OBJECTIVE:To explore the application value of dual chamber round tissue expander in immediate breast reconstruction. METHODS:Sixteen patients, who had been provided immediate tissue expander/implant two-stage breast reconstruction using dual chamber round tissue expander in our hospital from March 2022 to October 2023, were involved in this study, and the relevant information was analyzed retrospectively. The overall design of the expander is a round shape, consisting of two equally divided semi-circular chambers. The two expansion chambers are connected by a silicone pad below and are respectively connected to their own water injection tubes. Both chambers are designed to expand unidirectionally towards the surface. The expansion principle, insertion process, and type of expander selection were investigated. The expansion effect and incidence of complications were summarized. The aesthetic effect of reconstructed breasts was evaluated from three aspects after stage Ⅱ surgery: the position of infra mammary fold, the breast protrusion, and the breast volume. RESULTS:Among sixteen patients in this study, three patients were selected with the type of 400 mL expander and thirteen patients were given the type of 600 mL expander. The median time of tissue expansion was 4.0 (2.0, 5.0) months, with an average volume of expansion of (538.8±111.7) mL. The average expansion ratio of upper/lower chamber was 45.4%±8.4%. The position of the infra mammary fold needed not to be adjusted during the prosthesis exchange process. All the patients were applied anatomical prostheses, and the median volume of the prosthesis was 395 (345, 410) mL. One patient developed seroma during expansion period, who got improved after local aspiration. The average follow-up time was (9.0±3.6) months. 81.3% (13/16) of the patients achieved an aesthetic evaluation of "Good" in breast reconstruction, and 75.0% (12/16) of the patients got a grade Ⅰ or grade Ⅱ capsule contracture of the prosthesis. CONCLUSION:The application of dual chamber round tissue expander could effectively dilate the lower pole of the breast, personalize the expansion ratio of the upper and lower poles of the breast, and avoid the displacement of the expander during the expansion period. Therefore, it could provide a good foundation for subsequent prosthesis exchange.

Purpose:Polyacrylamide hydrogel (PAHG), which had been used widely for breast augmentation, has been banned for more than 15 years. Patients who had been injected PAHG for breast augmentation need evacuation surgery to remove as much as possible. To provide a series of diagnosis and treatment process MRI and intraoperative color Doppler ultrasound are combined for maximal removal of PAHG.Methods:The patients who received evacuation surgery in Peking University Third Hospital from 2010 to 2022 after PAHG injection for breast augmentation were included in this research. MR scanning was performed preoperatively and postoperatively in some of these patients and color Doppler ultrasound was applied to help evacuate PAHG intraoperatively. The mean clearance rate of PAHG was calculated according to the MRI outcomes.Results:Two hundred and 4 patients had received evacuation surgery after PAHG injection for breast augmentation with an average age of 42.8 years and an average body mass index of 21.2 kg/m2. The average PAHG retention time was 13.5 years. Among them, 52 patients underwent pre- and postoperative MRI scanning. The mean three-dimensional (3D) volume of PAHG was 684.8 mL (range, 350.0-1,123.9 mL), and the average residual 3D volume of PAHG was 53.7 mL (range, 12.4-98.3 mL). The mean clearance rate was 92.1%.Conclusion:MRI and intraoperative color Doppler ultrasound can provide effective and precise location information of PAHG for evacuation surgery, which is a reliable method to ensure the maximal removal of PAHG.

Background Aesthetic improvement of the chin is increasingly requested by patients, including those of Chinese origin. Methods A randomized, evaluator-blinded, no-treatment controlled study evaluated the effectiveness and safety of a flexible hyaluronic acid (HA) filler, Restylane ® Defyne TM (HA DEF ), in the correction of chin retrusion in a Chinese adult population over 12 months after treatment. On Day 1, subjects were randomized 3:1 into two groups, HA DEF or delayed-treatment controls, and those in the HA DEF group were administered treatment. An optional touch-up treatment was administered 1 month after treatment to obtain optimal chin augmentation. The initially untreated control group was offered delayed-treatment after 6 months (including 1-month touch-up). Results HA DEF was superior to no-treatment in improving chin retrusion according to the blinded evaluator at 6 months [Galderma Chin Retrusion Scale (GCRS) responder rate (≥ 1-point improvement from baseline) of 81% vs . 5% for untreated controls; p < 0.001, meeting the primary effectiveness objective. A majority of subjects maintained improvement at 12 months (61% in the HA DEF group). All subjects reported satisfaction with results at 6 months after treatment with HA DEF and aesthetic improvement rates per the global aesthetic improvement scale (GAIS) were high for 12 months following treatment, with an acceptable safety profile. Conclusions These results demonstrated HA DEF to be effective and safe for the correction of mild-to-moderate chin retrusion in Chinese subjects, confirming findings previously observed in a western population. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

