Digital evaluation of breast symmetry with 3D scanning technique / 中华整形外科杂志

<p><b>OBJECTIVE</b>To establish a standard method for digital evaluation of breast symmetry with 3D scanning technique.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>3D scanning technique can provide an accurate 3D measurement of breast. A thorough and objective evaluation of breast symmetry can be achieved.</p>

Functional annotation of the microRNA-mediated network in gigantomastia by integrating microRNA and mRNA expression profiling / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>This study addresses the need for better diagnosis and treatment of gigantomastia by providing new insight into the molecular mechanisms underlying this disease.</p>

Application of MDCT angiography for breast reconstruction with deep inferior epigastric artery perforator flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the significance of preoperative MDCT angiography for breast reconstruction with abdominal flap.</p><p><b>METHODS</b>Preoperative MDCT angiography scans were performed on 34 patients who underwent breast reconstruction with abdominal flaps during December 2006 to June 2009. The operation was designed based on the MDCT results. Then the MDCT results were proved intraoperatively. Another 22 cases who underwent breast reconstruction with abdominal flap without preoperative MDCT were selected as controls. The rate of operative method change, the operation time and the flap necrosis were compared between the two groups.</p><p><b>RESULTS</b>The preoperative design changed in 23.53% of the patients, based on the MDCT results. No one had any method change intraoperatively in the group with MDCT. The operative method was changed intraoperatively in 13.64% of the patients in the control group. The mean time spending on flap harvesting was (2.51 +/- 0.64) h in the experimental group and (4.42 +/- 0.21) h in the controlled group (P < 0.05). The rate of complication was 6.12% in the experimental group and 12.5% in the control group (P = 0.017).</p><p><b>CONCLUSIONS</b>Preoperative MDCT angiography is an easy and reliable method for breast reconstruction with abdominal flap. The preoperative design can be more reasonable. It helps to save the operation time and reduce the risk.</p>

Nipple-areolar reconstruction with the modified arrow flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the clinical experience of nipple-areolar reconstruction with the modified arrow flap.</p><p><b>METHODS</b>The arrow flaps were modified for nipple-areolar reconstruction in 12 cases. Among them, 2 cases were treated with combined thin split-thickness skin graft; 4 cases with autologous rib implant and tattoo; 6 cases with tattoo.</p><p><b>RESULTS</b>All the reconstructed nipples were survived. The reconstructed nipples lost projection 1 month after operation in 2 cases. The other 10 cases retained 50% of the nipple projection 3 months after operation. The results were maintained with satisfactory symmetry during the follow-up period of 6 months to one year.</p><p><b>CONCLUSIONS</b>The modified flap is easily performed with reasonable design and no need of donor site. The nipple projection can be maintained with good long-term effect.</p>

Repeated operation for removement of polyacrylamide hydrogel from breast / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the technique of repeated operation for removement of polyacrylamide hydrogel from breast.</p><p><b>METHODS</b>17 cases after uncomplete removement of PHG were reoperated through inferior periareolar incision. The PHG and affected denatured muscle and gland tissue were removed.</p><p><b>RESULTS</b>Preoperative MRI or CT showed PHG distributed diffusely in muscle and gland. There was only minimal residual PHG after operation. Histological examination showed PHG distributed in the denatured and proliferative fibrous tissue, including giant cells, many neutrophilic cells infiltration, and foreign body granuloma. The symptoms, such as intramammary pump or nodule, chest and back pain, infection, were relieved after operation.</p><p><b>CONCLUSIONS</b>Blinded suction technique can not remove PHG completely and can also result in malposition of PHG and make the tissue denaturation worse. We suggest open approach to remove the PHG and denatured tissue completely through periareolar incision.</p>

