胸大肌最佳离断位置计算公式在双平面隆乳术中的应用

Application of the formulas of optimal location in splitting pectoralis major in modified dual-plane breast augmentation

目的评估胸大肌最佳离断位置计算公式对I型、Ⅱ型双平面隆乳术设计的指导作用和分型治疗优势。方法选取65例诊断为,J,SL症或乳腺发育不良的女性隆乳者，I型双平面设计：胸大肌最佳离断位置一新乳房下皱襞长度×3／4；Ⅱ型双平面设计：胸大肌最佳离断位置一新乳房下皱襞长度×2／4。术前、术后6个月分别用BREAST—Q隆乳术模块中文版进行测评。应用QScore软件进行数据的百分制转换。结果所有患者术后乳房对称性好，形态自然、逼真，活动度好。未发现重度包膜挛缩、假体移位、假体可触及等并发症。术前2周隆乳者对乳房的满意度、社会心理状况与性生活状况3个领域分别为（27．9±4．3），（17．4±8．3），（30．3±5．5）分；术后6个月分别为（62．0±8．9），（65．0±17．2），（60．5±14．2）分；术前术后差异均有统计学意义（P〈0．05）。身体状况得分在术前2周（85．3±9．5）分与术后6个月（84．7±10．6）分差异无统计学意义（P〉0．05）。术后总体效果的满意度为（90．6±5．4）分。结论胸大肌最佳离断位置计算公式使双平面隆乳设计更简易精准，新双平面确保了对假体能提供最佳软组织覆盖，术后远期效果及满意度良好，显著提高了隆乳者的生命质量。

Objective To evaluate the design formulas o{ the optimal location for splitting pectoralis major in terms of making type I orⅡ dual-plane implant pocket. Methods Sixty-five patients with micromastia were collected. Breasts were divided into two types according to the soft-tissue pinch thickness of the lower pole： type I （thickness〉2 cm; 34 cases） and type Ⅱ （thickness ≤2 cm; 31 cases）. The optimal levels at which the pectoralis major （PM） was severed were 3/4 or 2/4 of the distance of new inframammary fold for type I or Ⅱ dual-plane pockets, respectively. All patients completed the pre- and post-operative BREAST-Q augmentation modules before and 6 months after surgery. The scores were changed into hundred-mark system by QScore software. Results The recovery processes were well-off. The breasts contour was good. Patients reported higher scores of satisfaction with breasts, psychosocial well-being and sexual well-being after surgery than before surgery （62.0±8.9 vs 27. 9±4. 3, 65. 0±17.2 vs 17. 44.8. 3, 60. 54.14.2 vs 30. 3±5. 5, P〈 0.05）. The mean satisfaction score for the overall outcome was 90.64.5.4. However, there was no significant difference in physical well-being between before operation and aftre operation （85.3±9.5 vs 84. 7 ± 10.6）. No complications such as severe capsular contracture, or displacement occurred. Conclusions The design formulas make the determining procedure of the optimal location for pectoralis major splitting for two types dual-plane implant pockets easier and more exactly. Our modified design method can provide the implant with the optimal soft tissue coverage, and bring desired and stable breast aesthetic outcomes. The higher satisfaction and quality of life reported by patients indicate that the formulas are feasible and worth to recommend.