经胸大肌外下方前锯肌筋膜切口在硅凝胶假体乳房再造中的应用

目的:探讨胸大肌外下方前锯肌筋膜切口在硅凝胶假体乳房再造中的应用效果。方法:回顾2014年2月—2015年1月124例行乳腺切除加假体植入乳房再造的乳腺癌患者临床资料,其中传统的乳腺癌改良根治术23例,保留皮肤的全乳切除术22例,保留乳头乳晕的全乳切除术79例,患者均应用胸大肌外下方前锯肌筋膜切口行硅凝胶假体乳房再造。分析手术情况,术后效果,并发症及远期随访结果。结果:124例患者均成功完成手术,手术时间为65～120 min,平均(83.62±14.18)min;术中出血量为45～105 mL,平均(78.14±17.47)mL。术后外观评价"优良"率为82.25%(102/124)。术后血清肿7例,经引流后好转;切口愈合不佳,伤口裂开5例,经抗炎,换药,再次缝合后好转;无假体取出患者。随访22～50个月,失访9例,失访前均无瘤生存;骨转移5例,肺转移1例,肝转移1例,无局部复发患者。结论:胸大肌外下方前锯肌筋膜切口在硅凝胶假体乳房再造中安全有效,操作简便,适合推广。     

应用钛化物聚乙烯网完全覆盖假体皮下植入行乳房重建15例分析

目的探讨钛化物聚乙烯网(TCPM)完全覆盖假体皮下植入在乳腺癌即刻乳房重建手术中的应用价值。方法回顾性分析2016年8月至2017年2月首都医科大学附属北京同仁医院肿瘤中心收治的15例因原发性乳腺癌行保留乳头乳晕乳腺切除-TCPM完全覆盖假体皮下植入即刻乳房重建病人资料。分析病人的手术及术后并发症资料。结果手术时间(156.7±33.7)min,胸壁引流量(307.3±51.0)m L,引流时间(8.9±1.2)d。15例病人平均随访5.6(3~8)个月均未发生乳头乳晕坏死、皮瓣坏死、血清肿、伤口裂开、感染和异物反应。重建乳房外观评价:优10例,良5例。结论 TCPM完全覆盖假体皮下植入即刻乳房重建可简化手术过程,完全避免胸肌损伤,缩短手术时间,不增加相关的术后并发症,具有较好乳房重建效果。     

乳腺癌切除术后扩张法即刻分期乳房再造术

目的 探讨于不去皮的乳腺癌切除术后以扩张法为媒介行即刻分期乳房再造术,以简化手术操作方法,有利于放疗的进行.方法 乳房再造分两期完成:Ⅰ期在乳房切除同时,于胸大肌后间隙置入圆形扩张器,并于术后4～12周扩张至满意体积;Ⅱ期手术取出扩张器后换置硅凝胶乳房假体,或行背阔肌肌皮瓣+硅凝胶乳房假体置入,或单纯扩大背阔肌肌皮瓣转移,或单纯腹壁下动脉穿支(DIEP)皮瓣转移完成乳房再造.结果 采用该技术进行即刻分期乳房再造术34例,平均完成乳房再造共需时间5.5个月.术后无假体外露、皮瓣坏死等并发症出现.术后随访6～18个月,患者对手术效果满意率97.1％.结论 即刻分期乳房再造,简化了即刻Ⅰ期再造的手术难度,避免了术后放疗对乳房假体的影响,无需修补胸部皮肤缺损,因而避免了乳房表面的“补丁”样形象,是一项理想的即刻乳房再造方法.     

乳腺叶状肿瘤手术原则和即刻乳房再造术的探讨

目的探讨乳腺分叶状肿瘤的手术切除原则和即刻乳房再造的可行性。方法回顾分析2006年收治的4例乳腺分叶状肿瘤行手术切除与即刻乳房再造的临床资料，使用硅凝胶假体。1例为良性（Ⅰ级），行局部广泛切除术；2例为交界性（Ⅱ级），行单纯乳房切除术；1例为恶性（Ⅲ级），行简化乳腺癌改良根治术。术后即刻放置乳房假体行乳房再造。结果4例术后无并发症发生，3例外观良好，与对侧乳房基本对称，1例因对侧乳房下垂而不对称。4例随访3、12、8、9个月，未见肿瘤复发和假体相关并发症。结论手术应根据病理组织学的分级、肿瘤的大小、乳房的大小、病人的要求，制定合理手术切除范围和即刻乳房成形术，术后根据病理的性质，长期观察和随访。     

