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Objective:To evaluate the aesthetic results of bilateral breast symmetry after reduction mammaplasty, we proposed a handheld 3D scanner-based evaluation method to achieve the desired aesthetic effects.Methods:From June 2018 to June 2019, a total of 56 female patients with an average age of 34 years (18 to 56 years) requested for bilateral breast reduction in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Three-dimensional scans were performed intraoperatively in 27 cases in study group, and symmetry adjustments were made during breast contouring based on the analysis results; in the control group, a total of 29 patients did not undergo three-dimensional scans intraoperatively. Three-dimensional scans were obtained from both groups 3 months after surgery to objectively assess breast symmetry. Six third-party physicians scored the two groups based on anonymous photographs of the patients in 5 dimensions of breast symmetry to assess the symmetry of the pre- and post-operative bilateral breasts.Results:The difference in breast volume in the study group was significantly smaller bilaterally than in the control group [35.26 (20.01, 55.61) vs 110.02 (43.52, 186.30) cm 3,U=221.00, P=0.001]. The results reported by the evaluators showed that all five aspects of breast symmetry measured by breast reduction were significantly improved in the study group compared to the preoperative period ( P<0.001) and were all statistically superior to the control group ( P<0.05). Conclusions:Intraoperative three-dimensional scanning technology presents a dependable method to facilitate in optimizing bilateral breast symmetry, which in turn provides an opportunity to enhance the aesthetic outcome after reduction mammoplasty.
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Objective To evaluate the clinical outcomes of the endoscopic assisted axillary approach in treating gynecomastia with comparison against the conventional periareolar open excision method,and to present our experience utilizing this technique.Methods Fifty participants diagnosed with gynecomastia were included in this study,among which twenty-six were treated using periareolar open excision,and twenty-four were subjected to endoscopic assisted axillary approach.Clinical out comes and patient reported satisfaction were assessed postoperatively.Results One hematoma (4.2％),one seroma (4.2％),and one wound dehiscence (4.2％) were encountered in the endoscopic assisted axillary group;two hematoma (7.7％) and two nipple hypoesthesia (7.7％) occured in the periareolar group.The total complication rate between the two groups was of no significant differences (P＞0.05).The patient reported satisfaction score of the endoscopic assisted axillarygroup rated sig nificantly higher than the periareolar group on the scar domain (t =2.064,P =0.044).Conclusions Endoscopic assisted axillary approach presents higher patient satisfaction and low complication rate,which is worth widely using in future clinical practice.
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Objective To investigate the related factors of fat necrosis nodules after autologous fat grafting for breast reconstruction.Methods Different methods of purification,number of operations,and history of breast radiation were analyzed.The relationship between fat graft and necrosis were compared.A total of 48 patients undergoing autologous transplantation for breast reconstruction after radical mastectomy between January 2015 and June 2017 in Chinese Academy of Medical Sciences were retrospectively analyzed,and 51 breasts were used.Results After surgery,9 cases of palpable nodules were found in the breast,including 8 cases in the centrifuge group and 1 case in the sedimentation group.There were 20 cases of multiple hypoechoic nodules in breast ultrasound,including 13 cases in the centrifugation group and 7 cases in the sedimentation group.The incidence of breast nodules in the centrifuge group was 33.33％,and the incidence of fat liquefaction cysts was 54.17％;the incidence of breast nodules in the sedimentation group was 3.7％,and the incidence of fat liquefaction cysts was 25.93％.In this study,there were 4 cases of breast fat filling surgery,18 cases of fat graft for 2 times,23 cases of breast fat filling for 3 times,and 6 cases of fat filling for 4 times;the more time of fat graft surgery,the higher of the fat necrosis incidence.There were 21 cases of breasts with radiotherapy history,30 cases of breast without radiotherapy history,7 cases of nodules after autologous fat transplantation and breast reconstruction in radiotherapy group,2 cases of nodules that could be touched after autologous fat transplantation without breast reconstruction,and 2 cases with radio therapy.The incidence of fat necrosis after fat transplantation breast reconstruction was higher than those without radiotherapy.Conclusions The incidence of fat necrosis after fat-purified with centrifugation autologous grafting for breast reconstruction is higher than that by sedimentation method.The higher rate of fat necrosis is observed after breast reconstruction with autologous fat grafting in radiotherapy than that without radiotherapy.
