国产充注式乳房假体62例应用报告

为了评估国产充注式乳房假体的临床效果,总结了1994年3月至1995年5月间手术的62例123侧隆乳病例。假体由上海地区生产,容量200～450 ml,均置于胸大肌后间隙。术中假体作短暂性超定量注水,扩张周围组织。结果:1例假体因缝针误伤致术后乳房缩小,2例因伴乳房下垂欠满意,其余病例效果满意。32例3个月随访时乳房外形对称,柔软,未见萎缩。认为,①国产充注式乳房假体的质量是好的。②术中假体短暂的超定量注水,扩张周围组织,优点明显,值得推荐。     

国产充注式乳房假体62例应用报告

为了评估国产充注式乳房假体的临床效果，总结了１９９４年３月至１９９５年５月间手术的６２例１２３例隆乳病例。假体由上海地区生产，容量２００－４５０ｍｌ，均置于胸大肌后间隙。术后假体作短暂性超定量注水，扩张周围组织。     

生理盐水充注式乳房假体的临床应用

为避免硅凝胶渗漏而导致的自身免疫性疾病，作者１９９４年３月～１９９５年８月应用上海威宁整形制品有限公司生产的生理盐水充注式乳房假体为４９例小乳症者做了隆乳术，其中２２例经６个月以上随访，结果令人满意。作者建议术中即时过度扩张后容量复原，可以获得良好的手感和自然的形态，国产生理盐水充注式乳房假体可作为隆乳术常规选择的假体     

充注式乳房假体隆乳术的改进与体会

充注式乳房假体隆乳术在我国已较广泛开展，但其手术方式、麻醉方法和术中术后处理等方面，仍有许多可探讨之处。为此，作者对６１例１２１侧小乳症、轻度乳房萎缩、乳房下垂症等行充注式乳房假体隆乳术。术中采用腋顶皱襞切口，胸大肌下间隙置入，封闭式灌注加适量抗生素的生理盐水，放置负压引流术后穿紧身衣。改用肋间神经阻滞麻醉，加静脉内麻醉，效果良好、安全，受术者术后无痛苦记忆，使隆乳术更趋完善。６１例受术者中５５例外形满意、柔软、感觉良好，２例２侧乳头和乳房外侧象限有早期感觉减退，３例乳房假体位置偏高，１例因伴乳房下垂外形欠佳。作者认为，腋顶切口，封闭式灌注加有抗生素的生理盐水，术后引流及改良的麻醉方法，值得推荐。     

组织扩张后行假体乳房再造的对称性处理

目的探讨组织扩张后使用假体进行乳房再造过程中,可使两侧乳房对称的方法。方法 2006年6月至2014年6月,对48例患者行组织扩张后假体乳房再造,在再造过程中采用对称性处理,方法包括:1选择直径与健侧乳房基底直径相近的扩张器,对称位置埋置,下极位置低于对称下皱襞2~3 cm,超量注水扩张;2依据扩张器注水容积,模拟假体容量及健侧乳房的三维摄像数据选择大小、形态适合的假体;3采用包括患侧的自体颗粒脂肪注射移植、背阔肌肌瓣移植、乳头乳晕移位,健侧乳房缩小、假体置入增大、上提固定等对称性修整手术。结果本组患者术后随访6~48个月,平均11.9个月。术后双侧乳房均达到基本对称,患者对再造效果满意。结论对乳房准确的测量,选择合适的扩张器,置入恰当的假体,结合两侧适当的修整,可以获得对称的再造效果。     

充注式绒毛状乳房假体的临床应用

为减少光滑面乳房假体隆乳术后纤维包囊挛缩的并发症，我院自１９９５年４月￣１９９６年４月对１２例隆乳患者采用充注式绒毛状乳房假体。其中８例随访６月以上获得了预期的效果，文中介绍了具体的操作方法，理论依据，优点及手术注意点。认为该类型假体为目前临床首选的乳房假体之一。     

模拟乳房假体扩张器在即刻扩张隆乳术中的应用

目前,假体置入隆乳术已成为广大美容整形医师普遍选择的一种手术方法.2006年,赵茹等报道了乳腺癌切除后在胸大肌下埋植圆形扩张器,经3个月超量注水扩张30%～50%后取出扩张器置入永久性假体,取得了较好的效果.自2008年5月至2009年1月,我们对20例患者应用模拟乳房假体扩张器即刻扩张行乳房假体置入术,满意效果.     

隆乳术后假体取出75例临床分析

随着人们生活水平和质量的不断提高，隆乳术已成为一种常见的美容外科手术。目前使用的假体材料主要为硅凝胶乳房假体和盐水充注式乳房假体。我科2000年1月-2006年12月共收治隆乳术后假体取出病例75例，现进行回顾性总结，分析其取出原因，供临床参考。     

新型注水式乳房假体的研制与应用

为寻求新的对机体无害的充注式乳房假体并证实其实用性,现报告我们在过去扩张囊的基础上所研制的新型充注式乳房假体以及动物实验与临床应用81例143只乳房的观察结果。     

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.     

