聚丙烯酰胺水凝胶隆乳术后取出及乳房畸形修复方法

Removal of injected polyacrylamide hydrogel and repair of deformity after breast augmentation

目的 探讨聚丙烯酰胺水凝胶（polyacrylamide hydrogels,PAHG）注射隆乳术后取出PAHG及修复术后乳房畸形的手术方法和时机.方法 经乳晕下缘1/2长切口,利用内镜辅助进行注射物清除术,根据注射物侵蚀范围确定是否行同期硅凝胶乳房假体（以下简称假体）置入术,利用生物修补膜固定假体并重塑乳房下皱襞.结果 46例中,39例注射物及其包膜被完全取出,7例取出游离PAHG,而包膜因广泛且单薄致有残留.14例同期置入乳房假体,其中5例应用生物修补膜;4例Ⅱ期置入假体;切口均Ⅰ期愈合,切口瘢痕不明显;1例伴发乳腺癌患者切除患侧乳房;1例同期置入假体及生物修补膜,术后3个月出现假体移位,再次手术重新固定;1例应用生物修补膜,术后出现注射物残腔积液,最终取出生物修补膜.结论 采用经乳晕下缘1/2长切口内镜辅助下行PAHG取出并完整去除包膜的手术,注射物取出彻底,可应用假体同期或延期修复取出术后乳房的畸形,必要时应用生物修补膜固定假体并重塑乳房下皱襞形态.

Objective To explore surgical methods of removing polyacrylamide hydrogel （PAHG） and the right time of repairing the deformity of breast after removing PAHG.Methods We operated with endoscopy to remove PAHG through the lower mammary areolar incision.According to injection influence,we made the dicision whether to put the silicon gel prosthesis （hereafter referred to as prosthesis） simultaneously,and to fix the porsthesis,and to rebuild the imframammary fold of breast using biological repair membrane （hereafter referred to as membrane）.Results In all 46 patients,39 patients＆#39; injection and their envelope were removed entirely.7 patients left part of the envelope because of its thin and wide characters.14 of them accepted prosthesis augmentation mammaplasty simultaneously and 5 of these accepted membrane repair.4 patients received prosthesis augmentation in stage Ⅱ.All patients＆#39; incision were primary healing.The incision scars were not obvious.1 patient with breast cancer suffered breast excision; 1 patient who received prosthesis and membrane simultaneously appeared prosthesis displacement after 3 months and fixed again.1 patient who received membrane appeared hydrops in residual cavity,and the membrane was removed finally.Conclusions This method with endoscopy through mammary areolae is necessary for cleaning PAHG entirely.We can use prosthesis to repair the deformity of breast after removing PAHG,and if necessary use membrane to fix the implant and rebuild the inframammary fold of the breast.