硅凝胶假体隆臀26例临床体会

目的 探讨应用硅凝胶乳房假体矫正臀部形态不良的方法及其临床可行性.方法 于尾骨点以上沿臀间沟处作手术切口,剥离皮下组织,沿臀大肌起点处切开,于臀大肌下间隙、臀中肌及梨状肌以上钝性剥离,置入合适的硅凝胶乳房假体,留置负压引流,分层缝合.自2007年1月至2010年10月,对26例臀部形态不良者进行假体丰臀治疗.结果 本组26例求美者,术后随访6～43个月,臀部外观挺拔,手感佳.术后1例切口愈合不良,经换药后愈合.无血肿、感染、假体破裂等并发症发生.结论 应用圆形硅凝胶乳房假体改善臀部不良外观,术式安全、有效,能获得较持久的塑形效果.     

乳房再造术中的假体选择策略

目的 探讨乳房再造术中的假体选择策略。方法 回顾分析2006年8月至2021年8月,在我院行乳腺癌切除术后单侧假体乳房再造的217例患者的相关资料,总结围手术期各环节针对最终假体型号选择的经验,包括利用三维体表成像技术对健侧乳房进行测量、乳癌术中记录切除组织体积、在扩张器/假体两阶段再造方法中记录双侧乳房体积相近时的注水体积量、术中利用假体试模完成假体置入前的形态和体积验证等。术后从乳房下皱襞位置、乳房突度以及乳房容量三方面评价再造乳房的美学效果。结果 本组中,行即刻乳房再造164例,延期再造53例;行术后即刻假体置入41例,行扩张器/假体两阶段再造176例。组织扩张中位周期为7.0(5.5,10.4)个月。应用解剖形假体189例,圆形假体28例,假体体积中位数为225(200,270) mL。术后随访中位周期为7.0(5.0,12.0)个月。再造乳房美学评价为“优”者占75.1%(163/217),绝大部分患者假体包膜挛缩分级为Ⅰ级或Ⅱ级（168/217,77.4%）。结论 围手术期各环节均能够为最终假体型号的选择提供重要的参考信息,正确选择假体可使再造乳房达到和健侧乳房较为对称的体...     

即刻及延期乳房再造方法的选择

目的回顾总结乳腺癌根治术后应用单纯假体植入、Becker可扩张假体植入和单蒂腹部横形腹直肌肌皮瓣（TRAM）移植、扩大背阔肌肌皮瓣（ELDF）移植乳房再造术的经验,探讨手术的适应证、方法和效果。方法自2002年7月至2005年10月,共67例患者进行了乳腺癌根治术后乳房再造术。即刻乳房再造56例：单纯假体植入38例、Becker可扩张假体植入16例、单蒂TRAM移植2例。延期乳房再造11例：单蒂TRAM移植6例、ELDF移植4例、Becker可扩张假体植入1例。结果手术效果满意,优良率超过90％。5例患者出现轻微并发症：皮瓣局灶性坏死2例,保留的乳头乳晕部分坏死1例,血清肿2例。结论单纯假体植入用于即刻乳房再造,适用于乳房较小、行保留皮肤的乳腺癌根治术后的患者,不宜用于延期乳房再造;可扩张假体植入即刻乳房再造适用于乳房较大或改良乳腺癌根治术的患者,同时可扩张假体植入延期乳房再造可用于皮肤、肌肉保留较好的乳腺癌根治患者;TRAM和ELDF皮瓣移植乳房再造是自体组织移植,其安全性高,可用于即刻和延期乳房再造。     

硅凝胶乳房假体隆乳的临床应用体会

目的：探讨硅凝胶乳房假体置入隆乳术的临床疗效。方法：依据测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据确定选用的假体类型、容量;采用腋窝切口或乳晕切口,将假体置于胸大肌深面或浅面。结果：统计我科自2010年5月至2011年12月采用国产硅凝胶毛面假体隆乳术122例,其中置于胸大肌深面68例、置于浅面54例,术后随访3个月至1年,所有患者乳房外形逼真,手感真实柔软,出现轻度包膜挛缩1例,未见感染、血肿及假体扭曲等并发症。结论：硅凝胶乳房假体与身体组织相容性好,适当的手术方法及术后处理可明显降低包膜挛缩率。     

