Application of three-dimensional scanning technology in evaluating breast symmetry in reduction mammaplasty / 中华医学美学美容杂志

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.

Endoscopic assisted axillary approach of gynecomastia subcutaneous mastectomy: a prospective cohort study / 中华医学美学美容杂志

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.

Biomechanical Effects of Primary Cilia in Articular Cartilage / 医用生物力学

Biomechanical factors play a crucial role in the steady-state maintenance of articular cartilage. The primary cilium (PC) is a kind of organelle which can sense mechanical and chemical signals at the same time. It is also distributed on the surface of chondrocyte membrane. It is involved in multiple signal transduction pathways as well as in the process of chondrocyte phenotype maintenance and material metabolism. Abnormalities in PC are also associated with a variety of human bone and joint diseases. This paper mainly discusses the mechanism of PC in mechanical microenvironment of chondrocytes and the interaction with other signaling pathways, and explores its relationship with bone and joint diseases, so as to provide some scientific basis for clinical and basic research in orthopedics.

Factors of fat necrosis after breast reconstruction with autologous fat graft / 中华医学美学美容杂志

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.

Quality of life and effects of breast reconstruction in patients with breast deficiency: a cross-sectional study / 中华整形外科杂志

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.

Classification and applications of the pedicled deep inferior epigastric artery perforator flap / 中华整形外科杂志

Objective@#To propose a classification method and explore the indications and technical tips of the pedicled deep inferior epigastric artery perforator (DIEAP) flap.@*Methods@#From July 2005 to December 2017, 18 patients underwent soft-tissue defect repairment using the pedicled DIEAP flap. The defect locations included abdomen (n=6), iliolumbar region (n=2), perineum (n=4), and proximal thigh (n=6). The flaps were divided into two types. The type Ⅰ flap were further subdivided into two subtypes. The type Ⅰa flap was solely based on the DIEAP. The type Ⅰb flap was also based on the DIEAP, however, the main trunk of the deep inferior epigastric vessels needs to be divided to further improve the pedicle length. The type Ⅱ flap was the traditional pedicled DIEAP flap.@*Results@#Twenty flaps were included in this series. The mean flap size and pedicle length of the 4 flaps in type Ⅰa were 19.0 cm× 6.5 cm and 2.88 cm respectively. The rotation angles were 60 degrees (n=1), 120 degrees (n=1), and 180 degrees (n=2). The 3 flaps of type Ⅰb was 26 cm × 6 cm, 20 cm × 5 cm and 24 cm × 7 cm in size, and the pedicle lengths of them were 6 cm, 7 cm and 7 cm, respectively. All flaps in this subtype were rotated by 180 degrees. The mean flap size and pedicle length of the 13 type Ⅱ flaps were 21.46 cm × 9.38 cm and 11.08 cm. 17 flaps completely survived postoperatively. Small-sized necrosis of the distal portion of the flap occurred in 3 flaps. All patients were followed up for 6 months to 5 years, with the averaged 11 months follow-up time. All patients were satisfied with the final outcomes. Tumor recurrence was not noticed for the oncological patients.@*Conclusions@#The pedicled DIEAP flap has remarkable versatility in the defect repairment for the regions including abdomen, iliolumbar region, proximal thigh, and perineal region. Combining with the " propeller flap" concept, the clinical application of pedicled DIEAP flap could be further expanded. The pedicled DIEAP flap is a reliable reconstructive method for defect repairment in abdominal and iliolumbar regions.

Breast reconstruction with external tissue expansion-assisted autologous fat grafting / 中华整形外科杂志

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.