Objective When implantation of a prosthesis is performed for patients with a local defect of the breast after the removal of polyacrylamide hydrogel,incomplete coverage of the surface of the prosthesis occurs in these cases.The aim of this study was to explore the effectiveness of acellular allogeneic dermis in the repair of defects after prosthesis implantation.Methods Breast prosthesis implantation together with acellular allogeneic dermis repair was performed in 46 cases.Acellular allogeneic dermis was applied to cover the surface of the prosthesis,and interrupted suture was used between the margin of the dermis and the incisional margin of the gland,while appropriate tension was maintained.Results There were no complications occurred postoperatively.Correction of local depression in the breast was excellent in all cases.Histological examination showed the implanted acellular allogeneic dermis was integrated into the peripheral tissue.Conclusions Acellular allogeneic dermis can be used for repairing breast and muscle defects,in order to cover the prosthesis.Although it cannot significantly increase the thickness of the subcutaneous tissue,it can maintain the integrity of the peripheral tension around the prosthesis.In this way,it can avoid bulging of the prosthesis caused by a sudden reduction of local tension.Moreover,donor site injury is avoided.Acellular allogeneic dermis is an effective method for the repair of local breast defects.

Background The dual-plane technique has been widely used in augmentation mammaplasty procedures. However, there are some concerns about aesthetic contour maintenance for long time after muscle releasing. This study aims to track and analyze breast dynamic morphological changes after dual-plane breast augmentation with three-dimensional (3D) scanning technique. Methods Thirteen dual-plane anatomic implant augmentation patients underwent 3D scanning preoperatively (pre-OP) and postoperatively in four time points (1 month: post-1M, 3 months: post-3M, 6 months: post-6M and 12 months: post-12M). The linear distance, breast projection, nipple position, breast volume and breast surface area were measured and analyzed on the 3D models over time. Results Compared with post-12M, no significant differences were found in distances of nipple to midline, nipple to inframammary fold and sternal notch to the level of inframammary fold after 6 months in both straight-line distance and its projection on surface. The distances between sternal notch and nipple had no significant difference after post-1M. Breast volume changes had no significant difference after post-3M. The volume and area percentage of upper pole decreased while the lower pole's increased gradually. The surface showed no significant changes after post-1M. The changes of breast projection had no significance after post-1M either. The nipple moved 1.0±0.6 cm laterally(X axis), 0.6±0.7 cm upward(Y axis) and 2.3±1.1 cm anteriorly (Z axis) at post-12M, and the differences were not significant after post-1M. Conclusions 3D scanning technique provides an objective and effective way to evaluate breast morphological changes after augmentation mammaplasty over time. Dual-plane augmentation optimizes breast shape especially in the lower pole and maintains stable aesthetic outcome during the 12 months follow-up. Most of the contour changes and the interadaptation with the implant have completed 6 months after operation. Therefore, 6 months could be chosen as a relatively stable observing period in the assessment of postoperative outcomes of dual-plane breast augmentation.

BACKGROUND:Gigantomastia is the overdevelopment of the female mammary gland, and it causes great physiological and psychological burdens to patients. A better understanding of the molecular mechanisms involved in gigantomastia is needed to develop less invasive and more effective medical treatments. MicroRNA (miRNA) is a class of small noncoding RNAs that play an important regulatory role at the post-transcriptional level. These miRNAs are known to be involved in many diseases, including breast cancer; however, the relationship between miRNA and gigantomastia is largely unknown.METHODS:Whole genome-wide expression of miRNA and mRNA in gigantomastia was detected using microarray and functional annotation was performed based on the altered expression of miRNAs and mRNAs.RESULTS:We found many miRNAs and mRNAs to be significantly differentially expressed in gigantomastia compared with normal breast tissues. Functional annotation analysis indicated that APK, Wnt, and Neurotrophin signaling pathways may participate in gigantomastia.CONCLUSION:This study addresses the need for better diagnosis and treatment of gigantomastia by providing new insight into the molecular mechanisms underlying this disease.

