生物组织补片在隆乳术中的应用

目的:探讨生物组织补片在隆乳术中的应用,并对其早期临床效果进行评价。方法:选择50例女性患者随机分为实验组与对照组,两组各25例,采用乳晕切口,乳房假体植入胸大肌后间隙;实验组将胸大肌对假体压迫最明显的部位切开,直到假体无明显压迫为止,形成的胸大肌裂口用生物组织补片进行修补;对照组将胸大肌裂口直接拉拢缝合。结果:所有病例均随访6个月,除对照组出现1例包膜挛缩外,余均未出现排斥、过敏、感染、积液、裂口假体疝等并发症。实验组术后各项血液生化指标均无明显改变,术后乳房形态、手感、动感明显优于对照组。结论:隆乳术中应用生物组织补片修补胸大肌裂口,增加了胸大肌后间隙容量,为乳房假体植入提供足够空间,对术后乳房自然形态、手感和动感有良好的作用,患者满意度高。     

奥美定注射隆乳取出后二期假体隆乳术的疗效观察

目的观察乳房内注射奥美定取出后二期行硅胶假体隆乳术的疗效。方法自2003年3月至2016年3月,对60例注射奥美定隆乳的患者采用乳晕下缘入路取出注射物,并根据患者的局部情况,25例于注射物取出后6个月行胸大肌后间隙或乳腺后间隙置入硅胶假体隆乳术,术后随访观察其疗效。结果本组60例患者中,25例行二期置入硅胶假体隆乳术,近期观察术后效果均良好,无血肿和感染发生,外观自然,手感柔软。随访6~12个月,均未出现包膜挛缩,乳房形态正常,效果满意。结论经乳晕下缘入路取出注射物,二期行胸大肌后间隙或乳腺后间隙置入硅胶假体隆乳术,其方法可行,效果良好,可以推广应用。     

三种不同层次假体隆乳术的适应证和优缺点

相对于其他隆乳手术方法,假体隆乳由于其术后对人体健康损害极微且取出容易、并发症少等优点,而成为当前的隆乳手术中当之无愧的首选方案。然而,为追求其术后的形态更加逼真,手感更加自然,这又给美容医师在手术方法上提出了更一步的要求。作者于2007年度完成27例隆乳手术,根据美容就医者自身乳腺组织量多少及乳房基底大小不同,分别采用胸大肌下、乳腺下、联合层次下3种不同假体置入层次的方法施行手术,术后均获得美容就医者的较满意效果,同时观察到不同的假体置入层次所具有的术后形态及手感的差异。一、临床资料27例美容就医者,按假体置入…     

内窥镜辅助腋窝入路隆乳术临床应用体会

目的探讨内窥镜辅助腋窝入路假体隆乳术的临床手术效果。方法自2014—2016年,对收治的30例小乳症患者采取术前个性化选取假体,采取腋窝切口,沿皮下潜行分离至胸大肌外侧缘,进入胸大肌后间隙;采用内窥镜辅助下精确剥离,形成假体置入腔隙,同时内窥镜直视下离断胸大肌下缘,形成双平面后置入假体。术后随访观察乳房形态及相关并发症。结果 30例患者术后均未出现血肿、感染、双侧不对称等早期并发症;随访12个月,无一例发生假体移位及包膜挛缩,乳房形态自然、弧度优美、手感及动感良好。结论内窥镜辅助腋窝入路假体隆乳术,具有操作精确、术中出血较少、损伤较小、术后并发症较少,手术效果确切等特点;且术后乳房形态自然,动感良好。     

胸大肌浅筋膜下假体隆乳术临床应用的文献复习

对于假体隆乳术,整形外科医师一直在寻找一个最佳的假体置入层次.传统的置入层次有乳腺下和胸大肌下.置入乳腺下的隆乳术,在术后的乳房外观上常可见假体的边缘及皱褶,特别是对于身材瘦小的女性求美者,而且有较高的包膜挛缩概率.有学者认为[1-2],将假体置入乳腺下的隆乳术其术后乳房的外形自然,但只适合那些组织量(皮下脂肪和乳腺组织)充足、乳房轻度下垂的女性,能够保证在假体上有足够的软组织覆盖.     

