Comparison study of clinical effect and complications between subfascial and submammary breast augmentation / 中华整形外科杂志

<p><b>OBJECTIVE</b>To compare the clinical effect and complications of subfascial breast augmentation and submammary breast augmentation.</p><p><b>METHOD</b>From Sept. 2009 to May 2012 , 25 patients with subfascial breast augmentation and 31 patients with submammary breast augmentation were observed. The postoperative results including visible implant edge or ripple, upper pole of the implant and long-term implant ptosis were compared respectively. The complications including hematoma, infection and capsular contraction were also recorded.</p><p><b>RESULTS</b>56 cases were followed up for 2 months to 26 months. The incidence rate of visible implant edge or ripple was 4.0% (1/25 ) in the subfascial group and 29.0% (9/31) in the submammary group, showing a significant difference between them ( PC 0.05). The incidence rate of convex upper pole of the implant was 8.0% (2/25) in the subfascial group and 35.5% (11/31) in the submammary group, showing a significant difference between them ( P < 0.05). Long-term implant ptosis was not found in the two groups. The incidence rate of hematoma was 4.0% (1/25) in the subfascial group and 6.5% (2/31) in the submammary group, infection was not found. The incidence rate of capsular contraction was 8.0% (2/25) in the subfascial group and 12.9% (4/31) in the submammary group, showing no statistical difference between them ( P > 0.05 ).</p><p><b>CONCLUSIONS</b>Subfascial breast augmentation has more clinical advantages compared with submammary breast augmentation, but no evident difference was found in the common complication rate, such as capsular contraction.</p>

Reduction mammaplasty with central gland pedicle based on Würinger's horizontal septum / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the method and efficacy of reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum in the treatment of female breast hypertrophy.</p><p><b>METHODS</b>From Mar. 2009 to Sept. 2011, a series of 21 consecutive patients with mild and moderate hypermastia underwent reduction mammaplasty with central gland pedicle. Only the mammary gland located at cranial portion of septum was resected and the mammary gland located at caudal portion of septum was preserved.</p><p><b>RESULTS</b>In our series, the mean resection weight per breast was (327.8 +/- 148.6) g, the mean nipple-to clavicle midpoint was 20.0 cm (range, 18.0-22.0 cm) and the mean nipple-to-sternal-notch distance was 21.0 cm (range, 19.5-22.5 cm) postoperatively. Nipple was moved upward 6.5 cm on average (range, 4.0-10.0 cm). There was no hematoma and nipple-areolar complex (NAC) necrosis. Minimal wound dehiscence occurred in one case and healed by dressing change. 17 cases were followed up for 3 months to 2 years. Satisfactory breast shape was achieved with good NAC sensibility.</p><p><b>CONCLUSIONS</b>The reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum is a safe and reliable technique for mild and moderate hypermastia. Satisfactory breast contour, as well as NAC viability and sensibility, could be achieved with lower occurrence of hematoma or seroma.</p>

Primary culture of mammary epithelial cells derived from human breast hypertrophy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the primary culture of mammary epithelial cells derived from human breast hypertrophy.</p><p><b>METHODS</b>Mammary epithelial cells of human breast hypertrophy were isolated and cultured by the collagenase digestion method. The morphology observation and identification of the cultured cells were performed by inverted microscope observation, HE staining and cytokeratin immunohistochemical staining.</p><p><b>RESULTS</b>Most of the cultured cells were pebbles-like or polygon under the inverted microscopy. Some had irregular form. They had typical island-like appearance during multiplication with close connection between the cells. The HE staining results showed the cytoplasm was stained pink or lilac, the nucleus was stained bluish violet and was round or oval in shape, with clearly visible chromosomes in dark blue. The cytokeratin immunohistochemical staining demonstrated the tissue-specific expression of cytokeratin 18 in epithelial cells by the cytoplasm stained claybank.</p><p><b>CONCLUSION</b>High purity of primary mammary epithelial cells derived from human breast hypertrophy can be obtained by the collagenase digestion method and conditioned medium.</p>