There are few studies of Chinese patients who request silicone breast implant removal after at least 10 years of implantation without any complications. This study aimed to study the characteristics of these patients, explore their reasons for breast implant removal and associate factors that affect their choice, so as to provide valuable information on clinical decision making. A total of 55 eligible female patients (110 breasts) were enrolled from 2016 to 2022. A preoperative questionnaire survey before removal surgery and a telephone follow-up 1 year after removal surgery were conducted to collect data. The mean age of the patients was 40.6±8.8 years with the average time from breast augmentation to implant removal or replacement ranged from 10 to 15 years. Concerns about the aging of silicone gel-filled breast implant and the adverse effects of its long-term placement on body health were the top two reasons for breast implant removal. 63 www.springer.com/00266 .

The chin significantly influences facial aesthetics, contributing to the overall balance and harmony of the face. This study aimed to assess the effectiveness of the hyaluronic acid filler Hyamax® Volumizer for chin augmentation and correction of chin retrusion compared to a no-treatment control. Participants aged 18–55 years with mild to moderate chin retrusion were randomized in a 3:1 ratio to receive either the treatment group (n = 150) or control group (n = 50). Evaluations included blinded assessments using the validated Galderma Chin Retrusion Scale, Global Aesthetic Improvement Scale for aesthetic enhancement, and safety follow-up. The Galderma Chin Retrusion Scale responder rate (≥1 grade improvement) was significantly higher for the treatment group (70 www.springer.com/00266 .

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积容量、乳房突度以及下皱襞位置,更易获得满意的美学效果.

Background:. This study evaluated the efficacy and safety of IncobotulinumtoxinA 20 U for treatment of glabellar frown lines in Chinese subjects. Methods:. This was a prospective, randomized, double-blind, active-controlled, phase-3 study conducted in China. Subjects with moderate to severe glabellar frown lines at maximum frown were randomized to receive IncobotulinumtoxinA (N = 336) or OnabotulinumtoxinA (N = 167). Results:. For the primary efficacy endpoint at day 30, response rates at maximum frown (score “none” or “mild”) on the Merz Aesthetic Scales Glabella Lines – Dynamic were comparable between IncobotulinumtoxinA (92.5%) and OnabotulinumtoxinA (95.1%) per investigator’s live rating. Noninferiority of IncobotulinumtoxinA versus OnabotulinumtoxinA was successfully demonstrated, as the two-sided 95% confidence interval of −0.97% to 0.43% for the difference in Merz Aesthetic Scales-based response rates (−0.27%) lay completely above the predefined noninferiority margin of −15%. For the secondary efficacy endpoints assessed at day 30, Merz Aesthetic Scales-based response rates (score “none” or “mild”) at maximum frown were similarly comparable between both groups per subject (>85%) and independent review panel (>96%) rating. Per Global Impression of Change Scales, greater than 80% of subjects and greater than 90% of investigators in both groups rated treatment results as at least “much improved” at day 30 compared with baseline. Safety profiles were consistent between groups; IncobotulinumtoxinA was well tolerated, and no new safety concerns were identified in Chinese subjects. Conclusion:. IncobotulinumtoxinA 20 U is safe and effective for treatment of moderate to severe glabellar frown lines at maximum frown in Chinese subjects and is noninferior to OnabotulinumtoxinA 20 U.