OBJECTIVE:To establish a standard method for digital evaluation of breast symmetry with 3D scanning technique.METHODS:From January 2009 to July 2010, 167 patients received 3D scanning before breast augmentation. The coordinate system was established and the 3D reconstructed breast models were analyzed by software. The discrepancy of nipple level, the distance between nipple to midline, inferior mammary fold location, breast width, breast projection, breast volume and anterior chest wall projection were measured.RESULTS:The mean discrepancy of nipple level, the distance between nipple to midline, IMF level, breast width, breast projection and anterior chest wall projection were (4. 8 +/- 3.9) mm, (4.5 +/- 3.4) mm, (4.6 +/- 3.7) mm, (4.8 +/- 2.9) mm, (5.4 +/- 3.9) mm and (4.8 +/- 3.3) mm, respectively. The mean difference of breast volume was (51 +/- 44) ml. The incidence of significant asymmetry was 73% (122/167)in nipple position, 95% (159/167)in breast shape, 38% (63/167)in anterior chest wall projection.CONCLUSIONS:3D scanning technique can provide an accurate 3D measurement of breast. A thorough and objective evaluation of breast symmetry can be achieved.

BACKGROUND:Venous augmentation enhances the viability of the deep inferior epigastric perforator (DIEP) flap. We compared the efficacy of three venous superdrainage procedures on survival area and hemodynamics of the DIEP flap model. METHODS:In 24 castrated Yorkshire pigs, a true abdominal perforator-based flap was created based on four perforators arising from the deep superior epigastric vessels. Three remaining venous tracts were alternated to represent different venous augmentations of the DIEP flap. Analyzed were flap perfusion, venous blood pressure, and venous blood gas. In control animals, all three supplemental veins were ligated; the ipsilateral superficial superior epigastric vein (SSEV) was retained in the IS (ipsilateral SSZV augmented) group, the contralateral SSEV in the CS (contralateral SSZV augmented) group and the contralateral deep superior epigastric vein (DSEV) in the CD (contralateral DSZV augmented) group. The flap was then returned to its bed, and animals sacrificed on the seventh day postoperatively. DIEP flap survival was then recorded. RESULTS:All four intraoperative parameters showed improved perfusion of the distal flap area under distal venous augmentation. Efficacy was CDSEV > CSSEV > ISSEV > none. Skin islands of the CD and CS groups survived completely. In the IS and control groups, 96.33 ± 3.16% and 84.00 ± 7.55% of skin islands survived, respectively. Test groups were statistically significantly different from the control group but not from each other. CONCLUSIONS:Venous superdrainage effectively enhances DIEP flap survival. Benefit was relatively the same for all procedures. An additional venous route should be preserved with large or multiterritory flaps to improve venous congestion.

Objective To introduce the key points about the transplantation of lymphatic transverse rectus abdominis myocutaneous/deep inferior epigastric perforator(TRAM/DIEP) and evaluate the therapeutic effect of lymphatic TRAM/DIEP to treat mastectomy related upper limb lymphedema.Methods Ten patients of postoperative lymphedema after breast cancer surgery from Jan.2008 to Mar.2011 were enrolled in this study.All the patients suffered from unilateral upper-limb lymphedema accepted abdominal transplantation of lymphatic TRAM/DIEP.Results All flaps worked well.One case with breast reconstruction was found to have delayed cure of breast cuts.All the patients felt the pain and swellings of edematous upper limbs relieved.Conclusion To apply the transplantation of lymphatic TRAM/DIEP to treat mastectomy related upper limb lymphedema,accompanied by using elastic bandages as an auxiliary post-operative treatment is considered to be an effective method to restore the breast configuration and upper limb function.