Retrospective analysis of complications of breast augmentation with injected polyacrylamide hydrophilic gel in 90 cases / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the complications of breast augmentation with injected polyacrylamide hydrophilic gel (PAHG) in order to avoid further injury by taking treatment at the right moment.</p><p><b>METHODS</b>90 patients with some side-effects after breast augmentation with injected polyacrylamide hydrophilic gel had been undergone the treatment in our hospital from 1999 to 2006. Their clinical data were analyzed.</p><p><b>RESULTS</b>The major complaints of the patients were feeling pain, multiple indurations, secondary deformity, PAHG displacement, low-grade fever of unknown reason, limitation of upper limb activity, spillage of milk and blood, ulceration and sinus tract of breast, inversion of nipple, infection. All patients were treated by surgical operations to remove the injected PAHG.</p><p><b>CONCLUSIONS</b>The complications are might not only related to the injected material but also caused by incorrect manipulation during operation. To do suction several times may cause the injected material distributed diffusely and the tissue was badly injured. Operation can remove the PAHG as completely as possible. It is a better treatment for the complications of PAHG injection for augmentation mammaplasty.</p>

Breast reconstruction with a combined skin flap of DIEP and TRAM / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate breast reconstruction with a combined skin flap of the deep inferior epigastric perforator (DIEP) and the transverse rectus abdominis musculocutaneous (TRAM).</p><p><b>METHODS</b>The DIEP and TRAM united flap was elevated with the vessel pedicle of the deep inferior epigastric perforator on the affected side and the rectus abdominis muscle pedicle on the intact side. The reconstructive breast was shaped after the deep inferior epigastric vessels were anastomosed to the internal mammary vessels or the thoracodorsal vessels ipsilaterally.</p><p><b>RESULTS</b>We have used the DIEP and TRAM united flaps for breast reconstruction in 17 cases. All of the flaps survived, and the reconstructed breasts were well-shaped with the follow-up of 6-18 months.</p><p><b>CONCLUSIONS</b>The DIEP and TRAM united flap possesses of advantages such as rich blood supply, abundant tissue volume and easy shaping. It is especially applicable to the cases who have large chest defect and need large volume tissue.</p>

A study of incision pattern and pedicles in reduction mammaplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy, indication, advantage and disadvantage of methods for reduction mammaplasty.</p><p><b>METHODS</b>Thirty one cases with breast hypertrophy received reduction mammaplasty using various incisions and pedicles. Based on the follow-up of the cases, the appearance, nipple-areola complex sensory function and scars were evaluated.</p><p><b>RESULTS</b>Among the skin incision pattern, inverted T, short-horizontal invert T and vertical incision got excellent breast contour (100%), otherwise, periareolar incision got the less scar (100%). The postoperative result of lateral pedicle, lateral inferior pedicle and mammary gland pedicle were satisfactory in terms of the nipple-areola sensation and the amount of mammary tissue removed.</p><p><b>CONCLUSIONS</b>Breast contour and scar formation postoperative are related to incision design, Invert T incision or short-horizontal invert T incision is a good alternative to moderate and large hypertrophies, Periareolar incision is suitable to small hypertrophies. There is a relationship existing between pedicle location and retention of sensation or amount of mammary tissue removed. The inferior pedicle and lateral-inferior pedicle allows better shaping as well as maintaining good sensation.</p>