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Objective@#This is a study to evaluate complication rate, satisfaction and quality of life after breast reconstruction under different classifications. The classification criteria are the timing of operation, surgical procedures, and patients′age.@*Methods@#By reviewing the surgical cases from August 2004 to June 2018, the authors summarized the data of 102 patients with breast reconstruction of the same surgeon in Peking University People′s Hospital and Plastic Surgery Hospital (Institute) CAMS PUMC. Fifty-four patients who met the inclusion criteria and completed the BREAST-Q breast reconstruction module scale, were divided into immediate group or delayed group, according to the timing of operation; divided into abdomen group or other procedures group, according to the surgical procedure; and divided into the young patients′group or senior patients′group according to age. The index were (1) postoperative complication rate, (2)satisfaction with breasts, psychosocial well-being, physical well-being of chest and abdomen, sexual well-being, satisfaction with outcome, satisfaction with information, satisfaction with care (based on the BREAST-Q scale).@*Results@#Complication rate was 9.1%(1/11) in the immediate group, 16.3%(7/43) in the delayed group, 14.7%(5/34) in the abdomen group, 15.0%(3/20) in other procedures group, 13.6%(3/22) in the young patients′group, and 15.6%(5/32) in the senior patients′group. There was no significant difference in the incidence of complications (P>0.05). The postoperative scores of satisfaction with breasts, psychological well-being and sexual well-being were significantly higher in the immediate group than in the delayed group(P=0.026, P<0.001 and P=0.001, respectively). The score of postoperative physical well-being of chest was significantly higher in the abdomen group than other procedures group(P=0.020). The score physical well-being of abdomen was lower compared with the preoperative in the abdomen group (P<0.001). The score of physical well-being of abdomen was lower in the senior patients′group than that of the young patients′group (P=0.010).@*Conclusions@#The complication incidence of breast reconstruction patients was similar among different groups. The breast reconstruction surgery can significantly improve satisfaction and quality of life of patients. To some extent, immediate breast reconstruction can reduce the psychological and physiological effects of breast loss on patients, leading to higher postoperative satisfaction. Breast reconstruction with abdominal flaps can provide patients with better chest health but poor abdomen health. Although elderly patients undergoing breast reconstruction will have poor physical well-being of abdomen, they can still achieve higher satisfaction of operation.
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Objective@#To investigate the satisfaction and well-being of Chinese women with breast deficiency, and to analyze the relevant influencing factors.@*Methods@#A cross-sectional study was conducted using a self-designed questionnaire to investigate the women with breast deficiency, visiting the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from November 2013 to August 2018. The BREAST-Q BR (breast reconstruction) pre-operation and post-operation modules were used to assess the quality of life.@*Results@#A total of 139 effective questionnaires were collected, including 83 patients before BR surgery and 56 post. There was no difference in quality of life in different ages, marital status, education levels, working status, and causes of breast deficiency. Mean scores of satisfaction with breasts, psychosocial well-being and sexual well-being of patients after breast reconstruction were significantly higher than those of patients without reconstruction (P=0.000), but there was no statistical difference in physical well-being-chest score. The physical well-being abdomen scores of patients with abdominal flap reconstruction was lower than that of the patients without reconstruction (P=0.007). With regard to analysis of specific items, compared with preoperative patients, patients with abdominal flap reconstruction reported lower scores in the items related to abdominal muscle weakness (P<0.05).@*Conclusions@#The breast deficiency resulting from Poland syndrome, breast cancer and other causes, can lead to a significant decrease in quality of life. Breast reconstruction can improve satisfaction with breast, psychosocial and sexual well-being in women with breast deficiency. The abdomen well-being of patients with abdominal flap reconstruction is decreased. Therefore, more attention should be paid to retain abdominal muscles to maintain abdominal shape and motor function during operation.