Objective To provide anatomic basis for the clinical application of the transverse upper gracilis flap supplied by profunda femoris artery in breast reconstruction.Method In 8 adult cadaver lower extremities injected with red latex,we observed the presence rate,route,outer diameter and pedicle length of the branch of the profunda femoris artery.The accompanying vein and nerve were also examined.Result The presence rate of artery supplied TUG flap was 100%,in which 75%were from profunda femoris artery,and 25%from medial femoral circumflex artery.The pedicle entered the gracilis(13.21 ± 1.03) cm below the start of gracilis with outer diameter being(1.35 ±0.30) mm,giving off 2-3 cutaneous branches alongside.The pedicle length was(74.14 ±9.42) mm with outer diameter being(2.77 ±0.54) mm,and(2.83 ±0.63) mm for the accompanying vein.In our study,the presence rate of the great saphenous vein branches was87.5%,only one specimen had no branch,all the others had one with the outer diameter of(2.60 ±0.64) mm.The diameter of obturator nerve was(1.85 ± 0.53) mm.Conclusion ①The profunda femoris artery branch had a high presence rate in upper 1/3 of gracilis,thus the transverse upper gracilis flap is a reliable donor site for breast reconstruction.②There were relatively constant great saphenous vein branch,which could be reserved for better venous return.③It was possible to make a perforator flap in some cases to avoid unnecessary muscle damage.④The feasibility of the transverse upper gracilis flap supplied by branch of the profunda femoris artery was demonstrated by the modeling operation on the cadaver.⑤The incision was subterranean and more acceptable by patients.⑥The flap was designed on the basis of the defect size during mastectomy,for readily closing without tension,and it can be used not only on the whole breast reconstruction,but also on the local damage after breast-conserving surgery,furthermore,it can provide two flaps to repair bilateral breast coloboma.

Objective To observe the clinical effects of autologous fat injection augmentation with external tissue expander.Methods 26 cases wore the Brava device,a bra-like vacuum-based external tissue expander for 4 weeks before autologous fat injection augmentation.Patients resumed Brava wear for 14 more days after fat injection.Results 26 women had a mean augmentation volume at 3 months of 76 ml per breast after single fat injection.Follow-up ranged from 1 month to 12 months.There were no complications such as nodules,masses,or cysts occurred.Patient satisfaction was as sessed:25 cases (95.6 ％) were satisfied with the cosmetic results.Conclusions The addition of Brava expansion before autologous fat grafting leads to significantly larger breast augmentations,with more fat graft placement,higher graft survival rates,and minimal graft necrosis or complications,demonstrating high safety and efficacy for the procedure.

目的 改变传统隆乳手术盲视下剥离假体腔隙的方法.采用内窥镜辅助技术,达到对剥离腔隙的精确控制.方法本组隆乳手术患者 189例,年龄22～36岁.手术全部采用腋窝切口入路,通过内窥镜辅助及针刺定位,用电刀对假体腔隙进行精确剥离.结果 所有患者术后均恢复顺利,无出血、感染等早期并发症发生.随访6～24个月,乳房形态自然,除1例双侧包膜挛缩之外,无假体移位、双侧不对称、"双泡样"畸形等并发症发生.结论 采用内窥镜技术结合使用体表穿刺定位的方法,可以十分准确地对乳房假体腔隙进行剥离、定位,且止血确切,可达到对假体隆乳术的精确控制.

Objective To introduce the application experience of immediate and delay,total and partial breast reconstruction with latissimus dorsimyocutanuous flap after surgical of breast cancer.Methods Clinical data of 15 cases of breast reconstruction with latissimus dorsimyocutanuous flap from Nov.2009 to Jan.2011 were analyzed retrospectively.Results Five patients were received immediate breast reconstruction(4 cases were used for surface covering post mastectomy for clinical Ⅳ stage),10 patients were received delayed breast reconstruction.Three patients were received transposition and repair of latissimus dorsimyocutaneous flap with pedicle only(2 cases received repair of partial deformity after breast conversation therapy).Three patients of breast reconstruction were used latissimus dorsimyocutaneous flap transposition with pedicle plus breast implant.Partial deformity after breast conversation therapy were repaired using skin flap of healthy breast(1 patient).One patient was received transposition and repair of latissimus dorsimyocutaneous flap under the helping of endoscope.Two cases were used transposition of local flap with tissue expander.The entire flap survived well with satisfied results.Conclusion The autografting in repairing the partial tissue deformity after breast conversation therapy has become convenient and agility for Chinese patients with smaller breast generally.Meanwhile,breast autologous reconstruction can repair the deformity of axilluary and not affect the treatment of radiotherapy and chemotherapy after breast conversation.Thus,it will have a good prospect.