Antioxidant activity constituents from root of Rubus crataegifolius / 中国中药杂志

<p><b>OBJECTIVE</b>To study the antioxidant constituents from the root of Rubus crataegifolius.</p><p><b>METHOD</b>The constituents isolation and purification from the root of R. crataegifolius was carried by reported column chromatography including silica gel, toyopearl, and their structures were elucidated on the basis of spectral compounds. DPPH method was used to evaluate the free radical scavenging activity of the isolated compounds.</p><p><b>RESULT</b>Nine compounds were isolated from the root of R. crataegifolius, and their structures were identified as follow: euscaphic acid (1), kaempferol-3-O-beta-D-galactopyranoside (2), tormentic acid (3), 2alpha, 19alpha, 24-trihydroxyurs-12-ene-3-oxo-28-acid (4) , 2alpha-hydroxy-oleanolic acid (5), ursolic acid (6), daucosterol (7), beta-sitosterol (8) and polydatin (9). By experiment of antioxidant activity, the result showed compounds 2 and 9 revealed DPPH free radical scavenging rates were 95.60% and 75.23% at the concentration of 50 mg x L(-1).</p><p><b>CONCLUSION</b>Compounds 1-8 were isolated from this plant for the first time, and compounds 2 and 9 showed the significant antioxidant activity.</p>

Auricular reconstruction by soft tissue expansion techniques without skin grafting / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate a method of auricular reconstruction by soft tissue expansion techniques without skin grafting.</p><p><b>METHODS</b>Two tissue expanders (50 ml and 70 ml) were implanted under the skin of mastoid in 15 patients with grade II or III microtia. One big expander (100 ml) were implanted under the skin of mastoid in 13 patients with grade I microtia and 3 patients with grade II or III microtia. After skin expansion, the expanders were taken out. The autologous rib cartilage or Medpor scaffolds were implanted. The superior expanded skin flap was used to cover the frontal surface and the upper part of the back surface of the framework. The inferior expanded skin flap was transplanted to cover the lower part of the back surface of the framework. The remained expanded skin flap was transplanted to cover the wound in the lateral of head.</p><p><b>RESULTS</b>No skin graft was needed in all the patients. Epidermis blister occurred at the distal part of flap in one case. No other complication was happened. A follow-up of 6 to 12 months (mean 10.9 months) was carried out in all patients with good cosmetic result when the reconstructed ear underwent second-stage operation. The scar size on the dornor site was (5.2 +/- 0.6) cm2 The satisfactory rate was 90% (28/31).</p><p><b>CONCLUSIONS</b>The expanded skin with this new method is enough for auricular reconstruction without skin grafting, leaving less complication and less scar at donor site.</p>

Expression of estrogen sulfotransferase in the mammary gland of hypertrophic breast and its significance / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of estrogen sulfotransferase (EST) in the mammary gland of hypertrophic breast and its significance.</p><p><b>METHODS</b>EST expression in the mammary gland was detected by EnVision two step method of immunohistochemistry in 15 cases with normal breasts and 32 cases with hypertrophic breasts, including 19 gland-associated cases and 13 fat-associated cases.</p><p><b>RESULTS</b>The positive expression rate of EST in mammary gland was 34.4% (11/32) in hypertrophic group and 93.3% (14/15) in normal group, showing a significant difference between the two groups (P < 0.01). The positive expression rate of EST was 10.5% (2/19) in gland-associated group and 69.2% (9/ 13) in fat-associated group, showing a significant difference between the two groups (P < 0.01).</p><p><b>CONCLUSIONS</b>Decrease or deletion of EST in the mammary gland may be related to the development of hypertrophic breast, especially gland-associated hypertrophic breast.</p>

