Lanhua Mu

Breast augmentation by autologous fat injection grafting: management and clinical analysis of complications.

Autologous fat is an excellent soft-tissue filler, given its abundance and ease of harvest. Nevertheless, the technique is accompanied by postoperative complications such as fat necrosis, calcification, and sclerotic nodules. These problems directly influence surgical efficacy.Computed tomography or magnetic resonance imaging was used to confirm the location of abnormal adipose tissue preoperatively. Depending on the characteristics of the lesion, the liquefied fat was aspirated or the sclerotic lesion excised. Pressurized dressings were used postoperatively for both techniques.Seventeen patients who experienced complications after autologous fat injection were treated. Pathologic examination of excised samples demonstrated changes including fat necrosis, calcification, hyalinization, and fibroplasia.Intramammary autologous fat injection should only be used with caution. Selecting suitable indications and correct surgical techniques make autologous fat grafting an ideal method for breast augmentation. Strictly controlling the injection volume and injecting diffusely in multiple layers to allow fat granules to distribute evenly within the breast, are effective methods to reduce postoperative complications.

A prospective study of breast dynamic morphological changes after dual-plane augmentation mammaplasty with 3D scanning technique.

Background The dual-plane technique has been widely used in augmentation mammaplasty procedures. However, there are some concerns about aesthetic contour maintenance for long time after muscle releasing. This study aims to track and analyze breast dynamic morphological changes after dual-plane breast augmentation with three-dimensional (3D) scanning technique. Methods Thirteen dual-plane anatomic implant augmentation patients underwent 3D scanning preoperatively (pre-OP) and postoperatively in four time points (1 month: post-1M, 3 months: post-3M, 6 months: post-6M and 12 months: post-12M). The linear distance, breast projection, nipple position, breast volume and breast surface area were measured and analyzed on the 3D models over time. Results Compared with post-12M, no significant differences were found in distances of nipple to midline, nipple to inframammary fold and sternal notch to the level of inframammary fold after 6 months in both straight-line distance and its projection on surface. The distances between sternal notch and nipple had no significant difference after post-1M. Breast volume changes had no significant difference after post-3M. The volume and area percentage of upper pole decreased while the lower pole’s increased gradually. The surface showed no significant changes after post-1M. The changes of breast projection had no significance after post-1M either. The nipple moved 1.0±0.6 cm laterally(X axis), 0.6±0.7 cm upward(Y axis) and 2.3±1.1 cm anteriorly (Z axis) at post-12M, and the differences were not significant after post-1M. Conclusions 3D scanning technique provides an objective and effective way to evaluate breast morphological changes after augmentation mammaplasty over time. Dual-plane augmentation optimizes breast shape especially in the lower pole and maintains stable aesthetic outcome during the 12 months follow-up. Most of the contour changes and the interadaptation with the implant have completed 6 months after operation. Therefore, 6 months could be chosen as a relatively stable observing period in the assessment of postoperative outcomes of dual-plane breast augmentation.

Transaxillary dual-plane augmentation mammaplasty: experience with 98 breasts

The dual plane technique is a popular procedure for breast augmentation. However, traditional dual-plane augmentation mammaplasty usually requires incisions through the areola or inframammary crease, which produces a scar on the breast. Therefore, women may not favour this technique, especially Chinese women who are genetically susceptible to hyperplastic scars. In our institution, endoscopic transaxillary dual-plane augmentation mammaplasty was performed in patients under general anaesthesia. Incisions (4 cm long) were designed to overlap the natural creases of the skin bilaterally behind the mid-transaxillary frontline. The space behind the pectoralis major muscle was separated conventionally. Assisted by a 10mm/30 degrees endoscope, part of the ectopectoralis was excised. Through the transaxillary incision, the rough-surfaced silicone gel breast prosthesis was implanted. The volume varied from 185 to 315 g, and a routine indwelling drainage tube was inserted. From March 2006 to May 2007, we performed 49 cases of augmentation mammaplasty applying endoscopic-assisted dual-plane technique. At 6- to 12-month follow up, the surgical outcomes were satisfactory. There were no complications, such as capsular contracture, bleeding, scar hyperplasia, or infection. We believe that the dual-plane augmentation mammaplasty can be performed via transaxillary incision using an endoscope. Since the surgical incision is far from the front of the breast with this method, no scarring of the breast develops. Furthermore, the adoption of the dual-plane technique provides superior form to the anatomical prosthesis in the breast, alleviates postoperative pain, and improves suppleness of the postoperative breast.

