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２００～４５０ｍｌ，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。     

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.     

Spontaneous Autoinflation and Deflation of Double-Lumen Breast Implants

A rare late complication of textured, double-lumen breast implants developed 15 years after routine augmentation mammaplasty. The patient required secondary surgery for removal of the implants in both breasts because of their spontaneous autoinflation and deflation. Mammography showed autoexpansion of the right breast implant and deflation of left breast implant in the outer lumen without evidence of silicone leakage 15 years after implantation. The spherical shape of the right implant was filling with red-brown fluid. The deflated left implant had a thick capsule. Both implants were characterized during surgery and removed. Few reports have described spontaneous autoinflation of breast implants. Several causes of implant autoinflation have been proposed, such as valve defects, osmotic swelling, and inorganic salts produced by the texturization process or injection of saline with nonstandard salt concentrations. However, the exact mechanism remains unknown.     

Plasma expander for use to fill inflatable implants

Summary To prevent volume loss of inflatable breast implants through osmosis, I have been using plasma-expander instead of saline to fill the implants over the last four years.     

Effect of cortisone on capsular contracture in double-lumen breast implants: Ten years' experience

Two groups of patients are compared with respect to capsular contracture after insertion of silicone breast prostheses. Six hundred seventy four women received single-lumen gel prostheses and 700 received double-lumen prostheses with cortisone. The addition of 12.5 mg of prednisolone to double-lumen prostheses diminished capsular contracture (Baker II to IV) dramatically; in patients with simple augmentation from 19% to 4.9%, in patients with subcutaneous mastectomy from 54% to 14.9%, and in patients with breast reconstruction from 64% to 24.4%. The use of double-lumen implants has three distinct advantages: (l) There is no bleeding and therefore no contact of the body with the silicone gel. (2) There is no danger of ruptured implants, even if the outer shell shows leakage. (3) if prednisolone is administered, capsular contracture is prevented to a significant degree.     

Late unilateral breast enlargement after insertion of silicone gel implants: A histopathological study

Late unilateral breast enlargement after the insertion of silicone gel breast implants is a very rare phenomenon. The present study reports five women who presented with this finding over the past 20 years. Three of these patients presented with late unilateral hematomas, which developed nine, 12 and 14 years, respectively, after initial breast augmentation, in the absence of any known trauma. These patients presented for treatment one, four and 12 months, respectively, after their breast enlargements initially appeared. Two of these patients had developed chronic expanding hematomas. Extensive histopathological analyses of the capsules of all three patients provided explanations for the etiologies and progressions of the findings in these patients. In each of the three patients, the etiology of the hematoma was consistent with erosion of a capsular artery. Numerous large vessels were seen within the wall of the capsules. In each case, there was a class IV capsular contracture, which could have increased the friction of the intact implant against the capsule, and there was both old (hemosiderin deposits) and new bleeding into the pocket from the capsules. This supports the concept that numerous episodes of bleeding had occurred in each case. Histopathology also demonstrated the progression of the hematomas. After four weeks, only liquefied hematoma was present, while after four months, there were both liquefied hematoma and blood clotting. The hematoma on the surface of the capsule was becoming organized peripherally, but not centrally. After 12 months, the hematoma was becoming very well organized compared with the hematoma at four months. In one of the two remaining cases, late infection was the cause of the breast enlargement. Histopathology of this capsule showed that the involved capsule was six times as thick as the other side. It also showed edema and infiltration by scattered mononuclear cells, polymorphonuclear cells, and irregular crenated and degenerating nuclei. In the final patient, chronic inflammation appeared to be the cause of the breast enlargement. The histopathology of this capsule was unique. Its inner surface showed re-epithelialization and metaplasia of the ductal epithelium to form stratified squamous epithelium with early surface keratinization. These findings are consistent with synovial metaplasia. Several areas of the fibrous portion of the capsule showed patchy loss of cellular staining with loss of nuclei, indicative of necrosis. This produced a ‘washed out’ staining appearance. This tissue was paucivascular and fibrotic, and showed areas of fibrinoid necrosis, suggestive of mechanical abrasion and increased pressure.     

