Transareolar incision for augmentation mammaplasty

In the past, unacceptable results were obtained in attempts to correct hypoplastic breasts, so that patients seeking augmentation mammaplasty were afraid of possible hazards. Silicone inclusions were a great advancement in biological engineering. Their implantation through the transareolar incision by Pitanguy seems to be more physiologic and gives welcome aesthetic resuls. Furthermore, the incision allows adequate undermining and good hemostasis. Because there is no inframammary scar and consequent tissue weakness, early mobilization of the prosthesis by precocious manipulation is possible, decreasing the occurrence of capsule formation.Professor of Plastic Reconstructive Surgery at Catholic University of Rio de Janeiro, Chief of the Plastic Department at the 38th. Infirmary of the Santa Casa de Misericórdia General Hospital, and Member of the National Academy of Medicine.     

Combined abdominoplasty and augmentation mammaplasty through a transverse suprapubic incision

Simultaneous breast augmentation and abdominoplasty through a transverse suprapubic incision offers women the opportunity to undergo body restoration with one operation, one anestheitc, one incision, and no scars on or near the breasts. Prompted by the earlier work of Planas [5] and others, we have performed this combined procedure on 8 women since February, 1977, and have compared the results with those in 4 additional patients who underwent separate abdominoplasty and breast augmentation operations.     

The transverse intra-areolar infra-nipple incision for augmentation mammaplasty

Visible scarring remains a considerable concern for patients seeking augmentation mammaplasty. We describe an intra-areolar infra-nipple incision that provides a good surgical access in most cases and allows inflatable as well as prefilled implant insertion with limited subcutaneous tunneling over the inferior glandular quadrants. The resultant scar is minimal and can be easily camouflaged by the pigmented and contractile areolar skin.     

经乳晕切口手术治疗隆乳术后包膜挛缩

目的 探讨隆乳术后纤维包膜挛缩所致乳房硬化的治疗方法，以及治疗后再次挛缩的预防措施。方法 经乳晕切口，楔形切除囊腔基底与囊壁间部分包膜及纤维性愈合组织，囊腔壁做放射状切开松解；术后早期进行充分有效地按摩。结果 本组26例，术后17例随访半年以上，效果满意。结论 对挛缩包膜进行剥离松解后，楔形切除基底与腔壁间纤维组织，使假体在适宜大小腔隙内平滑移动而不受阻碍，加之早期充分有效地按摩，可达到治疗和预防包膜再次挛缩的理想效果。     

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。     

Transaxillary submuscular augmentation mammaplasty

At least three different implant pockets for transaxillary submuscular (TASM) augmentation mammaplasty have been reported in the literature. To verify and clarify the features of the anatomical structures involved in a TASM procedure the authors studied the anatomy of the anterior thorax in operated and unoperated breasts of ten fresh female cadavers. In particular, some fascial and muscular observations are stressed, demonstrating that TASM augmentation mammaplasty always leads to a pocket where the upper one-third of the prosthesis is covered by the pectoralis major muscle, while the inferior two-thirds lies in a subglandular/subcutaneous plane.     

History of augmentation mammaplasty

The history of breast augmentation started effectively after World War II. Until then, this surgery was almost irrelevant because the indications were considered very rare and technical possibilities limited. During about two decades after 1945, two types of procedures were proposed. The first ones used autologous tissue especially fat in the form of dermofatty grafts taken from the buttocks. The results were very bad and sometimes disastrous for both techniques. At the beginning of the sixties, under the impulse of the Dow Corning Company, two surgeons: Frank Gerow and Thomas Cronin from Houston (Texas, USA) proposed an implant with a sheath filled with silicone gel. This new prosthesis had an immediate success and the number of breast augmentations growed very quickly. After an optimistic period, it had to be admitted that the results were sometimes deceiving or frankly bad. The breasts were often too firm, sometimes hard and even deformed. Capsular contracture occurred around the implants. During the 70's and 80's both consistency and envelops of the implants were regularly modified. The incision and the positioning were changed. At the end of the 80's, the problem of capsular contracture seemed to be resolved with the implants used, meanwhile a controversy took place about silicone in USA. Some cases of autoimmune diseases were attributed to silicone. In spite of scientific studies that proved the contrary, silicone implants were prohibited in the United States, Canada and temporarily in France.     