The efficacy of preoperative vascular mapping by MDCTA in selecting flap in abdominal flap breast reconstruction.

Abstract:  Current methods of breast reconstruction using abdominal tissue include the transverse abdominal myocutaneous (TRAM) flap, deep inferior epigastric arterial perforator (DIEP) flap, superficial inferior epigastric arterial (SIEA) flap, and some other composite flaps. Because of the variant vascular anatomy in abdominal region, it is hard to choose an appropriate flap for a specific patient without accurate preoperative vascular mapping. This study was drawn to address the efficacy of preoperative vascular mapping by multidetector‐row computed tomographic angiography (MDCTA) in selecting flap in abdominal flap breast reconstruction. A total of 34 breast reconstructions using abdominal flap from December 2006 to July 2009 were included. In all the patients included, MDCTA was performed preoperatively. Three indexes were obtained including choice of flaps, operation time, and flap complication rate. Then, these data were compared with the former data stored in the databank of our hospital from January 2004 to December 2006, before MDCTA was introduced in our center. Among the 34 patients, the flap selection was: SIEA flaps 11.8%, DIEP flaps 61.8%, TRAM flaps 11.8%, and bilateral flaps 14.7%. The correlate indexes from the data bank were as follows: SIEA flap 0; DIEP flaps 51.7%; TRAM flaps 32.8%; bilateral flaps 15.5%. p < 0.05 occurred between the comparison of SIEA, DIEP, and TRAM flap choice in the two groups. The operation time in the study group was as follows: SIEA flap (4.02 ± 0.46) hours, DIEP flap (6.23 ± 1.42) hours, TRAM flap (4.72 ± 1.53) hours, Bilateral flap (7.86 ± 1.16) hours; while the former correlate data were: DIEP (9.67 ± 1.74) hours, TRAM flap (6.64 ± 1.83) hours, bilateral flap (11.83 ± 1.35) (all the three comparison p < 0.05). The total flap complication rate was about 5.9% in the test group; while in the databank, it was 12.1% (p < 0.05). With the accurate mapping of vascular territory in abdomen by MDCTA, we could easily select a suitable abdominal flap for breast reconstruction, and we can also simplify the procedure to save operation time and make the process more safely.

The relationship between the thickness of de-epithelialization and occurrence of sebaceous cysts at the incision site after mastopexy and reduction mammaplasty.

Periareolar sebaceous cysts at the incision site after mastopexy and reduction mammaplasty are very unpleasant complications that affect the surgical result and the degree of patient satisfaction. The author sought to investigate the cause and prevention of such sebaceous cysts. Sixty patients undergoing mastopexy or reduction mammaplasty were randomly divided into 2 groups. Periareolar de-epithelialization was performed to a depth of superficial layer of the dermis in group A and nearly the full thickness of the dermis in group B, and the incidence of sebaceous cysts was compared between these 2 groups. Patients were followed-up for 2 to 4 years. In group A, sebaceous cysts at the incision site were found in 4 patients (13.3%); however, no sebaceous cysts occurred in group B. Increasing the thickness of de-epithelialization appears to decrease the incidence of sebaceous cysts at the incision site.

Reoperation for the Removal of Polyacrylamide Hydrogel in the Breast: Use of Periareolar Approach under Direct Visualization