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Breast cancer-related lymphedema is a chronic, progressive disease that occurs following axillary lymph node dissection. Treatment includes nonsurgical, surgical and biological engineering strategies. Conservative method are mainly used for prevention and in cases of subclinical lymphedema. Surgical options can be divided into two categories: reductive surgery and physiologic surgery. Biological engineering strategies use tissue engineering, stem cells and growth factors to automatically restore the lymphatic vessels. All the aforementioned techniques are not curative and, consequently, further research is imperative to establish a better regiman in management of lymphedema.
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Objective@#To compare the scar condition after breast implantation with axillary, periareolar and inframammary fold (IMF) incisions.@*Methods@#The consecutive patients who were diagnosed as breast hypoplasia and underwent breast implantation surgeries between May 2012 to December 2014 were included in the research. The scars were assessed at 1, 6 and 12 months after surgery with VSS and patient satisfaction scoring. The results were analyzed with Variance and Kruskal-Wallis test based on the data type.@*Results@#The scars of 173 patients were assessed 3 times with the follow-up rate being 82.4%. The VSS scores of every incision declined with time, and the patient satisfaction scores increased gradually. At one month after surgery, the media VSS scores were 6 in axillary group and 4 in periareolar and IMF groups, the differences had statistical significance (P<0.05). The media scores of patients satisfaction were 8 in periareolar group and 7 in axillary and IMF groups. The scores of periareola group were higher than those of axillary with statistical significance(P<0.05). When 6 months after surgery, the media VSS scores were 4 in axillary group and 3 in periareolar and IMF groups. The scores of axillary group were higher than those of IMF with statistical significance(P<0.05). The media scores of patients satisfaction were 8 in 3 groups. When 12 months after surgery, the media VSS scores were 0.5 and 1 in periareolar group (left and right respectively), and 2 in axillary and IMF groups. The media scores of patients satisfaction were 9 in 3 groups. No differences were found in VSS and patients satisfaction scores among three kinds of incisions (P>0.05).@*Conclusions@#The scars of three incisions achieved similar cosmetic effects and patient satisfaction at long-time follow-up.
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Objective@#To investigate the application and therapeutic effect of external tissue expansion-assisted autologous fat grafting for delayed breast reconstruction.@*Methods@#Patients began wearing the BRAVA negative pressure system 8 hours a day for recipient tissue expansion for one month before the fat grafting procedure. After fat grafting, BRAVA was recommended to be worn 8 hours a day from postoperative 48 hours to one month. The interval of each fat grafting procedure was 2.5 to 3.0 months. The procedures were repeated until the completion of breast reconstruction. Water-jet assisted liposuction and subcutaneous release of scars were also performed during surgery.@*Results@#From January 2013 to November 2016, 29 patients were followed up for 12 to 58 months, with average of 31.6 months. 28 patients completed the external tissue expansion-assisted autologous fat grafting breast reconstruction. Completion required 1 to 6 procedures, with average of 3.4 procedures. The total initial fat fill volume for each breast was ranged from 200 to 1 000 ml, with average of 583.7 ml. The initial fat fill volume for each breast was ranged from 92.5 to 243.7 ml per operation, with average of 173.8 ml. One patient underwent latissimus dorsi myocutaneous flap breast reconstruction after 3 fat grafting procedures. 8 patients completed the inframammary fold reconstruction, 3 patients underwent breast lift, 1 patient underwent lipofilling augmentation for the contralateral side. Postoperative satisfaction rate was 82.8% in patients and 75.9% in surgeon. Complication statistics: 5 cases of palpable nodules which recognized as fat necrosis (17.2%), one case of nontuberculous mycobacterial infection (3.4%) and one case of locoregional cancer recurrence (3.4%).@*Conclusions@#External tissue expansion-assisted autologous fat grafting is a minimally invasive procedure for breast reconstruction. Satisfactory results could be obtained for most of the patients who would like to choose fat grafting and have enough fat deposit in other parts of the body.