The Postoperative Shape of Round and Teardrop Saline-filled Breast Implants

Background: Teardrop saline-filled breast implants have been portrayed as having a more natural shape and appearance than round saline-filled implants. However, there are no data in the literature supporting this assertion. Objective: This study was conducted to evaluate the postoperative shape of round implants and compare it with the shape of teardrop implants. Methods: With patients upright and with nothing touching the breasts, lateral radiographs were taken to document the in vivo shape of breast implants. A total of 14 round saline-filled implants in 7 breast augmentation patients were studied. Implants included both smooth-surface and Siltex textured-surface models. Some implants were placed submuscularly and others subglandularly. None of the patients had capsular contracture. For comparison, 12 teardrop saline-filled implants in 6 breast augmentation patients were studied; all of these patients had BioCell textured-surface implants placed submuscularly, and none had capsular contracture. Results: Lateral radiographs with patients upright show that round and teardrop implants have similar teardrop shapes in vivo. Postoperative photographs also show a similar appearance. Lateral radiographs with patients recumbent show that the teardrop implant remains teardrop-shaped whereas the round implant settles back evenly. Conclusions: Although round and teardrop implants exhibit significantly different shapes on a table, they have similar teardrop shapes in vivo with patients upright. Because the appearance of the breasts with patients upright is similar for the 2 implant types, there is no basis for the claim that teardrop implants provide a more natural appearance. Round implants are actually more “anatomical” because they are teardrop-shaped with patients upright and settle back evenly with patients recumbent, as do normal breasts.     

One-stage immediate breast reconstruction with implant following skin-sparing mastectomy in Asian patients

The Asian breast reconstruction patient is usually of lower mean age, lower body mass index (BMI), and has relatively small breasts. This study aimed to investigate the outcome of 1-stage immediate breast reconstruction using saline-filled implants in the Asian patients.Between April 2002 and July 2005, 30 patients underwent skin-sparing mastectomy and 1-stage immediate breast reconstruction with a saline-filled implant. Mean age was 42.9 years, with a mean BMI of 21.9 and a mean implant volume of 283 mL.The overall success rate was 96.6%, with 1 case of implant exposure secondary to chest skin necrosis. At mean follow-up of 21.5 months (range 6 to 40 months), 1 patient developed local recurrence (3.33%).Perfusion of the chest skin flap is reliable enough to allow 1-stage breast reconstruction with small saline-filled breast implants. We present this as an additional option for immediate breast reconstruction in thin women with small breasts.     

Clinical follow up of the lateral thoracodorsal flap in breast reconstruction: comparative evaluation from two plastic surgical centres.

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.     

CLINICAL FOLLOW UP OF THE LATERAL THORACODORSAL FLAP IN BREAST RECONSTRUCTION: COMPARATIVE EVALUATION FROM TWO PLASTIC SURGICAL CENTRES

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.     

Unilateral Osmotic Swelling in Textured,Single-Lumen,Saline-Filled Mammary Implants: Clinical and MRI Findings

An odd complication following routine breast augmentations was observed in two patients. Single-lumen, textured, high-profile, saline-filled mammary implants were placed in the submuscular plane and postoperative course was uneventful in the presented cases. Unilateral, gradual, and spontaneous swelling in one of the operated breasts was observed 6–14 months after surgery that prompted patients for examination. MRI showed regular external contours of the mammary implants without any evidence of rupture or extracapsular leakage. However, a substantially volumetric increase in the auto-inflated implant was noted since transverse diameter of the right breast implant was twice the left normal implant. All cases had to be re-operated and implants were explanted. Auto-inflated implants were checked and were found to be intact. Intraoperative findings included swelling of the implant and brown discoloration of the previously-transparent saline solution. Furthermore, composition of the fluid inside the expanded implant was found to have changed, possibly through an osmotic gradient. Several mechanisms such as osmotic swelling, defect at the valvular system of the implant, and inorganic salts yielded from texturization process in the shell are suggested but further research with more refined techniques should be done. The present study provides supplementary MRI and confirmatory clinical findings on this bizarre phenomenon and other factors apart from the disruption of the implant integrity may play a role.     

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。     

The comparative dimensions of round and anatomical saline-filled breast implants

Background: Anatomical saline-filled breast implants have been portrayed as having a more natural shape and greater upright projection than round saline-filled implants. However, there have been no reports in the literature substantiating such claims. Objective: This study was conducted to compare the shapes, proportions, and dimensions of round and anatomical saline-filled breast implants. Methods: A series of 52 Mentor round and 21 McGhan anatomical breast implants were studied with upright “true” lateral radiographic views of the implants. All were submuscular, without capsular contracture, and at least 6 months postoperative. Upright projection and height were measured from radiographs; recumbent projection and height data were taken from manufacturers' catalogs. Statistical analysis was performed on all data to determine the relationship of projection to height and volume. Recumbent implant shape was also studied in a smaller group. Results: Round and anatomical implants have similar teardrop shapes, the same projection for a given height, and practically the same projection for a given volume when patients are upright. In the recumbent position, anatomical implants remain in a teardrop shape and retain relatively more projection for a given height and a given volume, whereas round implants settle back evenly like natural breasts. Conclusions: Round and anatomical implants have similar teardrop shapes and the same proportions in the upright position. Round implants are the more “anatomical,” with respect to implant shape, in both the upright and the recumbent positions.     

The semi-permeability of silicone: a saline-filled breast implant with intraluminal and pericapsular Aspergillus flavus.

Fungal infection of breast implants is a rare complication. Growth of fungi within the lumen of saline-filled implants has previously been demonstrated in laboratory studies, however, clinical infections are rare. We report a case of Aspergillus flavus growth within and around a saline-filled breast implant that was inserted 18 months previously. This was successfully treated with implant removal and wound irrigation. Possible routes of microbial contamination as well as survival mechanisms of organisms within saline-filled implants are discussed. This case re-iterates that the silicone envelope of a saline-filled implant is selectively permeable and we believe this is instrumental in facilitating intraluminal microbial growth. This also emphasises the importance of stringent asepsis when dealing with saline-filled breast implants including avoiding contamination of the saline filling fluid.