经腋下切口入路内窥镜辅助下双平面假体隆乳术

目的:探索内窥镜辅助下经腋下入路行假体隆乳术的效果。方法:采用腋下切口入路,在内窥镜辅助下,直视分离手术腔隙,离断部分胸大肌,将乳房假体置于胸大肌下和乳腺筋膜下双平面腔隙中。结果:本组就医者56例,经过平均11个月的随访,患者术后恢复快,未出现血肿,包膜挛缩等并发症,乳房形态自然,受术者满意度高。结论:经腋下切口在内窥镜辅助下的双平面假体隆乳术,变盲视操作为可视操作,视野清晰,操作简便;可在直视下进行胸大肌的松解,减少胸大肌对假体的束缚,降低了疼痛和包膜挛缩的发生,术后外形美观、手感逼真,可获得理想的动态效果,获得持久、满意的效果。     

硅胶囊乳房假体隆乳术66例报告

硅胶囊乳房假体隆乳术是一种比较简单安全可靠,形态及手感都很好的乳房美容手术。从1989年至今,采用国产乳房假体行隆乳术66例,效果较好,报告如下。1 临床资料隆乳术66例,年龄18～40岁,未婚8例,已婚58例。侧胸切口54例,乳晕切口12例。乳房假体植入胸大肌下64例,乳腺下2     

内窥镜双平面假体隆乳术的临床应用

目的：探讨应用内窥镜技术进行双平面假体隆乳术的优缺点及可行性。方法：自2010年6月至2011年5月,应用内窥镜开展双平面隆乳21例,6例为未婚女性,15例为哺乳后乳腺萎缩,其中6例伴轻度或中度的乳腺松垂。结果：21例就医者术后随访1～11个月,除1例乳房轻度欠对称外,其余就医者术后乳房形态良好,手感及动感好,无包膜挛缩,无血肿及感染。结论：采用内窥镜微创技术,可通过腋窝切口完成双平面隆乳手术,切口隐蔽,手术在直视下进行,安全性高,手术创伤小,恢复较快,就医者术后疼痛减轻,包膜挛缩发生率降低。由于结合了乳腺后及胸大肌下两个平面的优势,乳房形态更加自然,手感及动感逼真。适用于大多数需要隆乳者,尤其适用于哺乳后乳腺一定程度松垂的就医者。     

隆乳术切口和假体置放层次及手术剥离范围探讨

目的：探讨隆乳术的切口选择、假体置放层次和腔穴剥离范围。方法：于1996例9月至2001年9月间行隆乳术537例，选择三种手术切口；乳房下皱襞切口、乳晕切口、腋窝切口；假体置放于乳腺后间隙或胸大肌后间隙；胸大肌后间隙的剥离范围以第6肋间隙为下界。术后随访半年-5年。结果：术后乳房位置、形态、手感均满意511例（占95.2%）。结论：乳房下皱襞切口适于站立时乳房下皱襞明显或者乳房轻度下垂者；对于乳晕直径≥4cm的受术者，可采用乳晕缘内上或者内下弧形切口；腋下切口最为隐蔽，适于所有的受术者。假体置放于胸大肌后间隙具有手感更真实、不易形成纤维囊性硬变、不影响哺乳等优势。在胸大肌后间隙进行剥离，顺应乳房下皱襞韧带的解剖结构，将下界定于第6肋间隙。     

经腋窝切口内窥镜辅助下双平面隆乳的临床应用

目的:探讨应用经腋窝切口内窥镜辅助下双平面假体隆乳术治疗乳房过小症和轻、中度乳房松垂症的可行性和临床效果,并总结操作要点及手术经验。方法:2006年6月至2016年6月,采用经腋切口内镜下双平面假体隆乳术876例,其中97例伴轻度或中度的乳腺松垂。通过对876例手术病例分析,从术前设计、术中操作技巧、术后处理三方面归纳总结出其技术要点。结果:876例受术者均未出现术中难以控制的出血,术后均无明显乳头、乳晕感觉丧失。598例术后获随访6~36个月。除68例乳房轻度欠对称外,其余就医者术后乳房外形自然逼真,手感柔软及动感逼真,无包膜挛缩,无血肿及感染。37例出现包膜挛缩,其中15例为Baker III级,其余为Baker II级以下。结论:内窥镜辅助下双平面隆乳手术,由于采用双平面技术,即乳腺后及胸大肌下两个平面,能同时具有胸大肌后间隙和乳腺后间隙隆乳术的优点,术后乳房形态自然,手感及动感逼真。由于内窥镜的应用使所有手术步骤均在直视下操作,双平面的构建更确切,术区剥离更精准微创,止血更彻底。此手术方法以微创、精准为特色,具有安全性高,可控性强,腔隙剥离精准,术后切口隐蔽,恢复快,包膜挛缩发生率低等优势。适用于大部分隆乳需要者,满足现代女性对乳房美的诉求。     

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.     

