合分析并与术后隆乳效果进行相关性分析比较。结果　术前评估与术后隆乳效果评价的相应符合率A优 =88.79%A良 =5 6 .46 %A中 =83.15 %A差 =6 1.90 % ;整体符合率B =72 .5 8% ,并依据此方法设计了注射PAHG隆乳术前乳房局部条件评分评估方案。结论　PAHG注射隆乳术前评估可较准确地预见术后效果 ,为临床实践提供相对客观的参考指标 ,从而避免发生一些不必要的并发症和纠纷 ,对临床实践有一定的指导意义     

经腋窝人路内镜辅助双平面法解剖型假体隆乳术

目的 探讨应用内镜辅助技术,经腋窝人路双平面法硅凝胶假体隆乳术的可行性,并对手术操作经验进行总结.方法 手术在全麻下进行.切口位于双侧腋窝皮肤自然皱褶处,长约4cm.以常规方法剥离胸大肌后间隙,在10 mm-30°内镜辅助下,剪离断部分胸大肌.通过腋窝切口植 入毛面解剖型硅凝胶乳房假体,常规留置负压引流3-5 d.结果 临床应用79例,术后随访时间6～12个月,与单纯胸大肌后假体隆乳患者相比,本组患者术后疼痛程度明显较轻,外形更为自然,手 术效果满意,无包膜挛缩、血肿、瘢痕增生及感染等并发症出现.结论 在内镜辅助下,可以经腋窝入路完成双平面法硅凝胶假体植入隆乳术.该方法将乳腺后间隙假体隆乳术及胸大肌后间隙假体隆乳术的优点相结合,切口隐蔽.在双平面法隆乳术中,当患者要求采用隐蔽切口时,应用该技术是非常合适的选择.     

国人隆乳术前后乳房相关参数的变化

为了掌握隆乳术后乳房及相关部位体表参数的变化规律，借以为手术设计提供依据，预测术后效果，指导临床工作。通过对受术者进行术前、术后乳房及相关部位体表测量，应用ＧＲＡＦＴＯＯＬ软件对数据进行分析，获得标准体形及身高与胸围的关系曲线和隆乳术前后经乳头胸围标准参数的变化数值。结果发现，我国（尤其是南方）隆乳受术者，乳房及胸廓的发育状况与标准体形相差甚大。矮身材者通过隆乳术，其胸围可达到美学标准，而高身材者由于受自身条件的限制及审美观点的差异，其胸围难以达到美学标准。     

Preventing and treating capsular fibrosis after breast augmentation: A case report

A Radovan injection reservoir connected to a tube that reached behind a gel-filled implant has successfully been used to treat capsular fibrosis after mammary augmentation. The routine use of this device as a prophylactic measure is discussed.     

硅胶囊假体隆乳术并发症

应用硅胶假体的隆乳术在我国普遍开展，各种并发症也屡有报道，手术医生应掌握该方面的相关知识及并发症的防治方法，以使受术者的痛苦减少到最低程度。过去的十年里在我科共施行１１５例硅胶假体隆乳术，发生并发症９例，主要包括血肿、积液、假体破裂、位置不正。血肿和积液早期都会引起局部疼痛且有并发感染的可能，应尽早引流血肿和积液。假体破裂的诊断很重要，最常用的方法是Ｂ超，但以ＭＲＩ最为准确。位置不正可通过准确的分离腔隙和有效的包扎固定得以预防。与硅胶假体隆乳术相关的自身免疫性疾病越来越引起关注，１５例硅凝胶乳房假体的受术者的免疫功能检查，ＩｇＧ，ＩｇＭ及Ｃ３增高提示硅胶做为一种异物长期存在体内引起非特异性免疫活动增强，但这方面尚需做进一步的临床与实验研究证实。     

Augmentation Mammoplasty Using the Retrofascia Approach

In augmentation mammoplasty, the selection of placement for implants is based on the characteristics of each patient and the tissue conditions to ensure an optimal covering of these. The location must not be arbitrarily based on the preferences of the surgeon and the patient, but must ensure adequate tissue covering, thus minimizing shorts and long-term risks. Retromammary, retropectoral, and total and mixed retromuscular implants have been used. The retrofascia location of the mammary prosthesis reported in this article was described for the first time in the year 2000. This retrofascia technique refers to the collocation of the implant behind the fascia and in front of the pectoralis major muscle with the goal of achieving proper covering and good support of the implant. This is a nonrandomized prospective study investigated 110 cases of mammary hypoplasia and ptosis levels 1 and 2 from October 2001 to October 2002 with an average follow-up period of 1 year. Periareolar incisions were used in the retrofascia collocation of the mammary implant. The types of implants used included texturized silicone gel (85%) and smooth silicone gel (15%). As demonstrated by the findings, this surgical technique can achieve a good support to keep the prosthesis in an adequate position, maintaining the superior pole with a very natural projection. The incidence of complications was 7.6%, the most frequent of which was capsular contracture (3.53%).     

