内镜下经腋路双平面法假体隆乳术58例经验介绍

Transaxillary dual-plane breast augmentation using silicone gel implants under endoscope： 58 cases report

目的 探讨内镜辅助技术及双平面法在经腋路假体隆乳术中的优点及重要性,并总结操作要点及手术经验.方法 切口位于双侧近胸壁侧腋横纹,长4.0～5.0cm.根据患者乳房特点,设计新的乳房下皱襞水平（距乳头的垂直距离≥8.0cm）及内外侧剥离边界,根据腺体及皮下组织量的多少,设计胸大肌离断水平.插管下全身麻醉,在胸大肌后间隙,置入10mm-30°内窥镜,用电钩凝切分离至设计范围,沿胸大肌离断水平线凝切离断肌肉直至显露腺体,构成双平面,然后置入适合的硅凝胶假体,留置负压引流3～5d.结果 术后42例患者获随访6～12个月,与传统的盲视下单一平面假体隆乳患者相比,本组患者术后乳房外形更自然逼真,手感柔软,活动度增大,疼痛及局部肿胀明显减轻,无包膜挛缩发生,手术效果非常满意.结论 内窥镜的应用使双平面构建更确切,剥离更到位,止血更彻底,能充分发挥胸大肌后间隙和乳腺后间隙隆乳术的优点,摒弃其缺点.此手术方法以微创、精确为特色,满足了现代女性对自然美、和谐美的要求,是假体隆乳术的发展趋势.

Objective To discuss the importance and virtues of transaxillary dual-plane technique under endoscope and sum up the main experiences in breast augmentation using silicone gel implants. Methods The limits of implant pocket were outlined preoperatively, based on the characteristics of mammary glands, including the new levels under the breast fold （ the vertical distance from the nipple≥8.0 era）, left and right boundary, and pectoralis major muscle splitting location. All cases were under general anesthesia, a dual-plane im- plant pocket were dissected within the marking limits through a 4.0 to 5.0 cm transverse incision following the natural axillary creases, which was closed by the lateral chest wall, with the help of a 10 mm, 30° endoscope and endoscopic diathermy scissors. The silicone gel implant was placed into the pocket. The vacuum drainages were left in both sides for 3 to 5 days. Results Fifty-eight patients underwent the transaxillary dual-plane aug- mentation mammoplasty under endoscope. After 6 to 12 months follow-up, compared with traditional single- plane technique under blindness, both surgeons and patients were satisfied with aesthetically natural appearance and soft handle. There was no complication such as capsular contracture, lateral displacement, or double-bubble deformity. Conclusion This technique is an excellent tool for patients who prefer a distant incision. It provides good control over dissection, allows the use of dual-plane technique and keep a minimum bleeding during surgery, thus avoiding the risk of deflation. In addition, recovery is faster than other techniques with there is less bruising and pain.