Anatomy study of superior and inferior gluteal artery perforator flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To find anatomic basis for clinically modifying technique of harvesting superior and inferior gluteal artery perforator flap, in order to avoid muscle lossing in conventional superior and inferior myocutaneous flaps, keep the advantage such as large rich supplied volume soft tissue.</p><p><b>METHODS</b>5 cases 10 sides adult cadaver were used to study the numbers, position, Course of superior and inferior gluteal artery perforators. The position of perforators was located by ultrasound Doppler in 6 cases and 12 sides in patient's superior and inferior gluteal area.</p><p><b>RESULTS</b>Superior and inferior gluteal artery originated from internal iliac artery. Several main perforators of large caliber were found in the paraischia and central portions of the gluteal muscle, its number was 10 - 15. The length of the vessels varies from 3 to 8 cm and their diameter from 1 - 1.5 mm. These significant perforators pass through the muscle itself and the fascial portion of the muscle to the overlying skin on the gluteal region. The dorsal branches of nervorum lumbalium perforate the deep fascia just above the iliac crest, lateral to the posterior superior iliac spine. If a nerve branch with a substantial diameter crosses the incision line, the nerve can be harvested within the flap. This nerve can be anastomosed to the anterior ramus of the lateral branch of the 4th intercostals nerve. In adult female, 3 - 5 perforators were located by ultrasound Doppler. They distributed in the triangle area among posterior superior iliac crest, the great trochanter and the coccyx.</p><p><b>CONCLUSIONS</b>The area and diameter of perforators of superior gluteal artery were relatively confirmed. It's possible to harvest the perforator flap without any muscle. It has the advantage of conventional myocutaneous flap with out of its disadvantages. It's easy to detect those perforator by ultrasound Doppler clinically. The nerve can be harvested and anastomosed simultaneously. Because the inferior gluteal area is a weight loading area, we suggested to use superior gluteal artery perforator flap. This flap can be transferred pedicled to treat sacral pressure sores or to be transferred freely for the breast reconstruction.</p>

Vertical mammaplasty using the skin wrinkling suture techniques / 中华整形外科杂志

<p><b>OBJECTIVE</b>To reduce the incision scar produced by reduction mammaplasty.</p><p><b>METHODS</b>The periareola incision and the vertical incision below the areola were made when performing breast reduction. The incision in the submammary fold was avoided. The breast was suspended and moulded. The redundant skin and the long skin incision below the areola were sutured utilizing the skin wrinkling suture techniques. The wrinkling skin and incision became flat gradually due to the elasticity of the tissue itself.</p><p><b>RESULTS</b>13 cases have been treated with the techniques mentioned above. All incisions healed primarily and there were no complications such as hematoma, infection and necrosis of skin or areola. Of them, 3 patients with very large and ptotic breasts needed small corrective operations to excise the redundant skin that still existed 6 months postoperatively. The shape of the breasts and the vertical incision scars of the other patients were satisfactory.</p><p><b>CONCLUSIONS</b>The vertical mammaplasty using the skin wrinkling suture techniques can be used in breast reduction of various sizes, owing to the advantages of consistent, good and stable result, simplicity to perform and grasp and no scar in the submammary fold.</p>

Anatomic study of perforator neurovascular bundles of the deep inferior epigastric perforator flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the anatomic characteristics of the perforator neurovascular bundles in the anterior abdominal wall for the anatomical basis of the sensate deep inferior epigastric perforator (DIEP) flap.</p><p><b>METHODS</b>Abdominal wall dissection was performed on 9 embalmed female cadavers (18 sides).</p><p><b>RESULTS</b>Most of the deep inferior epigastric perforators emerged at the anterior sheath of the rectus. There were averaged 17.5 perforators on each side, with the diameter equal to or larger than 0.5 mm in 7.8 perforators. The number of skin perforators was the greatest in the supero-medial area. 56.2 percent of vascular perforators traveled with the sensory branches while 80.9 percent of larger perforators (> or = 0.5 mm in diameter) run with the sensory branches.</p><p><b>CONCLUSIONS</b>The lateral perforator neurovascular bundle was the first choice in the design of the sensate DIEP flap.</p>

Clinical analysis of 80 cases of breast reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the reasons for the complications after breast reconstruction.</p><p><b>METHODS</b>The reasons for the complications after breast reconstruction were analyzed in flap necrosis, abdominal wall laxity or hernia and seroma.</p><p><b>RESULTS</b>The partial necrosis rate of LDF, TRAM and DIEP was 7.5%, 26% and 14.2% respectively. The total flap necrosis rate in DIEP was 7.1%. In 19 cases using breast prosthesis, the capsular contracture rate was 21%.</p><p><b>CONCLUSIONS</b>The key to reduce the complications is proper selection of an operative method and the indications. The plastic surgeon should be qualified and with better comprehension of the knowledge about breast reconstruction.</p>