Background: Hyaluronic acid fillers are the preferred choice for minimally invasive facial volume restoration. In this study, a split-face design was used to compare the effectiveness and safety results of Belotero Balance Lidocaine (BEL) and Restylane (RES, control) to investigate whether BEL is noninferior compared with RES in nasolabial fold (NLF) correction. Methods: This was a prospective, controlled clinical study in Chinese subjects. Subjects with symmetrical moderate NLFs according to the Wrinkle Severity Rating Scale were randomized to receive BEL in one NLF and RES in the other. The primary objective was to investigate whether BEL is noninferior compared with RES after being injected mid-dermally in moderate NLFs after 6 months. Secondary objectives included responses at other visits and pain sensation. Treatment-emergent adverse events (TEAEs) were assessed. Results: A total of 220 subjects were enrolled. The Wrinkle Severity Rating Scale response rates at month 6 were 62.9% for BEL versus 64.9% for RES, demonstrating noninferiority. The secondary endpoints supported this. Significantly reduced pain scores were observed for BEL versus RES. For both products, injection site nodule and bruising were the most frequent treatment-emergent adverse events at the injection site. All treatment-related treatment-emergent adverse events were mild. Conclusions: The study showed that BEL is effective and well tolerated for correction of moderate NLFs in Chinese subjects. Noninferiority of BEL was demonstrated compared with RES, and regardless of applied pain treatment, a further reduction in injection pain was observed in BEL.

OBJECTIVE:To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy. METHODS:Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated. RESULTS:One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility. CONCLUSION:It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual's different conditions. The appropriate reconstructive methods could achieve satisfactory results.

Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.

Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy and results from mutations in the dystrophin gene. Currently no treatment is available for this devastating condition. Standards of care have been improving and are spreading world-wide, prolonging survival and increasing quality of life, however management of symptoms and complications remains the only interventions that can currently be offered to patients. New and promising experimental strategies to address DMD have been developed over the last few years and some of them are in or are approaching clinical trials. Different therapeutic options are being investigated, ranging from mutation-specific treatments, including nonsense codon suppressors and exon skipping, to gene therapy using viral and nonviral vectors and cell-based approaches. Here we review the current status of molecular investigational treatments in DMD, with a particular focus on those compounds and strategies that are currently in clinical trials or are likely to approach clinical application in the near future.

目的:总结在北京大学开设"医学美学与大众生活"公选课的教学效果和可行性.方法:本课程由北医三院成形外科11位具有丰富临床和教学经验的医师担任授课教师,讲授医学美学和美容整形的相关知识.根据学生的课堂表现、闭卷考试成绩以及学习心得和相关知识综述对学生进考核,对课程的教学效果进修评价.结果:选修学生共112人,所有学生期末考核成绩均超过70分(2018年)或合格(2020年).学生最感兴趣的课程内容是通过面部整形美容改变人生和各种畸形的治疗.关于"学习本课程后的感想",总结为以下三点:①通过本课程学习,增加了自己对人体美和医学美容的了解;②人体的外观可以通过医学技术加以改善,自己和家人可能会用得到;③部分医学生对医学美容发生浓厚兴趣,今后会进一步学习.结论:本课程让学生对医学美学和整形美容外科有了初步认识,值得进一步总结开展.

Background: Soft-tissue augmentation of the midface is increasingly requested by patients, and hyaluronic acid (HA) fillers are frequently used in treatment. Aims To evaluate the efficacy and safety of treatment of midface volume/contour deficit with a firm HA filler including lidocaine (HA(RL)). Patients/Methods: This was a 12-month, randomized, evaluator-blinded, controlled study. Chinese adults with mild to substantial volume loss were randomly assigned in a 3:1 ratio to treatment or untreated control groups. Results: A total of 148 subjects were enrolled. The primary objective was met; results of the midface volume scale (MMVS) rated by a blinded evaluator were in favor of HA(RL) at Month 6 (p < 0.0001 vs. the untreated control group). Similar to the MMVS improvement, improved midface fullness and aesthetic appearance was observed based on the Global Aesthetic Improvement Scale (GAIS) up to 12 months by both treating investigators and subjects (at least 96% at Week 4 and 65% at Month 12). Subject satisfaction was high, and the majority of subjects considered the results to look natural (>97%). The study product was well tolerated. Conclusions: Midfacial treatment using HA(RL) was effective, well tolerated, and led to high levels of satisfaction in a Chinese population for up to 12 months.

