乳房体积测量器在乳房整形中的应用

目的 使两侧体积不等的乳房在行乳房整形术后获得对称、满意的效果。方法 使用自制的乳房体积测量器，应用计算乳房标准体积的方法，对隆乳和缩乳的患者进行测量并计算。从而选择不同容积的置入假体和切除不同体积的乳房组织。结果 本组32例患者，经过3个月至2年的随访．其中有2例单侧隆乳患者因原乳腺组织局部缺损，术后外形欠佳。其余患者术后两侧乳房的体积基本对称。效果较为理想。结论 术前只有较准确地测量出乳房体积，计算出既符合美学要求又能满足患者愿望的乳房体积，并选择适当容积的隆乳假体或切除适当体积的乳房组织。才能保证术后两侧乳房体积的对称。使手术效果更加理想。     

乳房体积测量器在乳房整形中的应用

目的　使两侧体积不等的乳房在行乳房整形术后获得对称、满意的效果。方法　使用自制的乳房体积测量器 ,应用计算乳房标准体积的方法 ,对隆乳和缩乳的患者进行测量并计算 ,从而选择不同容积的置入假体和切除不同体积的乳房组织。结果　本组 32例患者 ,经过 3个月至 2年的随访 ,其中有 2例单侧隆乳患者因原乳腺组织局部缺损 ,术后外形欠佳 ,其余患者术后两侧乳房的体积基本对称 ,效果较为理想。结论　术前只有较准确地测量出乳房体积 ,计算出既符合美学要求又能满足患者愿望的乳房体积 ,并选择适当容积的隆乳假体或切除适当体积的乳房组织 ,才能保证术后两侧乳房体积的对称 ,使手术效果更加理想     

乳房体积测量器在乳房整形中的应用

目的使两侧体积不等的乳房在行乳房整形术后获得对称、满意的效果.方法使用自制的乳房体积测量器,应用计算乳房标准体积的方法,对隆乳和缩乳的患者进行测量并计算,从而选择不同容积的置入假体和切除不同体积的乳房组织.结果本组32例患者,经过3个月至2年的随访,其中有2例单侧隆乳患者因原乳腺组织局部缺损,术后外形欠佳,其余患者术后两侧乳房的体积基本对称,效果较为理想.结论术前只有较准确地测量出乳房体积,计算出既符合美学要求又能满足患者愿望的乳房体积,并选择适当容积的隆乳假体或切除适当体积的乳房组织,才能保证术后两侧乳房体积的对称,使手术效果更加理想.     

先天性单侧乳房发育不良不对称畸形整复一例

双侧乳房轻度不对称是相当常见的,轻度不对称是一种正常现象。我科收治的一例先天性单侧乳房发育不良,而另一侧乳房发育正常且呈中度下垂,经行双侧不等大硅胶假体隆乳及乳房悬吊术后,获得了满意效果,报道如下。1临床资料该患者女,35岁,已婚已育,自青春期后,右侧乳房未见发育,而     

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。     

自体脂肪颗粒注射填充矫正哺乳后乳房不对称

目的：讨论自体脂肪颗粒注射填充隆乳矫正哺乳后乳房不对称。方法：采用注射器吸脂,生理盐水中自然漂洗脂肪颗粒,注射隆乳。结果：75例术后均无血肿、感染、坏死、色素沉着、感觉迟钝及脂肪栓塞等并发症,两侧乳房不对称得到满意矫正,移植的自体脂肪存活率65％～75％,外观满意,手感良好,无供区畸形,随访1～5年,受术者满意。结论：自体脂肪颗粒注射填充隆乳术是良好的矫正两侧乳房不对称的方法。     

直线LEJOUR法乳房缩小术的临床应用

目的:探讨直线法Lejour术式对于肥大下垂乳房形态矫正的临床效果。方法:采用Lejour法术前设计,剥离皮肤及乳腺组织,切除下方和两侧皮肤皮下和腺体组织,形成上方腺体真皮蒂营养乳头乳晕,悬吊缝合腺体基底于第2肋水平,塑形成半球形后无张力缝合。结果:本组14例均获得满意的术后乳房形态,未发生乳头乳晕坏死,其中1例术后出现单侧乳头感觉迟钝,6个月后恢复,1例术后3个月切口下端"猫耳朵"予以手术修复。结论:直线Lejour法乳房缩小术设计操作简单、瘢痕短小、并发症少、效果良好,值得临床推广。     

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。     

乳房下皱襞不对称的矫治

目的：探讨乳房下皱襞不对称的矫治方法。方法：对11例乳房下皱襞不对称患者,采用乳晕上缘半环形切口,游离乳房后间隙,根据双侧不对称的差值,将过低侧乳房的上极腺体组织弧形切除并向上与胸肌筋膜缝合固定（其中9例同期行隆乳术）,切口上缘皮肤作适当切除。结果：11例患者术后双侧乳房下皱襞基本对称,形态满意,无并发症发生。结论：本方法操作简单,疗效可靠,便于推广应用。     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的 一次性完成隆乳并矫正乳房轻度下垂。方法 经乳晕上切口切除半月形皮肤，不切开乳腺置入乳房假体，将乳腺组织上移悬吊固定于胸大肌深筋膜。结果 23例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好，乳晕切口瘢痕不明显，乳头感觉及勃起正常，结论 该方法隆乳同时矫正下垂乳房效果可靠稳定，创伤小，止血彻底，瘢痕不明显。     