乳腺癌术后即刻假体植入乳房重建

目的探讨保留皮肤的乳腺癌改良根治术后即刻乳房重建的手术技巧及术后并发症的防治处理方法。方法26例乳腺癌女姓患者实施了改良根治术＋即刻假体植入乳房重建术,术后跟踪按摩并进行必要的辅助治疗。结果术后患者的乳腺癌得到根治,同时乳房达到形体美容的功效,大大减少了患者的心理障碍,提高了患者术后的生活质量。结论乳腺癌术后即刻假体植入乳房再造术易被广大医生及患者所接受。     

治疗硅凝胶假体破裂的十年临床经验总结

目的探讨硅凝胶假体破裂的临床表现及治疗效果。方法总结自2006年12月至2016年12月,10年间收治硅凝胶假体隆乳术后假体破裂的46例患者(硅凝胶假体破裂61只),其中单纯隆乳成形术37例,乳房再造9例;术中去除包膜,并采用庆大霉素盐水溶液、生理盐水及稀释的碘伏溶液反复冲洗创腔,术后留置负压引流管1枚。结果患者均一期愈合,术后无血肿、积液、感染等临床症状,并对治疗效果满意。结论经手术去除假体包膜,同时采用庆大霉素生理盐水等溶液大量冲洗对取出破裂硅凝胶假体的预后治疗,其效果安全、有效。     

Endoscopic breast surgery for breast cancer

Since 1995, endoscopic breast surgery (EBS) has been gradually established in Japan. Establishment of EBS was inextricably linked to explosive development of instruments for endoscopic surgery and profound theoretical understanding, how to perform broad & stable dissection of the compact connective tissue thorough small incisions. EBS consisted chiefly of two procedures added to breast and axilla and procedures to breast is classified into three methods according to incisions, axillar, periareolar and combined incisions. With EBS technique, any kind breast surgery, sentinel node biopsy, reconstruction, augmentation, and benign tumor excision, could be performed through same skin incisions. Curability of breast cancer EBS is same as that with conventional method and local recurrence rate after total and partial mastectomy. All breast cancer without skin involvement of cancer would be candidate for EBS. To minimize invasiveness of treatment and maintain cosmetic outcome of breast, combination treatment of ablation treatment, EBS and evolution of radiation therapy would be important.     

Diagnosis of breast tumors after breast reduction

We conducted a retrospective study to evaluate the diagnosability of breast tumors after breast reductions as this is a frequent surgical procedure. The data should shed light on the hypothesis that routine screening methods concerning the diagnosis of breast tumors prove more difficult after breast operations. All women who had undergone breast reduction at our department between January 1989 and December 1994 were examined. During this period we counted 166 patients; the majority of them (n = 144) had undergone a bilateral breast reduction and the rest of them (n = 22) a unilateral breast reduction for various reasons. After the operation, all patients were checked in standardized intervals. Those who developed any kind of breast mass (n = 6) were recorded and examined by ultrasound and mammography, and occasionally by an additional fine-needle biopsy. In case any doubt about the dignity had remained, an excisional biopsy was carried out. In none of our patients was it possible to get a precise diagnosis of an ill-defined mass with ultrasound. With mammography, some of the existing masses, which were really scars, mimicked different kinds of tumors, and once a carcinoma was initially interpreted as scar tissue with oil cysts. The diagnosis of breast masses after breast reductions with routinely used screening methods has proved to be more difficult as breast reductions lead to architectural alterations of the remaining breast parenchyma. Such alterations can and should be documented shortly after the operation so that later occurring tumors are distinguished more easily. Therefore, a basic mammography 3 months after each breast reduction has to be claimed in order to facilitate further breast tumor diagnosis.     

Ipsilateral breast tumor relapse after breast conserving surgery in women with breast cancer

Ipsilateral breast tumor relapse (IBTR) is a potentially a significant problem after breast conserving surgery (BCS). With a median follow-up period of 64.7 months, IBTR occurred as a first relapse in 67 (3.0%) of a total of 2243 patients and distant recurrence occurred in 167 (7.4%). A positive surgical margin and the omission of radiotherapy (RT) were independently associated with IBTR. The five-year cumulative IBTR rates were 5.1% in patients with positive margins and 2.0% in the patients with negative margins. The five-year cumulative IBTR rates were 1.8% in patients with RT and 8.1% in patients without RT. IBTR was independently associated with distant-recurrence-free survival rates as well as age, nodal metastasis, lymphovascular invasion and progesterone receptor status. The five-year distant-recurrence-free survival rates were 81.9% in patients with IBTR and 93.2% in patients without IBTR. In order to prevent IBTR, a negative margin and the administration of RT are therefore considered to be important in patients who undergo BCS.     

