胸肌筋膜下隆乳术的临床应用探讨

Approach of clinical application of augmentation mammaplasty by the plane inferior to fascia pectoralis

目的:探讨胸肌筋膜下丰胸的手术适应证及优缺点。方法:对我科近一年来124例假体丰胸病案进行总结,比较乳腺下、胸肌筋膜下及胸大肌下三个不同层次置入假体时操作难易度、术后并发症的发生率及患者术后满意度。结果:乳腺下及胸肌筋膜下置入假体时剥离较为费力,尤其是乳晕下缘至乳房下皱襞区域,胸大肌下置入假体时此区域的剥离相对来说较容易。相比较而言剥离胸肌筋膜时操作比较繁琐;术后疼痛感以胸大肌下置入假体最为明显,乳腺下与胸肌筋膜下无明显区别。胸肌筋膜下置入假体术后发生假体移位及出现包膜挛缩的几率最低,胸大肌下及乳腺下无明显差别。假体边缘的触及感以乳腺下最为多见。术后血肿的发生率胸肌筋膜下置入假体最低;术后满意度胸肌筋膜下置入假体最高。结论:胸肌筋膜下置入假体操作虽较繁琐但术后出现并发症的几率低,仿真性强,患者满意度高,有一定乳腺基础的患者是最适合的受术人群。

Objective To investigate the indications of augmentation mammaplasty by the plane inferior to fascia pectoralis and its advantages and short-comings. Methods Summarize 124 cases which received breast prosthetic implantation in our department in the past one year. Compare the degree of difficulty, postoperative complications and cosmetic effects of different methods. Results When stripping the lacune for prosthesis, it is relatively easier to lay the breast prosthesis via the plane inferior to pectoralis major than via the plane inferior to fascia pectoralis or via the plane inferior to mammary gland.When comparing the three methods, it is most difficulty for the surgeon to operate via the plane inferior to pectoralis major. While the postoperative pain appears most severe via the plane inferior to pectoralis major. The postoperative complications,including envelope contraction, hematoma and prosthesis displacement,occurred lest via the plane inferior to fascia pectoralis while the breast appearance showed to be satisfactory. Conclusion It could be an optimal alternative for patients with some basal mammary gland to undertake breast prosthesis implantation via the plane inferior to fascia pectoralis.