Technical aspects of immediate breast reconstruction with implants: Five year follow-up

We describe the technical aspects of 249 patients who had immediate breast reconstruction with implants and a follow-up of at least five years. The type of reconstruction was permanent expander prostheses (n=208), permanent prostheses (n=32), and temporary expander prostheses (n=9). The median total number of operations required to complete the reconstruction was 3 (range 1–6) with nipple-reconstruction included. Thirty-two patients developed local complications (13%) and three had systemic complications (1%). Eighteen implants were lost, so the failure rate of reconstruction was 7%. The technique of immediate breast reconstruction with implants is associated with a low overall morbidity. This, combined with earlier reported psychological advantages, no increased risk of cancer relapse, and reasonable cost, indicates the importance of immediate reconstruction with implants in the treatment of breast cancer.     

294例充注式硅囊隆乳术后并发症的分析

对观察了3～5年的294例行充注式硅囊隆乳术患者,进行了术后并发症的分析,以探讨其发生情况、临床表现、产生机理及治疗预防措施。常见并发症有出血、感染、包膜挛缩、硅囊破裂、硅囊外露、心理失衡、造型欠佳等7项。     

294例充注式硅囊隆乳术后并发症的分析

对观察了３～５年的２９４例行充注式硅囊隆乳术患者，进行了术后并发症的分析，以探讨其发生情况、临床表现、产生机理及治疗预防措施。常见并发症有出血、感染、包膜挛缩、硅囊破裂、硅囊外露、心理失衡、造型欠佳等７项。     

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.     

硅胶乳房假体表面改性的实验研究及CT评价

目的：研究乳房假体表面改性对减少纤维囊壁形成的影响及CT评价。方法：利用钴^60共辐射的方法把亲水性单体N-乙烯基吡咯烷酮(N-VP)接枝到硅胶乳房假体表面，改变其表面特性后植入兔的背部，以未经改性的正常假体作为对照组，隔一定时间通过组织切片及CT扫描的方法观察假体周围纤维囊壁的形成情况。结果：与对照组相比，改性后假体周围的炎症反应较轻，形成的纤维囊壁在各个时间段均薄于对照组；CT扫描显示术后8个月，改性的硅胶假体外形无明显改变，而未改性组外形显著改变。结论：在硅胶乳房假体表面接枝N-VP后可以有效地改善假体表面的组织相容性，减少周围纤维囊壁的形成。     

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

BackgroundCapsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants.MethodsA retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants.ResultsThree-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0–3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4–16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1–15.7) and 15.8% (95% CI: 4.1–15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003).ConclusionsAfter mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).     

McGhan解剖型乳房假体参数系统改进与手术技巧

目的：总结自2000年以来323只应用和改进McGhan解剖型假体参数系统的经验与手术技巧.方法：为便于国人个性化选用假体,将Tebbetts的经验参数系统加以改进.原则上：215g左右为起点,中突为主;分别以乳头至胸骨上切迹（SN-N）和乳头至中线（ML-N）决定假体长宽,身高作为参考.SN-N：19cm以上多选高长（FL,FM,FF）,19～17cm多选中长（ML,MM,MF）,17cm以下多选低长（LL,LM,LF）;ML-N：ML-N宽度＋2cm=假体宽度;身高：165cm以上多选高长,165～160cm多选中长,160cm以下多选低长.植入技巧是正面标记的两点要最后放入,且上点位于乳晕切口下1～2cm为宜,腺体越少标记点越应偏低.结果：323只假体中,MM型和体积205～235g最为常用;以乳晕切口为主（89.5%）;半数多置于腺体下;随访半个月～4年,103例（两个月以上87例）中无1例变形,但3例中等硬度,其中1例需手术松解矫正.外形均较满意.结论：解剖型假体的问世完全改变了传统圆形假体只有体积选择的概念,可通过不等比例的改变非正圆形假体的高、宽、突和体积参数,相对更自然、更科学的隆乳.     

One-stage breast reconstruction using McGhan Style 150 biodimensional expanders: a review of 107 implants with six years experience.