包膜囊上再置乳房假体隆乳术

目的探究隆乳术后包膜囊挛缩的手术治疗方法。方法采用原切口(腋窝顶或乳房皱襞下)，对隆乳后包膜挛缩者采用包膜囊保留并在其浅层再置人假体的方法进行治疗。结果治疗12例14侧乳房包膜囊挛缩症均取得良好效果。结论保留挛缩的包膜囊并在其浅层置人假体的乳房假体包膜囊挛缩治疗术具有创伤小、出血少、操作简便、安全性高、复发率低、并可通过腋窝顶小切口完成等优点，是治疗乳房假体包膜囊挛缩的较好方法。     

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。     

巨大乳房纤维腺瘤切除后的乳房成形术

目的：寻求巨大乳房纤维腺瘤切除后合理重塑乳房外形的方法。方法：按缩乳术原则设计乳头、乳晕新位置，标记需切除的表皮区和全层皮肤区。切除部分表皮、皮肤及全部肿瘤，再按隆乳方法重塑因肿瘤的和乳腺切除而空虚的乳房外形。结果：经远期随访本组7例（1例除外）乳房大小，乳头及乳房的挺拔性、对称性，手感及乳头、乳晕的感觉和勃起程度均较满意。结论：该手术方法可以较好地一期解决因切除肿瘤而后遗的乳房缩小畸形。     

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...     

采用隆乳切口行乳房肿块切除术

目的：探讨乳房肿块切除手术中切口选择的美学问题。方法：根据乳房肿块的大小、部位，应用三种隆乳术皮肤小切口，乳腺内放射状切口行乳房肿块切除。结果：临床应用56例，全部取得良好效果，切口瘢痕隐蔽，保持了乳房的较好外形。结论：采用隆乳切口行乳房肿块切除术是较理想的手术方式，传统的乳房肿块切除手术切口应加以改进。     

超声对聚丙烯酰胺水凝胶注射隆乳术后并发症的诊断价值

目的分析聚丙烯酰胺水凝胶注射隆乳术后并发症的乳腺超声表现,并探讨其应用价值。方法超声检查2003年5月至2006年6月在外院行聚丙烯酰胺水凝胶注射隆乳术,术后出现并发症到我院取出者101例(202个乳房),将其超声结果与手术结果相对照。结果注射层次紊乱98例195个乳房;急性血肿1例1个乳房;乳腺炎和乳腺脓肿5例7个乳房;注射隆乳合并纤维腺瘤3例3个乳房;注射隆乳合并乳腺癌2例2个乳房。结论乳腺超声在聚丙烯酰胺水凝胶注射隆乳术后并发症的检测中有较大的应用价值。     

Influence of patient age on capsular contracture after aesthetic breast augmentation

The influence of age on capsular contracture rates remains unclear. Most studies have only investigated early capsule development and not whether a link between age at primary surgery and the later development of capsular fibrosis exists. To clarify whether patient age impacts the development of late capsular fibrosis, the authors conducted a retrospective case study involving 43 patients who presented for surgical revision of capsular contracture (Baker grade ≥III) between four and 40 years after primary breast augmentation. Possible correlations between age and implant placement were analyzed. Late presentation of capsular fibrosis occurred a mean of 15.6 years after primary augmentation, with a slightly negative, but not significant, correlation between age at primary operation and duration of implant placement. Patients <40 years of age underwent an operative revision after a mean of 18.9 years, while patients ≥40 years of age needed an operative revision a mean of 11.9 years after primary breast augmentation (P=0.0368). The results suggest that with advancing age, the average time to develop capsular fibrosis is significantly shorter in individuals who develop capsular contracture. As more data are collected, appropriate advice can be provided to patients regarding factors that influence the long-term outcomes of breast augmentation.     

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。