Subpectoral breast augmentation through the abdominoplasty incision

Abdominoplasty and breast augmentation are often performed together, and subglandular augmentation through the abdominoplasty incision has been previously described. Nine cases of subpectoral breast augmentation and abdominoplasty performed through a single low transverse abdominal incision were performed between 2002 and 2005. The selection criteria included women who were healthy, nonsmokers, without true breast ptosis or breast deformity requiring additional shaping. The subpectoral space was accessed and the pectoralis major origins were mobilized under direct vision, and the implant pocket was shaped with the aid of a breast sizer and breast dissector. The mean follow-up was 22 months. The surgical goals were realized in all cases, with no asymmetry or implant-related complications. The standard abdominoplasty incision provides ample exposure for the creation of a subpectoral pocket and precise placement of implants. The procedure should be considered in patients who wish abdominal recontouring and breast augmentation and have minimal ptosis.     

Augmenting the narrow-based breast: The unfurling technique to prevent the double-bubble deformity

Routine subpectoral or subglandular mammary augmentation in women with a small breast (particularly lower pole deficiency) often results in poor late results with the appearance of a double-bubble deformity. We describe our experience with a technique of unfurling the breast tissue at augmentation in an effort to avoid this complication and improve the long-term results.     

Submuscular Periareolar Approach to Augmentation Mammoplasty in Korean Women

Augmentation mammoplasty can be approached by various methods according to the type of implant and implantation site depending on the status of the patient or surgeon's preference. The advantage for submuscular placement is based on problems associated with subglandular placement, especially capsular contracture and sensory changes in the nipple, and interference with the interpretation of mammograms is avoided. There are fewer complications such as hematoma, infection, and extrusion of the implant with submuscular dissection and relatively avascular, minimal sensory changes in the nipple compared with subglandular approach. The submuscular periareolar approach to augmentation mammoplasty was first described in the 1970s. This approach provides easy access to both the subglandular and subpectoral planes. It also provides a central point of access for creation of the implant pocket, which allows for easier and more accurate dissection in all diameters. The resultant periareolar scar is usually minimal with less injury to breast parenchyme and eventual biopsy or mastectomy incision to be performed through or around the areola. During the period of March 1999 to January 2000, 19 cases of who received submuscular periareolar augmentation mammoplasty under general anesthesia resulted in favorable scars with accurate access to pocket margin, easier dissection, and less bleeding compared with submuscular transaxillary augmentation mammoplasty. In our experience with the submuscular periareolar approach to breast augmentation it was highly versatile, safe, and less painful; postoperative hematoma incidence was greatly reduced and breast tissue injury was minimized.     

Transaxillary subpectoral placement of textured breast prostheses

Textured breast implants are difficult to introduce through a small incision. We have developed two new retractors and a new positioning regimen that enables us to use the transaxillary subglandular or subpectoral approach for breast augmentation. These retractors enable us to bluntly dissect the plane beneath the gland or the pectoralis muscle and then adduct the arm so that the relaxed pectoralis or subglandular space can be retracted to allow atmospheric pressure, gravity, and the surgeon's finger to work in unison.     

Outcome Assessment of Breast Distortion Following Submuscular Breast Augmentation

Background  Animation deformity or breast distortion during pectoralis muscle contraction following subpectoral breast augmentation is a known entity, but its prevalence and significance remain unclear. The purpose of this study was to identify the incidence and severity of animation deformity as well as its effect on patient satisfaction and interference with certain activities. Methods  All procedures were performed by the senior author using a variation of a previously described dual-plane technique. The first part of this study was an evaluation of breast distortion by a group of independent observers in a series of 40 consecutive patients who underwent primary subpectoral breast augmentation. The second part of the study was a questionnaire sent to 195 consecutive patients asking about overall satisfaction, degree of animation deformity, and whether there was interference with any activities. Results  Of the 40 patients’ photographs that were evaluated, 9 (22.5%) had no distortion, 25 (62.5%) had minimal distortion, 4 (10%) had moderate distortion, and 2 (5%) had severe distortion. Of the 195 questionnaires, there were 69 responses, a 35% response rate. Fifty-six (82%) described mild to no distortion, 7 (10%) were moderate, and 5 (7%) were severe. According to the survey, the most common activities that were problematic were lifting weights and exercising (24 and 19%, respectively). Only one (1%) patient stated that she would not recommend subpectoral positioning. Conclusion  Although animation deformities do exist, nearly all patients in this study would still choose subpectoral positioning. Patients who may be better candidates for subglandular placement are those for whom exercise is central to their daily living. As a result of this study, surgeons and patients should have more accurate and reliable information regarding the significance of animation deformity after subpectoral breast augmentation. S. L. Spear is a paid consultant to Lifecell Corporation, Ethicon Inc., and Allergan, Inc. This study was conducted without any funding.     