Correction of mild and moderate breast ptosis with glandular flap combined with dermal flap suspension / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of glandular flap combined with dermal flap suspension for correction of mild and moderate breast ptosis.</p><p><b>METHODS</b>The dermal flap was formed according to the breast ptosis and dissection was performed between the skin and gland. The superior-lateral gland was partially resected or cut vertically only to form the lateral glandular flap. Then the glandular flap was rotated medially and fixed to shrink the glandular base area. Then the breast was up-positioned and fixed with dermal flap to remodel the breast shape.</p><p><b>RESULTS</b>From Mar. 2006 to Mar. 2010, 46 cases were treated with satisfactory result. There was no severe complication, except for 2 cases of unilateral hematoma. 40 cases were followed up for 6 months to 4 years with good breast shape. No secondary ptosis, breast flatten and NAC sensation disorder was happened.</p><p><b>CONCLUSIONS</b>Glandular flap combined with dermal flap suspension is a good method for mild and moderate breast ptosis with reliable long-term results. The breasts have busty appearance and good projection with inconspicuous scar.</p>

Auricular reconstruction and correction of mild hemifacial microsomia with dermal fat graft in one stage / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of auricular reconstruction and correction of mild hemifacial microsomia with dermal fat graft in one stage.</p><p><b>METHODS</b>28 cases with microtia and grade I and II hemifacial microsomia were treated. The tissue expander was implanted under the skin of mastoid at the first stage. At the second stage, the auricular reconstruction was performed with autologous rib cartilage framework. The remained dermal fat tissue from the donor site was inserted subcutaneously to correct the asymmetric face of microsomia. 20 cases, who underwent auricular reconstruction only, were used as control group.</p><p><b>RESULTS</b>The facial asymmetry was greatly improved after operation in the 28 cases. The complications happened in 7% (2/28) of the patients, including one case of infection and one case of framework exposure. While it was 5% (1/20) in control group, showing no significant difference between the two groups (P > 0.05). The satisfactory rate was 93% (26/28) in one-staged group and 80% (16/20) in control group (P < 0.05).</p><p><b>CONCLUSIONS</b>The dermal fat graft which should be abandoned in the traditional auricular reconstructions could be used to correct mild hemifacial microsomia with satisfactory appearance improvement.</p>

The expression of aromatase P450 in the mammary gland of hypertrophic breast / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of aromatase P450 in the mammary gland of hypertrophic breast.</p><p><b>METHODS</b>The expression of aromatase P450 in the mammary gland was detected by SP immunohistochemistry in 28 cases of hypertrophic breasts and 12 cases of normal volume breasts. The results were analysed by SPSS 13.0, and comparison among groups was performed by Fisher's exact test.</p><p><b>RESULTS</b>The positive expression rate of aromatase P450 in hypertrophic group was 39.29%, while there was no positive expression in normal group, showing a significant difference between the two groups (P < 0.05). There was no significant difference between the gland hyperplasia group and adipose hyperplasia group (P > 0.05). There were also no significant difference between the groups with different lactation history or different extent of hypertrophy and mastocytosis (P > 0.05).</p><p><b>CONCLUSIONS</b>Overexpression of aromatase P450 in mammary gland may be related to the development of hypertrophic breast.</p>

Auricular reconstruction with overlapping tissue expansion techniques / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate a method of auricular reconstruction with overlapping tissue expansion techniques and without skin graft.</p><p><b>METHODS</b>Two tissue expanders were implanted subcutaneously at the mastoid. 6 patients with microtia (overlapping group) were treated. After completion of skin expansion, the expanders were removed. The autologous rib cartilage or Medpor scaffolds were implanted. The flap A made by the upper expanded flap was used to cover the upper part of the front and the back of the framework. The flap B made by lower expanded flap was transplanted to cover the lower part of the back of frameworks. The remaining expanded skin was designed to cover the postauricular wound. The other thirteen microtia patients who treated by the traditional auricular reconstruction were selected as control(traditional group).</p><p><b>RESULTS</b>Skin graft was not necessary in the patients of overlapping groups. The appearance of the reconstructed ear was very satisfactory. Epidermal necrosis of 0.5 cm x 0.5 cm happened at the distal end of postauricular flap in one case. All the other cases had no complication of infection or framework exposure. The patients were followed up for 3-6 months. Compared with the traditional group, the scar in the costal donor site was inconspicuous in overlapping group (P < 0.05). The complication rate was lower and satisfactory rate was higher in overlapping group (P < 0.01 and P < 0.05). But there was hair growth in the helix of reconstructed ear in overlapping group.</p><p><b>CONCLUSIONS</b>The overlapping expansion can provide enough skin for ear reconstruction. The skin graft is not necessary, resulting less donor site scar and low complications.</p>