Objective:To explore the value of tailor-tack technology in vertical mastopexy and to evaluate the clinical effect of vertical mastopexy in correcting breast ptosis.Methods:From April 2010 to August 2020, 47 women aged 18 to 51 years took part in the study, and the tailor-tack technology was used to ensure the amount of redundant skin removal. The patients＇ degree of ptosis was moderate or severe, and the average age was 38.2 years.Results:All the cases had their drainage tube removed 2-3 days after surgery and the wound stitches removed 12-14 days after surgery. All patients had tight and full breasts after surgery. Patients were satisfied with their new breast shapes. After surgery, no patients showed early complications such as necrosis of nipple-areola complex or skin, poor wound healing or abnormal nipple sensation. Follow-up lasted for 6 months to 5 years, and there were no long-term complications such as recurrence of breast ptosis, poor nipple shape, scar flatten and enlargement.Conclusions:Tailor-Tack technology is useful in vertical mastopexy. It can be helpful to evaluate the amount of skin removal, effectively avoiding the situation of insufficient or excessive skin removal. Therefore, this is a desirable clinical skill in mastopexy.

Background Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery. Methods A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction. Results The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases. Conclusions The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

Objective:To analyze a series of ultrasonic follow-up data of breast at different stages after breast autologous fat injection, and explore the value of ultrasound as a means of postoperative imaging evaluation.Methods:The clinical and ultrasonic data of patients who underwent breast autologous fat transplantation in the Department of Plastic Surgery of Peking University Third Hospital from October 2015 to September 2021 were analyzed retrospectively. According to the images, whether the breast structures at different levels (skin layer, subcutaneous fat layer, glandular layer, posterior breast space and chest wall muscle layer) were clear and whether there were abnormal echoes were observed. The location, size, shape, calcification and blood flow signals of abnormal echoes were recorded.Results:A total of 61 female patients, aged 20-41 years, were included. The single fat injection volume of unilateral breast was 70-300 ml (including 251-300 ml, 15 cases; 200-250 ml, 36 cases; less than 200 ml, 10 cases). The ultrasonic images of postoperative patients were continuously obtained. The changes were mainly reflected in two aspects. One was the fat band formed in the posterior breast space, which showed a medium vocal cord in the initial stage and lacked a cord like texture. With the passage of time, more and clear strong echo intervals gradually formed in it. Second, focal fat necrosis can be identified in the subcutaneous fat layer, glandular layer and posterior breast space. At the initial stage, it is irregular and anechoic with unclear boundary. Over time, its edge echo increases, forming round or oval anechoic with clear boundary.Conclusions:Ultrasound can be used as an effective and necessary means of postoperative management of breast autologous fat transplantation, and can provide valuable information for clinicians to accurately judge the surgical effect.

Objectives: To evaluate effectiveness and safety of LGP-HAL treatment for midface volume deficit and/or midface contour deficiency in Chinese subjects.

目的 探讨CBL和LBL相结合在整形外科进修医师培养中的应用效果.方法 对2016—2017年在北京大学第三医院成形外科进修12个月的20名进修医师进行以病例为基础的学习(case-based learning,CBL)联合传统授课(lec-ture-based learning,LBL)教学(CBL+LBL组),进修结束12个月后进行问卷调查,观察教学效果.将此期间来院进修6个月的20名进修医师作为对照组,并将其进修结束后的理论考试成绩与CBL+LBL组进行比较.结果 收回20份调查问卷,95％进修医师认为CBL+LBL教学模式能够提高学习主动性,85％进修医师认为能够提高临床思维能力,90％进修医师回院开展工作后其效果有所提高,35％进修医师提高了科研能力.对照组和CBL+LBL组理论考试成绩差异有统计学意义(P<0.05).结论 采用CBL联合LBL在整形外科进修医师培养中具有较好的教学效果.