Preliminary (3 years) experience with smooth wall silicone gel implants for primary breast augmentation

The goal of this study is to obtain data concerning the incidence of capsular contracture and reoperation rates in patients having primary breast augmentation utilizing modern low-bleed smooth-wall silicone gel implants. Data were collected retrospectively and consisted of 44 patients who underwent primary breast augmentation using smooth silicone gel implants (Mentor Corporation) in the period between 2001 and 2003. Of the 131 patients identified, 44 patients fit the criteria of primary breast augmentation. Secondary cases and primary augmentation with mastopexy were excluded from this study. This group of patients is still followed, and the data are being updated periodically. A total of 44 patients underwent primary breast augmentation. Average age was 32 years (range, 19-57). Average follow-up was 34 months (range, 28-40). Average operative time was 52 minutes. The inframammary incision was used in 65% of patients and the areolar incision in 35%. The subglandular position was used in 35% of patients versus the submuscular position in 65%. Nine patients (20%) developed capsular contracture. Six patients (13.6%) had Baker 3 capsular contracture, which required revision. Four of the 9 patients with capsular contracture had implants placed in the submuscular space and 5 in the subglandular position. Relative to the implant position, 4 patients (9%) with implants placed in the submuscular position developed capsular contracture. Relative to the subglandular position, 5 patients (11.3%) with implants placed in the subglandular position developed capsular contracture. Eight patients (19%) required implant revision, 6 patients for capsular contracture, and 2 patients requested size change. Preliminary data from this study indicate that the use of the new generation of gel implants yields less capsular contracture, as well as decreased revision rates. Subglandular placement of gel implants did not significantly increase the risk of capsular contracture. Longer follow-up and multicenter studies are still needed to confirm these findings. This cumulative data could challenge the current status of gel implant moratorium imposed by the incidence of capsular contracture and revision rates.     

Augmentation Mammoplasty: Personal Evolution of the Concepts Looking for an Ideal Technique

The purpose of this paper is to report our personal experience in the field of augmentation mammoplasty. This experience is based on over 15 years in practice and working with more than 400 cases using different types of prostheses (single-lumen gel-filled, single-lumen saline-filled, double-lumen, smooth or texturized surfaces), different routes (submammary, periareolar, transaxillary), and different locations of the implant (complete submuscular, subglandular, subpectoral). Our present preference is for a partial submuscular (subpectoral) augmentation mammoplasty through an inferior periareolar route. The results of 91 consecutive patients operated on with this technique from January, 1990 to December, 1994, during the blow-up of the controversy on silicone, are reported.     

内镜辅助下腋窝切口乳腺后间隙隆乳术

目的 减少常规隆乳术中因盲视分离对组织的损伤及术中出血,探讨在内镜辅助下经腋窝切口行乳腺后间隙隆乳术的可能性.方法 2005年以来,在内镜下经腋窝切口行乳腺后间隙隆乳术27例,术中出血显著减小,并大为减轻钝性分离的创伤.结果 27例术后除1例发生切口部分愈合不良外,均无血肿、血清肿及感染发生.16例术后随访6个月～1年,1例发生Baker分级Ⅱ度假体纤维包膜囊挛缩硬化,其余手感良好,外形满意.结论 内镜下隆乳术可降低对麻醉的要求,有效控制术中出血,减少术中创伤,便于置入假体的准确定位,减轻术后疼痛.     

Endoscopic breast subpectoral augmentation for second-degree breast ptosis

Glandular ptosis and first-degree ptosis are treated routinely with breast augmentation in select patients. Second-degree ptosis is difficult to treat with breast augmentation alone. Patients must be well informed and selected properly to obtain a satisfactory result. Historically, second-degree ptosis is treated most commonly with subglandular augmentation. The authors demonstrate that second-degree ptosis may be treated using endoscopic subpectoral augmentation. They think that the endoscopic approach gives more control and precision in the lowering of the inframammary fold and the placement of the implant. Additionally, there may be a decrease or maintenance in the distance from the clavicle to nipple because of shortening the pectoralis major as a result of dividing it from the sixth rib at the sternal attachment laterally to the serratus fascia.