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Objective To investigate Chinese patients' preferences for different types of incisions for breast augmentation surgeries and to evaluate the impacts of preoperative education on patients' choices.Methods The 403 patients who underwent implantation surgeries during May 2012 to Dec.2016 were included in the survey.These patients were investigated with questionnaires before and after receiving preoperative education in order to ascertain their preferences and concerns based on comprehensive understanding of different types of incisions.Results After receiving the preoperative education on incisions,158 (39.21％) patients changed their initial choices.The number of patients who chose axillary or periareolar approaches decreased to 205 (50.87％) and 31 (7.69％) respectively,while the number of patients who chose IMF incisions increased to 167 (41.44 ％).The majority of patients who chose the axillary of periareola incisions cited easily-hidden scars as their primary selection criterion (81.95 ％ and 93.55 ％,respectively).However,the patients who opted for IMF incisions primarily concerned about the lower capsular contracture rate (31.74 ％),less tissue trauma (22.75 ％)and lower possibility of injury to the breast parenchyma (21.56 ％).Conclusions The preoperative education materials help the Chinese patients fully understand the characteristics of different types of incision locations and make proper decisions.
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Objective To investigate the application of liposuction in refining the dog-ear deformity following autologous flap breast reconstruction.Methods Between May 2012 and September 2016,16 patients with dog-ear deformity in the donor site following autologous flap breast reconstruction were treated with liposuction.All the patients were female with an average age of 40.6 years (range,32-47 years).After the operational compression garment was used for at least one month.Regular follow-up was performed after the above operation.Results The follow-up period lasted for 6 to 8 months.The dog-ear deformity was restored to normal appearance.All cases achieved satisfactory results without complications such as local depression,infection,skin necrosis etc.Conclusions For some of the dog-ear deformity following autologous flap breast reconstruction,liposuction is a good and simple method without adjuvant incisions.
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Objective To present the clinical effect of the delayed tissue expanding breast reconstruction with implants.Methods For those who received breast tumor surgeries,round-shaped expander was implanted for increasing skin coverage and silicone implant was used for breast reconstruction after several months' expanding.Results 15 relevant cases were included in this study with an average of 5.1 months expanding period.Only one patient received reoperation for capsular contracture and there was no complication in the other cases.Conclusions Delayed tissue expanding breast reconstruction with implants,with a wide indication,is an ideal reconstructive method which can reduce the interference of tumor recurrence and radiotherapy and avoid the trauma of donor site and the patch-like appearance of breast.
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Objective@#To evaluate the safety, reliability and effectiveness of "free style endoscopic technique" assisted transaxillary high level dual plane breast augmentation; To explore endoscopic techniques that can achieve higher efficiency and better result ; To discover a safe and effective method for dual plane dissection with the help of endoscopy.@*Methods@#Using new endoscopic techniques to perform transaxillary dual plane breast augmentation: ① High level dual plane technique, the muscle division line is about 1.5 cm higher than the original inferior mammary fold, the cephalic side of the muscle is retracted to the lower border of the areola with a special retractor to form a high level dual plane cavity, thus the upper and lower portion of the implant would be covered by pectorilis major muscle, while the rest of the implant was partially under breast parenchyma. ② "Free style endoscopic techniques" , the endoscopy and retractor are not fixed to each other, thus the space is exposed by an assistant with a new designed special retractor, while the operator is concentrate on dissecting with endoscopy in one hand and long tipped bowie in the other hand. ③ Accurate navigate technique, define the dissection border by acupuncture via skin in a 90 degree angle, thus to make the dissection right as preoperative design.@*Results@#There were 1 106 cases underwent this kind of surgery, while 405 of them, whose minimum follow up were 12 months were included in this retrospective study. The follow up period ranged from 12-60 months, the average follow up period is 24.3 months. The average operation time is (1.47 ±0.46) h, the average drainage removal time is (4.23±0.51) d after surgery. The perioperative complication rate is 0.99%, including an incision site change caused by intraoperative bleeding, 1 case of pneumothorax, 2 cases of bleeding after surgery. Long period complication including: 6 cases (1.48%) Ⅲ grade capsular contracture, 21 cases (5.20%) of nipple-areola sensation disorders, implant palpable occurred in 14 case (3.46%), 3 cases (0.74%) implant malposition, 2 cases (0.49%) implant distortion, the total reoperation rate is 2.47%. There was no infection, hematoma, seroma, curtain deformity, double bubble deformity occurred in our study.@*Conclusions@#The high level dual plane techniques not only can solve the deficient soft tissue coverage problem thus to lower the rate of implant palpability, but also can relieve the relationship of the pectorilis major muscle and the inframammary fold(IMF), offering an option to replace Ⅱ and Ⅲ type of dual plane techniques, decrease the risk of curtain deformity and double bubble deformity. The free style endoscopic techniques are very flexible and efficient, with the help of accurate navigate technique, it can archive an accurate cavity dissection, accurate and definite IMF, and a lower complication rate. Though the learning curve is relatively longer, it is really a safe and effective breast augmentation method worthwhile to learn and spread.