3-Dimensional reconstruction of MRI in patients with polyacrylamide hydrogel injection for augmentation mammoplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effective diagnostic method for the patients with polyacrylamide hydrogen injection for augmentation mammaplasty.</p><p><b>METHODS</b>MRI scanning (layer thickness 1mm, t2 _ ps3d_ cor alignment) was performed on 23 patients with polyacrylamide hydrogen injection for augmentation mammaplasty. The data were imported into computer and processed. 3D reconstruction and analysis modules were run subsequently to do the volume reconstruction and surface reconstruction to obtain stereoscopic images of the gel and adjacent structures in virtual reality, and to calculate the volume of the hydrogel.</p><p><b>RESULTS</b>Among the 23 patients (46 breasts), the injected hydrogel with integrity capsule existed in retromammary space with no malposition in 5 cases (10 breasts). The capsule was not integrally formed and hydrogel was separately distributed with irregular edge in 6 patients (12 breasts). The pectoris major space, subcutaneous and gland invasion was found in 11 patients (22 breasts). Small amount of hydrogel sparsely distributed in mammary gland and degenerative muscular tissue in 1 patient (2 breasts) who had received extracting surgery before. The volume of hydrogel ranged from 220.309 ml to 372.371 ml (mean: 306.328 ml) in 22 untreated patients (44 breasts).</p><p><b>CONCLUSIONS</b>The volume and distribution of hydrogel can be known clearly by 3D MRI reconstruction technique. This feasible technique is helpful in removing the hydrogel completely.</p>

Analysis of the complications following the periareolar reduction mammaplasty using polypropylene mesh as suspension device / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the cause and the prophylactic measures for the complication following the periareolar reduction mammaplasty using polypropylene mesh as suspension device.</p><p><b>METHODS</b>From Dec. 1999 to Dec. 2005, 78 patients who underwent periareolar reduction mammaplasty using polypropylene mesh as suspension device were analysed. Among them, 47 cases were followed-up for 6 months to 5 years, and their long-term effect was evaluated.</p><p><b>RESULTS</b>Early after operation, complications included seroma (3 cases), infection (3 cases), delayed wound healing (3 cases), and paraesthesia of nipple-areolar complex (1 case). The 47 followed-up patients presented abnormal wave-like skin appearance in superior polar of breast (7 cases), palpable cord-like mammary content in peripheral region of breast (3 cases), widening of periareolar scar and secondary ptosis (2 cases) and paraesthesia of nipple-areolar complex (1 case). All other patients acquired good appearance and felt satisfactory. 2 patients could lactate after operation. 5 patients underwent mammary X-ray radiography after operation. No mesh shadow or calcification was revealed.</p><p><b>CONCLUSIONS</b>Although polypropylene mesh is a good suspension device in reduction mammaplasty, the long-term complication is relatively high because of the hardness of the tissue. More soft tissue is necessary as alternative device for clinical application.</p>