Permanent expanders have revolutionised breast reconstructive surgery, allowing one-stage procedures and the development of increasingly sophisticated implants (textured, anatomically shaped) has played an important role in enhancing the aesthetic outcomes. It is important to evaluate the tolerability of the implant. The aim of this present study was to evaluate the survival curves for McGhan Style 150 permanent expanders, in a consecutive series of breast reconstructions. Complications rates were also examined. Between April 1997 and May 2003, 107 McGhan Style 150 expanders (either full height or short height depending on patients' requirements) were used in 97 consecutive patients for a variety of breast reconstructive procedures. Overall, 46 devices were used for immediate reconstruction, 15 for delayed reconstruction and 46 for implant exchange, respectively. The mean age at implantation was 48 years (min: 26; max: 71). The mean follow-up was 60 months (min: 12; max: 72). Explantation was considered the most objective outcome variable, therefore this parameter was carefully monitored and then analysed using the Kaplan-Meier method of survival analysis. Different curves were compared using the log-rank test. Long term complications were also recorded. Among complications the most frequent finding was Baker 3-4 capsular contracture, occurring in 26% of immediate reconstructions at six years. Explantations increased in an almost linear fashion, with an overall rate of 25%, with a statistically significant difference among immediate reconstruction group and the implant exchange group. The rate of explantations was high, if compared with other series, because the sample included patients undergoing strong adjuvant therapies, particularly in the immediate group (locally advanced disease). The overall rate of explantations and of capsular contracture was found to be significantly lower in the delayed and substitution groups, than the immediate group (p<0.05). In our hands, the McGhan Style 150 anatomically shaped permanent expanders were associated with acceptable results, especially when used as 'permanent prostheses' for second stage procedures.     

A comparison of capsule formation following breast augmentation by saline-filled or gel-filled implants

A retrospective analysis of data on 307 patients was made. The incidence of firmness in breasts augmented by saline-filled prostheses was compared to the incidence in breasts augmented by gel-filled prostheses. A statistically significant lower rate of constricting capsule formation was found in the saline-inflated group.     

5-FU植入剂联合静脉化疗在乳腺癌新辅助化疗的临床观察

目的 对比CAF方案与植入型5-氟尿嘧啶（5-FU）替代CAF方案治疗II-III晚期乳腺癌的近期疗效与毒性反应。方法 将63名II-III期乳腺癌患者随机分组,植入型5-FU替代CAF方案为试验组,CAF（静脉给药）方案为对照组。结果 1）标准组有效率为56.3％,试验组为83.9％,差异有统计学意义;3）试验组消化道反应及III-IV度白细胞下降发生率较对照组低。结论 植入型5-FU可以提高II-III期乳腺癌新辅助化疗有效率,且毒性反应较低。肿瘤药物局部植入是一种有效安全的给药途径。     

Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants

PURPOSE: We compared infection rates in original inflatable penile prostheses implants between prostheses impregnated with InhibiZone (American Medical Systems, Minnetonka, Minnesota), an antibiotic surface treatment, and prostheses without antibiotic treatment. MATERIALS AND METHODS: We retrospectively reviewed patient information forms filed with the manufacturer following original implantation in the United States to implant AMS 700 series penile prostheses (American Medical Systems) between May 1, 2001 and April 30, 2003. We compared results in 4205 men, including 2261 with a mean age of 60.71 years who received prostheses with InhibiZone, a surface treatment combining rifampin and minocycline hydrochloride, and a control group of 1944 with a mean age of 61.04 years who received untreated prostheses. Followup in the treatment and control groups was 0 to 11.5 months (mean 5 and 8, respectively). In the treatment group only implants in which all components were treated were included. RESULTS: The reported incidence of infection after 60 days was 0.28% in the treated group and 1.59% in the control group (p = 0.0034). After 180 days the infection rate in the treated and control groups was 0.68% and 1.61%, respectively (p = 0.0047). The treated group had an infection rate that was 82.4% lower than in the control group after 60 days and 57.8% lower after 180 days. Erectile dysfunction etiologies occurred at statistically similar rates in the 2 groups and did not impact infection rate results. CONCLUSIONS: The use of InhibiZone to target postoperative infections results in a statistically significant decrease in penile prosthesis infection rates in original implants. Infection rates in the control group were consistent with those in the published literature.     

假体隆乳术后并发症的防治

目的探讨乳房假体隆乳术后并发症产生的相关因素及预防方法。方法对198例患者乳房假体隆乳术后1~17年出现的并发症进行分析,阐述防治措施,针对不同情况进行相应的处理。结果本组198例患者,其中92例患者随访半年至1年,除Ⅲ°包膜挛缩患者术后仍出现Ⅱ~Ⅲ°包膜挛缩外(包膜松解术后3例,包膜切除术后4例),余患者对治疗效果满意。结论乳房假体隆乳术后出现的并发症,多数是可以预防和治疗的,只要术中操作规范,对并发症及早准确的处理,是提高手术效果,减少并发症发生的有效方法。