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Objective To evaluate the implication and necessity of deepithelialization in mastopexy.Methods A total of 124 patients with mastoptosis were randomly divided into 2 groups:group Ⅰ and group Ⅱ,62 cases each.A double-circle incision technique was used for all the patients.In group Ⅰ,full thickness skin around nipple-areola was resected.While in group Ⅱ,deepithelialization was performed and the peri nipple-areola dermis was preserved.Results The average full skin resection time was 4.5 minute per side in group Ⅰ and the skin deepithelialization time was 15.8 minute per side in group Ⅱ.Postoperative follow-up was carried out for all the 124 patients with duration of 2 weeks to 4 years.In group Ⅱ,sebaceous cysts,epidermal inclusion cyst and suture knot exclusion were found at the incision site in 8 patients (12.9 ％) at 3 weeks to 1.5 years after operation.Conclusions The blood supply to the nipple-areola complex is not affected by full-thickness skin removal during mastopexy,while the incidence of complication at the incision site decreases significantly.We conclude that deepithelialization has not much clinical significance in mastopexy.
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Objective To analyze factors of volume maintenance percentage after autologous fat grafting breast augmentation.Methods From March 2011 to December 2014,39 patients were included.Age,BMI,donor site,breast preoperative volume,whether or not application of Brava and water-jet-assisted liposuction were collected as variables.We performed multivariate regression and univariate regression analyses in a general linear regression model and multilevel linear regression model to identify significant factors.Results The mean percentage of volume maintenance was (34± 12) ％.In univariate regression analysis,rate of volume maintenace was decreased 3.3％ as increase of age per 5 years;Brava application increased volume maintenace,compared with donor sites of the back and abdomen 8.4％ (40.7％ vs 32.3％,P＜0.05),application of leg fat increased by 9.6％ of volume maintenace (39.1％ vs 29.5％,P＜0.05).In the multivariate regression analysis,Brava use increased volume maintenance of 6.2％ (P＜0.05);use of leg fat increased by 6.0 ％ of volume maintenace as compared with donor sites of the back and abdomen (P＜0.05).Conclusions The age,Brava,and donor site are significant impact factors to percentage volume maintenance in autologous fat graft breast augmentation.
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BACKGROUND:As a mixture of several kinds of stem cels and progenitor cels, autologous bone marrow concentrate has been a research hotspot because of the advantages including easy to obtain, time saving and relatively low cost, which can avoid cel extraction, culture and amplification, and can preferably maintain the bioactivity of cels. OBJECTIVE: To review the current basic research and clinical research on bone marrow concentrate in regenerative medicine. METHODS: A computer-based search of CNKI and PubMed databases was performed for articles relevant to bone marrow concentrate published from January 2000 to February 2015. The key words were bone marrow concentrate, bone marrow mesenchymal stem cels, endothelial progenitor cel in Chinese and English, respectively, which appeared in the title and abstract. Finaly, 62 articles were included in result analysis. RESULTS AND CONCLUSION: Bone marrow concentrate can be harvested by density gradient centrifugation technique, with the advantages of easy to obtain and minimal risk of infection and immunological rejection. Currently, the bone marrow concentrate has been proved to be beneficial to wound healing, tissue regeneration and angiogenesis by numerous studies. Meanwhile, it has been successfuly introduced in clinical application. However, studies about the amount of transplantation are stil in need.