Study on alkaloids in Lobelia sessilifolia by ESI-MS(n) / 中国中药杂志

<p><b>OBJECTIVE</b>To make qualitative analysis on alkaliod in Lobelia sessilifolia.</p><p><b>METHOD</b>The ESI-MS(n) method was used for qualitative analysis.</p><p><b>RESULT</b>The structures of two alkaliods in plant extract of L. sessilifolia were successfully analyzed and identified as norlobelanine and 8, 10-diethyllobelidione by electrospray ionization multistage mass spectrometry in positive mode. Then the fragmentation mechanisms were explored.</p><p><b>CONCLUSION</b>SPE and ESI-MS(n) could simply and rapidly provide qualitative examination of alkaliods in L. sessilifolia.</p>

Studies on chemical constituents from stems and leaves of Jasminum lanceolarium / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the chemical constituents in stem and leaves of Jasminum lanceolarium.</p><p><b>METHOD</b>The constituents of the EtOAc-soluble portion of the 95% ethanol extractive were isolated and purified by means of column chromatographic methods. Compounds were identified by their physical characteristics and spectral features.</p><p><b>RESULT</b>Eight compounds were isolated and identified as 5, 7, 3', 5'-tetrahydroxyflavanone (1), (2S)-5, 7, 3', 4'-tetrahydroxyflavan-5-O-beta-D-glucopyranosie (2), mannitol (3), nonacosane (4), trans-p-coumaric acid (5), cis-p-coumaric acid (6), ferulic acid (7) and, trans-cinnamic acid (8).</p><p><b>CONCLUSION</b>Compounds 14 were isolated from this genus for the first time. And compounds 5 and 6 were isolated from this plant for the first time.</p>

Separation of gastrothoracopagus conjoined twins: 2 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate reasonable surgical therapy for conjoined twins.</p><p><b>METHODS</b>Two pairs of gastrothoracopagus were admitted in July 2004 and April 2005 respectively. The first pair was separated by emergency surgery for the rupture of umbilical hernia resulting in the exposure of intestines. The thoracic and abdominal wall was repaired with local skin flaps, and the secondary wound was covered with artificial skin. Skin expanders were embedded in thoracic and abdominal wall 2 months after birth in the second pair. The surgical separation was performed one month after. The deficiencies of pericardium, sternum and abdominal wall were reconstructed by allogenic grafting of pericardium, porous polyethylene implant and monofilament polypropylene patch respectively. The thoracic and abdominal wall was repaired with expanded rotation skin flap.</p><p><b>RESULTS</b>The first twins died of respiratory failure and circulatory and respiratory failure 2 hours and 39 hours after the separation respectively. Both of the second pair survived and were discharge after healing.</p><p><b>CONCLUSIONS</b>The separation of gastrothoracopagus should be performed after skin expansion in the interest of the closure of wound. It's better to use porous polyethylene implant and monofilament polypropylene patch to reconstruct the sternum and abdominal wall respectively.</p>

Preventive effect of chitosan on capsular contracture after implantation of silicone gel-filled mammary implants in rats / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the preventive effect of chitosan on capsular contracture after implantation of silicone gel-filled mammary implants in rats.</p><p><b>METHODS</b>18 SD female rats were divided into three groups randomly. Small silicone gel-filled mammary implants were implanted under each side of latissimus dorsi muscle. Chitosan was injected into left cavities as experimental sides, and nothing was injected into right cavities as control sides. 4, 8 and 12 weeks postoperation, specimens were dissected and observed using light microscope, and area density of collagen both type I and type III were also detected.</p><p><b>RESULTS</b>Fibrous capsules around implants consist of two layers: dense layer and loose layer. 4 weeks postoperation, total thickness of the experimental sides was less than that of the control sides (P < 0.01). Area density of collagen either type I or type III of the experimental sides was lower than that of the control sides (P < 0.01). Both 8 and 12 weeks postoperation, total thickness of the experimental sides was less than that of the control sides (P < 0.05). Area density of collagen type I of the experimental sides was lower than that of the control sides (P < 0.05). Area density of collagen type III was of no statistical difference between the experimental sides and the control sides (P > 0.05).</p><p><b>CONCLUSIONS</b>Chitosan can remarkably prevent capsule contracture during the early period after implantation of silicone gel-filled mammary implants.</p>