内窥镜辅助下腋窝入路隆乳术的临床体会

目的：为了减少在常规隆乳术中由于分离时存在视觉误区而对组织造成损伤,进而引起术中出血症状,探究在内镜辅助下腋窝入路隆乳术的,临床可能性及优势。方法：选择2009年1月-2011年1月来我院就医者52例,所有病例均进行双侧腋窝入路隆乳,观察患者术中出血情况以及隆乳效果分析。结果：52例患者中,38例患者48h内两侧引流量小于20ml,13例患者48h两侧引流量小于30ml,只有1例患者48h两侧引流量大于30ml,在进行完引流后术后的5天内拔管。术后常规抗生素应用3日后无感染、出血等并发症出现。乳房形态优美自然,活动度良好,出现包膜挛缩11例,6例患者出现术后乳头乳晕感觉异常,术后1月后均恢复正常。结论：内窥镜辅助下腋窝入路隆乳手术,创伤小、并发症少、恢复快、效果好。但也有许多的局限性,如乳房下皱襞较薄弱的患者,如何在内窥镜下进行脱细胞真皮片加强,如何解决在腋下切口进行腔内缝合固定的问题等等,还需进一步的研究与探讨。     

术中自主法隆乳术3747例

通过隆乳术所获得的乳房大小、形态,不仅对患者而且对医生来说也是最受重视的。因此,考虑开发于术中患者通过对置入临时模具的亲自观察后,决定选择型号的方法。命名为“自主法隆乳术”。胸段硬膜外麻醉、腋下切口、胸大肌下剥离,置入注入生理盐水的可调整容量的模具囊。患者坐位于镜前观察乳房大小、形态并选择决定,取同样大小的乳房假体置换插入。该术式的接受者较多,仅１０年间就完成３７４７例,满意率较高。现就本术式的优点及注意点概述     

Capsular contracture in augmentation mammaplasty

In a group of 331 augmentation mammaplasties performed at the Clinic of Plastic Surgery in Prague from 1994-1998, capsular contracture was recorded in 6% cosmetic and 12% of reconstruction operations. The main cause was, in particular, the quality of tissue surrounding the implants along with individual disposition. The incidence of this complication did not differ significantly in relation to the placement of the prosthesis beneath the muscle or gland. Based on histological analysis and the clinical finding, it is obvious that disintegration of the prosthesis does not always lead to severe grades of capsular contracture. It is despite the presence of foreign bodies in the connective tissue.     

Calcified capsule following augmentation mammaplasty

Five patients who developed calcification of the capsule following augmentation mammaplasty are described. This long-term complication may be encountered with increasing frequency and should be considered in evaluating women with solid, firm, constructed capsules.     

绕乳头基底乳晕纵切口结合肿胀麻醉隆乳术

目的：探讨绕乳头基底乳晕纵切口结合肿胀麻醉隆乳术的操作技巧及此方法的优点。方法：对我科39例腋下切口、15例乳房皱襞下切口、27例乳晕下缘弧形切口及35例绕乳头基底乳晕纵切口结合肿胀麻醉的116例隆乳患者的疗效及患者满意度进行比较。结果：采用绕乳头基底乳晕纵切口患者的疗效及满意度最高。结论：绕乳头基底乳晕纵切口结合肿胀麻醉是理想的隆乳术式,手术创伤小,切口隐蔽,易于操作,术后患者恢复快,形态好。     

Endoscopic transumbilical subglandular augmentation mammaplasty

This technique has provoked many controversial comments. With modification and adequate clinician training and experience, however, the results can improve, and complications can be minimized. The author's complications occurred in the early stages of the use of this method; as experience was gained, they decreased. Furthermore, fewer and less severe complications occurred when the techniques were modified, including using instrument dissection before tissue expansion, better patient selection, early massage, and more frequent postoperative follow-up visits. In addition, this method leaves no scar at the breast and allows a quicker recovery. Most patients who underwent this procedure have been pleased with their results. Transumbilical endoscopic bilateral augmentation mammaplasty is an attractive alternative technique, and with careful patient selection, operative modification, and technical expertise, results can be achieved comparable with an open subglandular augmentation.     

乳晕环状切口垂乳上提巨乳缩小术

自１９９０年５月，应用乳晕环状切口行垂乳上提及巨乳缩小术２２例，术后乳房形态自然美观，乳头乳晕感觉不受影响，切口位于乳晕与正常皮肤交界处，痕迹不明显，消除了传统术式倒Ｔ字瘢痕，手术损伤小，设计简单。     

乳晕环状切口垂乳上提巨乳缩小术

自1990年5月,应用乳晕环状切口行垂乳上提及巨乳缩小术22例,术后乳房形态自然美观,乳头乳晕感觉不受影响,切口位于乳晕与正常皮肤交界处,痕迹不明显,消除了传统术式倒T字瘢痕,手术损伤小,设计简单。