McGhan解剖型乳房假体参数系统改进与手术技巧

A modification of the parameter system and surgical techniques with McGhan anatomical implants for breast augmentation

目的:总结自2000年以来323只应用和改进McGhan解剖型假体参数系统的经验与手术技巧。方法:为便于国人个性化选用假体,将Tebbetts的经验参数系统加以改进。原则上:215g左右为起点,中突为主;分别以乳头至胸骨上切迹(SN-N)和乳头至中线(ML-N)决定假体长宽,身高作为参考。SN-N:19cm以上多选高长(FL,FM,FF),19～17cm多选中长(ML,MM,MF),17cm以下多选低长(LL,LM,LF);ML-N:ML-N宽度+2cm=假体宽度;身高:165cm以上多选高长,165～160cm多选中长,160cm以下多选低长。植入技巧是正面标记的两点要最后放入,且上点位于乳晕切口下1～2cm为宜,腺体越少标记点越应偏低。结果:323只假体中,MM型和体积205～235g最为常用;以乳晕切口为主(89.5%);半数多置于腺体下;随访半个月～4年,103例(两个月以上87例)中无1例变形,但3例中等硬度,其中1例需手术松解矫正。外形均较满意。结论:解剖型假体的问世完全改变了传统圆形假体只有体积选择的概念,可通过不等比例的改变非正圆形假体的高、宽、突和体积参数,相对更自然、更科学的隆乳。

Objective To describes the use of improved parameter system and surgical techniques with 323 McGhan anatomical implants for breast augmentations since 2000. Methods Tebbetts＇s parameter system （measurements） was simplified according to the oriental characteristics.A general rule of thumb： Usually select implants over 215 grams with mainly in the moderate projection;Implant height and width depending greatly on the two lines（i.e., the sternal notch distance （SN- N）and middle line to nipple （ML- N））,reference to body height.In cases in which the SN-N distance is longer than 19cm and the body height is over 165cm,the full-height implants can be considered.In cases in which the SN-N distance is 19cm to 17cm and body height is 165cm to 160cm,the moderate-height implants were suitable.When SN-N distance is less than 17cm and the body height is less than 160cm the low-height implants should be preferred.The implant width is usually decided by the ML to N adding 2cm.The two marked dots on the superficial surface of the implants should be put at the last implantation and the higher dot be seen below periaeorla incision for 1-2cm.The less the glandular is,the lower the dots was put. Results 323 anatomic implants were implanted in 162 women.Most of implant volume was range from 205-235 grams.The style 410 MM models were in common use.Most of implantation was made through the periareola （89.5%）. 103 patients were followed up for 2 weeks to 4 years. No distortion was observed with all patient satisfaction in outline. However, 3 of these have a slightly firmer breast compared with a traditional liquid silicone-filled implant breast.Severe capsular contracture was noted in one case and was treated by disentangling operation. Conclusion The fact that the stable form and the outline of cohesive fillers works against folding in the material is obviously preferable anatomical implants to round implants.