Association of breast cysts and breast cancer

A review of 915 consecutive patients with breast cancer and 812 with breast cysts showed that an association between the two is uncommon--5% of breast cancers were associated with cysts and 4% of cysts were associated with breast cancer. Four types of association were identified: (a) cystic cancers--easily diagnosed because of the characteristic features of the aspirate, failure of the mass to disappear and early recurrence in a patient whose age and menstrual status were not usually associated with cysts; (b) cancers occurring simultaneously with breast cysts--recognized because they did not contain cyst fluid; (c) cysts occurring after breast cancer--diagnosed by aspiration of the mass in premenopausal women; (d) cancers in patients who have had breast cysts--usually occurring many years after the cyst aspiration when menses had ceased. These associations were not sufficiently frequent to justify specific follow-up, but all suspected cysts should be successfully aspirated to confirm the clinical diagnosis.     

Cancer of the breast and breast prostheses

Plastic surgery operations designed to modify the breast volume do not increase the risk of cancer. Xeroradiography provides the best images of operated breasts. The least interfering prostheses are the most radiolucent and, in particular, retropectoral prostheses. The diagnosis of cancer is based on the detection of microcalcifications and star-shaped images. It is guided by clinical examination which is precise as the content of the breast is thin an lies on top of the anterior surface of the implant. The complications of prostheses (shells, collapse, rupture, displacement) have been well studied. After breast reconstruction examination of the contralateral breast is therefore of prime importance due to the risk of bilateral cancer.     

Correction of breast contour deformities using polyurethane breast implant capsule in revisional breast surgery

Surgeons are commonly confronted with breast contour deformities and defects that result from previous surgical interventions. These soft tissue deformities can be corrected by conventional reconstructive flap surgery using autologous tissue, but there can be donor site morbidity. Smaller volume replacement is possible using temporary fillers such as hyaluronic acid or polylactic acid, or by using 'permanent' fillers such as autologous fat, but large defects are notoriously difficult to fill and often the fillers resorb or migrate. The patient described in this case report had an exchange of polyurethane implant (PU) in the left breast and correction of a contralateral breast contour filling deformity. A left breast partial capsulectomy was performed after implant removal and the capsule graft was inserted into a predissected pocket where soft tissue augmentation was required. A biopsy from the PU capsule was reported to show a foreign body type giant cell reaction to PU material in a fibrous capsule, lined by synovial metaplasia. The post-operative result showed satisfactory soft tissue revolumisation. PU breast implant structured capsule has thus been used as filler to correct breast soft tissue deformity and contour defects. Clearly it may have a use in other anatomical sites.     

Calcifications in the breast and digital breast tomosynthesis

Our study was to compare the clarity with which calcifications are seen on conventional mammography (CM) with the same calcifications on digital breast tomosynthesis (DBT). We define clarity as the sharpness, contrast, and diagnostic quality by which the calcifications were depicted. In a HIPPA compliant Institutional Review Board approved study, 3,000 women volunteered to have both a screening mammogram and a DBT study. A total of 119 sequential cases with relevant calcifications (not clearly benign) were reviewed. Two board certified, dedicated, breast imaging radiologists reviewed the CM and DBT images in an unblinded paired comparison. Only the mediolateral oblique (MLO) projection was available for the DBT studies. The MLO and craniocaudal projections were reviewed using the 2D images. Window and leveling, and electronic zoom were permitted. Unlimited time was allowed to provide a subjective assessment as too how well the calcifications were seen, from a diagnostic perspective, when the two studies were evaluated side-by-side. In 41.6% of the cases, the readers felt that calcifications were seen with superior clarity on DBT. In 50.4% of the cases, the visibility of calcifications was the same for DBT and CM, and in 8% of the cases, calcifications were seen with greater clarity on CM than DBT. In 92% of the cases, the clarity with which calcifications were seen on DBT was equal to or better than for CM and in almost half, the clarity on DBT was judged to be better than for CM. Our analysis shows that calcifications can be demonstrated with equal or greater clarity on DBT as on CM, thus allowing for comparable, and, perhaps, improved interpretive analysis of detected calcifications.