Correction of the secondary deformity after reduction mammaplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate a safe method for correcting the secondary deformity after reduction mammaplasty.</p><p><b>METHODS</b>A periareolar incision or original incision was done and the wedge-shaped glandular tissues were removed inferior-laterally in 11 patients.</p><p><b>RESULTS</b>10 cases obtained the satisfactory results. One patient underwent the third operation 6 months after because of the obvious scar, and the result was yet unsatisfactory 1 year later.</p><p><b>CONCLUSIONS</b>No matter which pedicle was used in the first reduction mammaplasty, a periareolar incision or original incision with wedge-shaped glandular tissue resection is a safe method for repeated reduction mammaplasty.</p>

The periareolar approach management of postoperative complications of breast augmentation by injected polyacrylamide hydrogel / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analysis various complications of 30 patients of breast augmentation by injected polyacrylamide hydrogel and discuss the treatment through periareolar incision.</p><p><b>METHODS</b>All patients were classified according to the different complications. Open suction technique and partial mastectomies via periareolar incisions were performed in all patients, Only one patient had immediately breast reconstruction with prosthesis, five patients received secondarily breast prostheses implantation via a axillary incision.</p><p><b>RESULT</b>All the symptoms were relieved after remove of polyacrylamide hydrogel.</p><p><b>CONCLUSIONS</b>Polyacrylamide hydrogel should be prohibited for injected breast augmentation at present. A double-blinded randomized clinical study, controlled animal experiments and a large sample questionnaire survey for complications are necessary. The periareolar approach is valuable technique and can remove polyacrylamide hydrogel as completely as possible.</p>

Treatment of the complications of polyacrylamide hydrogel injection for augmentation mammaplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>The purpose of this study was to search for a perfect treatment for the complications after polyacrylamide hydrogel injection for augmentation mammaplasty.</p><p><b>METHODS</b>48 patients who accepted polyacrylamide hydrogel injection for augmentation mammaplasty were included in this study. Operations were performed for the complications of polyacrylamide hydrogel injection. The clinical data were analyzed and the experience in the treatment of the complications was summarized.</p><p><b>RESULTS</b>All patients were satisfied with the result of the operation. The B-ultrasonic examination showed that no visible polyacrylamide hydrogel remained in the cavity.</p><p><b>CONCLUSION</b>The best therapy for the complications of polyacrylamide hydrogel injection was removing of the polyacrylamide hydrogel and the pathologic tissue and irrigation of the cavity.</p>

The expression and interaction of cyclin D1 and p16 in fibroblasts of pathologic scars / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of cyclin D1, p16, AR and ER in fibroblasts of scars for further understanding the interaction of these factors and the roles that they play in scar development.</p><p><b>METHODS</b>Thirty samples of mature scar, hypertrophic scar and keloid were detected with immunohistochemical method (SP technique) and compared with normal skin.</p><p><b>RESULTS</b>There were on positive results in normal skin and mature scars. The expression of cyclin D1, p16 and AR was higher in hypertrophic scars and keloids than in normal skin with significant difference (P < 0.05). The expression of cyclin D1 in keloids was higher than in hypertrophic scars (P < 0.05). Though the expression of p16 was higher in keloids than in hypertrophic scars, the difference was not significant. There was significant correlation between the expression of cyclin D1 and AR in the pathologic scar.</p><p><b>CONCLUSION</b>The AR played an important role in scar formation and displayed its function through cyclin D1. The expression of p16 could suppress the excessive proliferation of cells to some extent. If the effect was not enough to resist the function of cyclin D1, long-term proliferation of cells would occur and lead to keloid formation. As the expression of cyclin D1 and p16 in hypertrophic scars was in a state of relative equilibrium, the cell proliferation showed a tendency of self-restriction.</p>