Adjustment of the contralateral breast following breast reconstruction

Surgery on the contralateral breast was performed in 64 of 100 patients for adjustment of size and shape or for diagnostic purposes. The patients found it more desirable to adjust size than shape asymmetry on the contralateral breast. There was only one early complication and six late ones. The former was a postoperative hematoma after a reduction mammaplasty. The latter were three cases of capsular contractures after augmentation mammaplasties. In these cases the implant was placed in a submuscular position. In three cases, patients asked for a secondary reduction mammaplasty because of poor symmetry. There were some difficulties in comparing pre- and postoperative mammography after augmentation mammaplasty. In the other adjustment procedures, there were only minor difficulties in a few cases comparing pre- and postoperative mammography. Patients with a high risk of bilateral breast cancer needing size and/or shape symmetry correction should be considered for mastectomy and immediate reconstruction.     

Breast Asymmetries: A Brief Review and Our Experience

The authors describe their personal experience with the management of mammary asymmetries. A review of their database from January 1998 to January 2005 identified 177 patients with idiopathic breast asymmetries. All these cases had been classified previously into six groups. Bilateral asymmetric hypertrophy and unilateral hypertrophy were treated with reduction mammaplasty. Unilateral hypertrophy with amastia or hypoplasia of the contralateral side was managed with reduction and augmentation mammaplasty. Unilateral amastia or hypoplasia (Poland’s syndrome) was treated with a single monopedicle transverse rectus abdominis muscle (TRAM) flap, and asymmetric bilateral hypoplasia was managed with augmentation mammaplasty. Unilateral mammary ptosis was treated with mastopexy and augmentation mammaplasty. The proposed classification, derived from the authors’ experience in this field, gives an idea of how they usually treat these patients. It is useful for a first evaluation, but after that, every treatment must always be individualized on a patient-by-patient basis.     

Vertical Mammaplasty as Secondary Surgery After Other Techniques

Vertical mammaplasty, a technique that avoids submammary scars, has proved to be a reliable method of breast reduction because it is adaptable to most cases and produces beautiful and durable results. What about secondary cases? In the last 14 cases referred for secondary mammaplasty, at 1–19 years after their initial surgery, patients' indications were poor shape (14), visible and improperly located scars (9), excess volume (8), asymmetry of the areolas (5) or the breasts (1), insufficient volume (2), and asymmetry with reconstructed breast (2). The original scars were inverted T (10), periareolar (2), oblique (1) or vertical (1). Their appearance was a concern for nine patients. All patients but one, who had long submammary scars surrounded by heavy stitch marks requiring correction, could benefit from a vertical mammaplasty. This avoided long months of scar redness and visibility along the submammary folds. Good symmetry and shape could be obtained in all cases by adjusting the markings to the needs. Liposuction was a great help to remove volume without endangering the blood supply of the areolas, possibly transforming reductions in simple mastopexies.     

Breast augmentation after reduction mammaplasty: getting the size right

Although patients are typically satisfied after reduction mammaplasty, a subgroup later deems the volume of remaining breast tissue inadequate and presents for breast enhancement. Our purpose was to identify patient and procedural risk factors that may contribute to an over-reduced breast and the desire for breast augmentation after initial reduction. Seven patients were identified who had breast augmentation an average of 13 years after breast reduction. Four patients were satisfied with breast size immediately after reduction mammaplasty but lost breast volume subsequent to weight loss or childbearing. Three patients with a body mass index of 18 to 20 were dissatisfied immediately after reduction. Body image improved in 100% of patients after enhancement. Getting the size right depends upon thorough discussion with the patient regarding desired size, insurance requirements, and potential for decreased size after weight loss or childbearing. Breast augmentation may improve body image in patients with small breasts after reduction.     

Immediate breast reconstruction with subpectoral implantation after transaxillary subcutaneous mastectomy for siliconoma

Immediate breast reconstruction on 14 patients suffering from breast hardening after augmentation mammaplasty by injection of silicone gel was performed. Transaxillary subcutaneous mastectomy was done followed by insertion of a double-lumen prosthesis into the subpectoralis plane. The result was greatly influenced by the amount of injected silicone gel. The patient was carefully observed after surgery, and the prosthesis was immediately removed when abnormal skin changes became apparent. Seven cases had no hardening on either side and 1 case had hardening on one side, 3 cases had hardening on both sides and 1 case on one side, 2 cases had the prosthesis removed from both sides and 2 cases from one side. All other cases with hardening or prosthesis removal, except one with removal from both sides, were subsequently reconstructed after more than three months.     