Objective To establish a preoperative evaluation system for breast reconstruction,and to simplify the selection of surgical methods for breast reconstruction in a standard way.Methods We investigated respectively 192 successful cases that underwent breast reconstruction from July 2003 to July 2009.The factors influencing selection of methods for breast reconstruction were studied.The results presented in more than 50 ％ were collected.Results A special table of the preoperative evaluation system for breast reconstruction was established by analyzing statistical results. Conclusions The selection of methods for breast reconstruction is simplified according to this preoperative evaluation system.

Objective To improve the clinical effect on the breast augmentation with autologous fat granule graft of multiple tubes and multiple layers.Methods Autolgous fat granules were harvested,purified and then injected in a wide distribution by multiple layers and multiple tubes.Results All the 213cases were involved in the study and satisfactory cosmetic results were achieved.There were no complications such as nodule,fat necrosis occurred.Conclusions Autologous fat granule graft is a suitable approach for augmentation mammaplasty.Pruification of the fat granule,broaden the contacts of fat granule and chest tissue by multiple tubes and multiple layers may increase the living opportunity of transplanted fat granule and decrease the complications.

Issues of hypertrophic circumareolar scars and malpositioning or irregularity of the nipple–areola complex (NAC) are frequently associated with breast reduction or mastopexy techniques that rely on an ample excision of skin around the areola, either alone or associated with a vertical incision. To avoid such problems, many efforts have been made to improve the accuracy of preoperative marking for the future NAC. However, the correct design and position of the NAC may be difficult to achieve for the patient at the end of the procedure after closure of the skin incisions. This article describes a novel, simple, and effective method for intraoperative shaping and positioning of the NAC. The described method is based on using a specially designed surgical instrument to determine the best position, diameter, shape, and configuration of a new NAC. This study aimed to demonstrate the efficacy of this method to reduce the common complications of the periareolar region in reduction mammaplasty and mastopexy.

Objective To explore the feasibility of using 3-D reconstruction technique for the volume measurement of breast and the breast implant in mammaplasty.Methods The CT data was used to reconstruct a digital prototype of the breast implant and the chest.The volumes of breast implants and the volumetric difference of bilateral breast were then measured by the software.Measurements were performed on 59 women.Suitable implants were also selected for the patients according to the results of measurements.The linear parameters of the bilateral breast were measured for evaluating the results.Results Fifty-nine Patients were all satisfied,as the shapes of postoperative breasts were ideality and almost symmetry.Conclusion 3-D reconstruction technique is simple,accurate and repeatable.It offers a new way to solve the difficult problems in the measurement of breast and breast implant.

目的 探讨采用自体脂肪颗粒注射移植修复乳房畸形的方法.方法 自2008年2月至2010年2月,我中心将脂肪颗粒分离纯化后进行多层次分散注射,采用少量多次的注射移植方法,对聚丙烯酰胺水凝胶取出术后乳房畸形及Poland综合征乳房畸形63例进行修复.结果 63例患者获随访6个月至2年,2例(3.2%)畸形纠正不彻底而欠满意,57例患者满意,4例患者较满意,满意率达90.5%.未出现明显脂肪液化、硬结、钙化 等并发症.结论 采用自体脂肪颗粒注射移植矫正水凝胶取出术后及Poland综合征导致的乳房畸形,控制脂肪颗粒在每隧道中注射量及移植总量,可以获得满意的手术效果.

An inverted nipple affects not only the aesthetic appearance of the breast but also breastfeeding. Most surgical procedures can cause injury to normal lactiferous ducts and sensory dysfunction. The authors present a simple, safe, and minimally invasive technique for treating inverted nipples.

