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>

Transaxillary dual-plane breast augmentation with endoscope assistant / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of transaxillary dual-plane breast augmentation with endoscope assistant.</p><p><b>METHODS</b>The submuscular pockets were separated through a 4 cm transverse incision in the axilla. The pectoralis major muscle were split from the costal margin with the help of a 10 mm, 30 degree endoscope and endoscopic diathermy scissors. Soft cohesive gel microtextured anatomic style silicone implants ranging in size from 185 to 315 g were placed through the axillary incision. The vacuum drainage was used for 3 approximately 5 days.</p><p><b>RESULTS</b>79 patients underwent the dual-plane breast augmentation. Postoperative analgesia requirements were reduced because of muscle strength releasing. The follow-up period was 4 to 6 months with satisfactory results. All the patients had aesthetically natural appearance, with the nipple at the most projected part of the breast. No rippling, lateral displacement, double-bubble deformity, or muscle contraction-associated deformities were seen. There was no complications such as capsular contracture, hematoma, hypertrophic scar, and infection.</p><p><b>CONCLUSIONS</b>Dual-plane breast augmentation using textured silicon gel implant can be completed with the endoscope assistance through the axillary incision. The technique combined retromammary and partial retropectoral pocket locations to optimize the benefits of each pocket location while avoiding the drawbacks of extra incision on the breast.</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>

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>