After China announced a ban on polyacrylamide hydrogel (PAAG) in 2006, many patients desired the surgical removal of it. To minimize the length of incisions, some surgeons a adopted cannula aspiration and suction technique [1–4]. However, we found that not only is this technique inefficient for complete removal of PAAG, the injury caused by repeated aspiration also results in diffusion of PAAG into the healthy peripheral tissue. Blind removal is likely to result in the following problems: First, PAAG is in the form of a gelatinous mass when inserted into the body. Because it is composed of a large quantity of granules, it is difficult to aspirate out with a cannula, even after dilution with a large amount of normal saline solution. Second, PAAG infiltrates into peripheral tissue and it cannot be removed by suction. Third, in some cases, when PAAG was injected into the breast, multilevel repeated aspirations were applied to allow diffusion of PAAG into the tissue. As such, it was difficult to remove the PAAG when it was mixed with the normal tissue. Fourth, when removal is performed blindly, the exact range and amount of PAAG cannot be determined even when preoperative imaging results are available for guidance. Furthermore, injury caused by repeated aspiration resulted in many tunnels in the peripheral tissue, and these tunnels filled with hydrogel. The outcome of this approach was the formation of a mixed structure comprised of hydrogel and normal tissue, thus making an open excision very difficult. We found that the more times a patient underwent aspiration, the greater the amount of hydrogel mixed with the tissue. Subsequently, the formed mass became denser and removal became more difficult. In addition, hydrogel is an excellent bacteria culture medium. When it is not completely removed, the residual hydrogel in the incision results in nonunion and induces infection (Fig. 1). Subsequently, this induces further infection in the interhydrogel space and produces systemic symptoms. Clinically, either acute or chronic infection symptoms or fistulation occurs in the aspiration point, and it takes a long time to recover from this complication. In our patients, an inferior periareolar arc incision was used to remove the PAAG under direct visualization. Dissection was completed along the surface of the mammary gland downward to the inferior edge of the gland. A radial incision then was made on the mammary gland. Generally, residual PAAG and degenerated tissue could be

Repetitive arterial crisis of deep inferior epigastric perforator flap after mental stress: a case report.

The authors report a case of mental stress-induced repeatedly failing microsurgical flap. A 33-year-old female patient underwent a left breast reconstruction with deep inferior epigastric perforator flap. Repetitive arterial crisis occurred postoperatively, which eventually led to flap necrosis. In this case, there was clear correlation between the arterial crisis and mental factors. Mental stress may lead to arterial crisis.

Correction of chest wall depression in Poland's syndrome with flipped LDM flap

Preoperatively, the marking of the skin island flap and approximate range of dissection are made while the patient is in standing position. The specific location and size of the skin island depend on the arc of rotation and extent of the chest wall depression. In the operating room, the patient is positioned lateral decubitus. After the cutaneous incision, the dorsal skin and superficial fascia around the skin island is carefully detached from the underlying fat pad, which was right on the surface of the latissimus dorsi muscle. During this process, it is very important to avoid damaging the subdermal vascular plexus, which is essential to the blood supply of the detached dorsal skin. The latissimus dorsi muscle is mobilized in the traditional manner. The skin island is then deepithelized. An incision (usually 8e10 cm in length) in the axillary fold is made for preparation of the skin pocket on the deformed chest wall (with or without tissue expansion). Then, the myocutaneous flap is flipped and transposed into the skin pocket through a subcutaneous tunnel. The origin of the muscle is transected to make the transposition easier. Care should be taken not to injure the neurovascular pedicle. The de-epithelized skin island simply fills in the chest wall depression to a turn. The bottom of the flap is anchored to the chest wall in order to restore a normal inframammary fold, as well as to prevent inferior displacement of the prosthesis. The silicone gel prosthesis is then implanted behind the muscle flap. The final procedure is closure of the donor site and the incision in axillary fold (Figures 1 and 2).

An innovative method for intraoperative shaping and positioning of the nipple-areola complex in reduction mammaplasty and mastopexy.

Issues of hypertrophic circumareolar scars and malpositioning or irregularity of the nipple–areola complex (NAC) are frequently associated with breast reduction or mastopexy techniques that rely on an ample excision of skin around the areola, either alone or associated with a vertical incision. To avoid such problems, many efforts have been made to improve the accuracy of preoperative marking for the future NAC. However, the correct design and position of the NAC may be difficult to achieve for the patient at the end of the procedure after closure of the skin incisions. This article describes a novel, simple, and effective method for intraoperative shaping and positioning of the NAC. The described method is based on using a specially designed surgical instrument to determine the best position, diameter, shape, and configuration of a new NAC. This study aimed to demonstrate the efficacy of this method to reduce the common complications of the periareolar region in reduction mammaplasty and mastopexy.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.