The correction of chest wall depression is very important in the treatment of Poland's Syndrome, and various surgical techniques have been developed to solve this problem. 1 Dingeldein M.W. Lu C.Y. Kim A.W. Ostric S. Liptay M.J. Holterman M.J. Simultaneous costal cartilage-sparing modified Ravitch procedure and latissimus dorsi transfer for chest wall deformity repair in Poland's syndrome. J Pediatr Surg. 2009; 44: e29-32 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 2 Pinsolle V. Chichery A. Grolleau J.L. Chavoin J.P. Autologous fat injection in Poland's syndrome. J Plast Reconstr Aesthet Surg. 2008; 61: 784-791 Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar , 3 Veir Z. Dujmović A. Duduković M. Mijatović D. Cvjeticanin B. Veir M. Endoscopically assisted latissimus dorsi flap harvesting and breast reconstruction in young female with Poland syndrome. Coll Antropol. 2011; 35: 1303-1305 PubMed Google Scholar We described a new method of flipping the latissimus dorsi myocutaneous (LDM) flap to correct the chest wall depression.

Objective To summarize the experiences of immediate breast reconstruction with deep inferior epigastric perforator(DIEP)flap and to evaluate indications and advantages of the technique.Methods From April 2003 to June 2009,immediate breast reconstruction following mastectomy using DIEP flap was performed in 21 patients who had received mastectomy for stage I and II breast cancer(radical mastectomy in 6 cases and modified radical mastectomy in 15).Before the operation the location of DIEP was determined by using MDCT(multidetector computed tomography)angiography and Doppler perfusion flowmeter.When mastectomy was completed DIEP was dissected to obtain DIEP flap simultaneously.And the deep inferior epigastric vessels were anastomosed to the thoracodorsal vessel for immediate breast reconstruction.Results The follow-up time was 6 months to 6 years.Among the 21 patients 20 had their flaps completely survived postoperatively,fat necrosis of the distal part(1/3)occurred in one.One case suffered from hematoma in recipient site.No complications such as abdominal hernia and bulge or fat necrosis in donor sites were found.The reconstructed breasts were well-shaped.Conclusion Immediate breast reconstruction using DIEP flap possesses the advantages of satisfactory recipient condition,abundant tissue volume and minimal donor site injury.

The authors report a case of mental stress-induced repeatedly failing microsurgical flap. A 33-year-old female patient underwent a left breast reconstruction with deep inferior epigastric perforator flap. Repetitive arterial crisis occurred postoperatively, which eventually led to flap necrosis. In this case, there was clear correlation between the arterial crisis and mental factors. Mental stress may lead to arterial crisis.

Abdominal flaps have recently gained considerable popularity in breast reconstruction, and their importance and advantages have been widely accepted. Given the unreliability of the distal parts in these flaps and the advancement of microsurgery, many modifications and improvements have been made. To get a better understanding of these flaps, researchers have encouraged the search for a suitable flap model. The purpose of this study was to clarify the anatomical and physiological features of the transmidline abdominal flap model in pig. We included 16 white female Yorkshire pigs in this study. In six pigs, the vascular anatomy of the abdominal region was studied by multidetector row computed tomographic angiography and anatomic dissection. In the remaining 10 pigs, three kinds of transmidline abdominal flap models were established. The pigs were scanned on the abdominal flap to evaluate the perfusion zones after the true abdominal transmidline flap was created, and then they were sacrificed to determine the flap survival area 7 days after surgery. The results of the study were as follows. (1) The pig's deep inferior epigastric vessels were smaller than deep superior epigastric vessels both in length and diameters. (2) The deep superior epigastric artery always bifurcates into two groups; each group gives off five or six branches. (3) The superficial superior epigastric veins were present, while the superficial epigastric arteries were absent in all the animals included. (4) The linea alba abdominis was tough and lack of vascular structures. The average perfusion units were 197.0 ± 24.2, 103.2 ± 36.4, 138.8 ± 25.4, and 30.2 ± 11.8 from zone I to zone IV. All the flaps underwent partial necrosis. The flap survival area percentage was 85.9 ± 4.1%. The transmidline abdominal skin flap in pig is a reliable and true abdominal flap model for future physiological studies, especially the circulatory dynamics in transmidline abdominal flaps.