应用聚丙烯单丝网片行乳房悬吊的常见并发症及处理

目的 探讨在乳晕周围环形切口乳房缩小整形术中应用聚丙烯单丝网片作支撑悬吊材料常见并发症发生的原因及防治措施.方法 对1999年12月至2005年12月行此项手术的78例患者的临床资料进行分析.并对其中得到随访(6个月至5年)的47例远期手术效果进行评价.结果 78例患者的近期并发症中血清肿3例,感染3例(伴网片外露2例),切口延期愈合3例,乳头乳晕感觉障碍1例,未发生血肿、皮瓣坏死及脂肪液化等并发症.47例得以随访者乳房上极皮肤波浪状畸形7例,乳房边缘触及硬结3例,乳晕周围瘢痕增宽继发下垂2例,乳头乳晕感觉障碍1例,其余病例外观和自我感觉均良好.有2例术后成功哺乳,5例术后行乳房X线摄影,未发现网的显像和乳房钙化灶.结论 聚丙烯单丝网片作为乳房悬吊材料效果尽管较好,但因质地较硬、远期并发症较高,有必要寻找更为柔软安全可靠的替代材料.     

Oncoplastic surgery: the evolution of breast cancer treatment

Oncoplastic surgery is an establish approach that combines conserving treatment for breast cancer and plastic surgery techniques. It allows wide excisions and prevents breast deformities by immediate reconstruction of large resection defects. The procedures are mostly useful for resection of 20-40% of the breast - a group of patients normally treated by mastectomy in the past. Four features are integral to oncoplastic breast surgery: (i) Appropriate surgery for cancer excision. (ii) Partial reconstruction to correct wide excision defects. (iii) Immediate reconstruction with the full range of available techniques. (iv) Correction of volume and shape asymmetries relative to the contra-lateral healthy breast. There are two fundamentally different approaches: (i) volume-replacement procedures, which combine resection with immediate reconstruction by using local flaps (glandular, fasciocutaneous, and latissimus dorsi mini-flaps), and (ii) volume-displacement procedures, which combine resection with a variety of different breast reduction and reshaping techniques, according to the location of the tumor. Oncoplastic surgery increases the oncological safety of breast-conserving treatment because a much larger breast volume can be excised and wider surgical margins can be achieved. Moreover, a "surgical screening" of the contra-lateral breast allows the diagnosis of occult cancers. Among oncoplastic approaches, a very unique technique is the possibility of implant use (augmentation mammaplasty) in case of quadrantectomy and simultaneous delivery of intraoperative radiotherapy to the tumor bed.     

Reduction Mammaplasty in Teenagers

Background Asymmetrical breasts are an aesthetic problem for teenagers that should be dealt with by a plastic surgeon before it causes significant psychosocial problems. Incision placement is crucial, and attempts must be made to ensure that the scar is well hidden. Methods Eleven teenage girls with asymmetrical breasts underwent unilateral reduction mammaplasty of the larger breast, and four of them also underwent augmentation of the smaller-than-normal contralateral breast with a gel-filled implant. A submammary incision was made for reduction mammaplasty, and the natural elasticity of the young skin was put to good use. Results There were no postoperative complications, and all the patients were highly satisfied with the final results. The scars are invisible, concealed in the submammary crease. Conclusions Reduction mammaplasty is feasible for teenagers. The author recommends the procedure for correction of breast asymmetry to avoid emotional and social problems in the adolescent girl.     

Safety and efficacy of contra-lateral breast reduction for women with mammary hypertrophy undergoing mastectomy for breast cancer

Women with mammary hypertrophy undergoing mastectomy for breast cancer suffer disability because of disproportionate asymmetry. The case notes of all women with mammary hypertrophy undergoing mastectomy and immediate contra-lateral reduction mammaplasty for primary breast cancer from February 2001 to December 2008 were reviewed. Thirty-three women were identified of whom twenty-seven underwent inferior pedicle reduction mammaplasty and six inferior dermoglandular pedicle reduction with free nipple graft. The duration of surgery ranged from 75 to 146 (median 110) minutes. Between 475 and 2350 (median 1090) grams of breast tissue was excised from the contra-lateral breast. No immediate or delayed complications were observed and there were no delays in commencing adjuvant therapy. Immediate contra-lateral breast reduction in women with mammary hypertrophy undergoing mastectomy for breast cancer is safe and effective means of reducing the physical, psychological and cosmetic problems associated with unilateral mammary hypertrophy following mastectomy.     

乳房假体隆乳术后并发症12例分析

目的 减少隆乳术并发症的发生，提高隆乳术的远期效果。方法 对１２例乳房假体隆乳术后１～１３年间出现并发症患者的临床表现及包膜病理变化进行分析讨论。结果 １２例１５侧乳房中，单侧９例并发１种并发症者４例，并发２种者４例，并发３种者１例；双侧３例，并发同一种并发症者２例，并发３种并发症者１例。各种并发症有其特有的包膜病理及临床特点。结论 严格执行无菌操作、熟练掌握该术技能、造反优质假体、首选胸大肌下置