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Objective To observe the surgical effect of nipple retractor to inverted nipples.Methods Between January 2001 and January 2014,this nipple retractor to inverted nipples was used to correct 604 inverted nipples of 322 patients.The follow-up period ranged from 6 to 24 months.The clinical results and complications were evaluated.Results Excellent nipple morphology and patient satisfaction were achieved in 211 cases (93.8 ％),basically normal nipple morphology and patient satisfaction were achieved in 12 cases (5.3％),and recurrent nipple inversion occurred in three cases (1.3％).The latter three patients had experienced failed open correction for their inverted nipples,and some degree of nipple inversion occurred after removal of the frame.In this study,28 patients (12.4 ％) experienced successful pregnancy and breast-feeding.No loss of nipple sensation occurred in 225 cases.Nipple erection was observed after stimulation in 215 cases (95.6％).Conclusions The described technique is minimally invasive,simple,safe,and reliable.Satisfying aesthetic results can be achieved without destroying breast feeding function and nipple sensation.
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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.
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Objective:To demonstrate the selection of breast implant during an immediate breast reconstruction post-mastectomy and analyze the indication of this technique. Methods:From June 2007 to June 2012, a total of 121 patients with breast cancer received immediate breast reconstruction with breast implants. Among the 121 patients, 89 patients had simple mastectomy, while the rest under-went modified radical mastectomy in the Department of Breast Neoplasm, Nanchang No.3 Hospital. The volumes of the resected breast tissues were measured using Archimedes principle. The diameters of the tissues were also determined. Proper breast implants were se-lected according to the measured data. Results: Postoperative complications, such as implant exposure, flap necrosis, and infection, were not found. Follow-up period ranged from 6 months to 12 months. Patients answered a questionnaire that displayed their degree of satisfaction for the breast operation outcome. Results show that 89.3%of the patients (108/121) were very satisfied, 9%were (11/121) satisfied, and 1.7%(2/121) were unsatisfied. Conclusion:Immediate breast reconstruction with breast implant post-mastectomy is an ideal method for rebuilding the breast. This technique is advantageous because it prevents damage to the donor site and retains the maxi-mal elasticity of the skin for breast reconstruction. Accurate parameters of breast implants, which are important to achieve good surgical results, could be obtained using Archimedes principle.
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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.
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Objective To present our experience in two-stage procedure immediate breast reconstruction,which aimed to retain local tissue condition for breast reconstruction,overcome the limitation of radiotherapy on implant reconstruction,and simplify the procedure as well as improve cosmetic result.Methods The proceduces of our method were divided into two stages:in the first stage,the round-shaped expander was implanted in the subpectoral major space during the procedure of mastectomy; at the same time as expander implanted,the first saline injection was performed; with 4 to 8 weeks of inflation,the tissue expander offered adequate tissue for breast reconstruction; in the second stage,silicon gel implant,latissimus dorsi muscle flap,extended latissimus dorsi muscle flap and deep inferior epigastic perforatior flap were used for breast reconstruction after the tissue expander was exchanged.Results Thirty-four patients had undergone the two-staged breast reconstruction using tissue expansion.The average time of therapy was 5.5 months.There were no postoperative complications such as implant exposure,additional scar,and flap necrosis.The follow-up time was 6 to 18 months and the result showed excellent contour of the breast at a satisfactory rate of 97.1％.Conclusions Two-staged technique using tissue expansion in breast reconstruction is easily done and the complications are rare.The technique possesses advantages such as avoiding affection of radiotherapy on silicongel implant and elasticity of skin,retaining maximal local tissue for breast reconstruction.There is no necessary for correction of skin defect and additional scarring,thus the patch-like appearance of breast is avoided.The patients need not to experience depression post mastectomy.Two-staged procedure immediate breast reconstruction is a safe and reliable technique that is especially applicable to the patients who need radiotherapy.