Background: Gender-affirming hormone therapy and surgery are important medically necessary approaches to transgender care. However, few related data exist in China. Aim: To understand the desire and access of transgender cares in the Chinese transgender men and women population. Methods: A cross-sectional self-selecting survey targeting the Chinese transgender population was conducted in 2017 using a snowball sampling method. Participants completed an online questionnaire anonymously. Gender identity was verified by specifically designed questions. Data analysis of this study was performed in 2019. Outcomes: The main outcome was the status of receiving transgender medical care, including the desire vs actual state of receiving gender-affirming hormone treatment and gender-affirmation surgery, methods of accessing hormonal therapy and surgery, and risky behaviors associated with obtaining treatments. Results: Of the total 2060 valid questionnaires, there were 1,304 transgender individuals (626 transgender men and 678 transgender women), with a median age of 22 (interquartile range, 19-26) years. Among them, 1,036 (79.4%) expressed desires for hormonal therapy, but of 1,036, 741 (71.5%) considered it difficult to obtain medications from doctors. Of 1,036 individuals, 275 (26.5%) and 172 (16.6%) had thoughts or behaviors of self-injury, respectively, when lacking access to hormone therapy. Of 1,036 individuals, 602 (58.1%) had used hormones. Of those 602 hormone users, 407 (67.6%) had ever obtained medications from informal drug dealers, and 372 (61.8%) of them did not perform regular monitoring. 868 of 1,303 (66.6%) participants had received or wanted to undergo gender-affirming surgeries, but 710 of 868 (81.8%) considered the surgery resources not adequate or very scarce. Clinical Implications: The transgender medical resources in China are scarce, and many transgender individuals have engaged in high-risk activities to access care. Strengths & Limitations: This is the first study to focus on the current status of gender-affirming hormone therapy and surgery in the Chinese transgender population, providing valuable and real-world data for under-standing the need for transgender health care in China. But, the online questionnaire could not provide the prevalence and other epidemiologic information about transgender individuals in China, and the survey did not address specific medication regimens, dosages, sex hormone levels, and specific hormone therapy-related or surgery-related adverse events. Conclusion: Significant improvement in access to gender-affirming medical and surgery care is needed in China. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

OBJECTIVE:To investigate the outcomes of breast reconstruction with employing improved techniques throughout the tissue expander/implant two-stage breast reconstructed process, which involved the tissue expander placement, the saline filling intraoperatively and postoperatively, the implant selection, and the permanent implant replacement. METHODS:In this study, 68 patients who had been provided immediate or delayed tissue expander/implant two-stage breast reconstruction with autologous fat injection post-mastectomy in Peking University Third Hospital from April 2014 to September 2018 were involved, and the relevant information was analyzed retrospectively. The enhancements of the techniques, involving the incision selection, the expander placement, the principle of expansion, the management of capsule, the prosthesis selection, and the assisted reconstruction method were summarized, and the reconstruction outcomes were evaluated objectively through three-dimensional surface imaging. RESULTS:Among the 68 patients in this study, immediate reconstruction was conducted in 25 patients and 43 patients underwent delayed reconstruction. The median time of tissue expansion was 7.0 (3.0, 20.0) months, and the average volume of expansion was (372.8±87.2) mL. The median size of breast implant was 215 (100, 395) mL. The median number of injections for fat grafting was 1 (1, 3), and the average volume of fat grafting was (119.3±34.1) mL. The median follow-up time was 7.0 (4.0, 24.0) months. During the process of breast reconstruction, the tissue expander leakage was observed in two patients, and one of them underwent expander replacement due to the secondary infection. In the immediate reconstruction cases, the volume symmetry of bilateral breasts after reconstruction got even better than that before mastectomy (t=4.465, P<0.01). And in the delayed reconstruction cases, the volume between bilateral breasts also achieved good symmetry after reconstruction (t=0.867, P>0.1). CONCLUSION:Good results of tissue expander/implant two-stage breast reconstruction could be achieved through the techniques enhancement, which involved the preferred transverse incision, the downward placement of expander, the rapid expansion of chest soft tissue, the release of capsule tension, the application of sizer in prosthesis selection, and the assisted autologous fat grafting.