乳房假体取出即刻自体脂肪移植隆乳的临床报告

Clinical application of simultaneous implant exchange with fat

目的探讨乳房假体取出即刻行自体脂肪移植隆乳术的临床效果。方法回顾性分析中国医学科学院整形外科医院形体雕塑与脂肪移植中心,2013年1月至2019年6月收治的26例行假体取出即刻自体脂肪移植隆乳术患者的临床资料。患者均为女性,年龄(35.2±8.3)岁。通过腋窝切口、乳房外侧与胸壁交界处放射状切口或乳房下皱襞切口取出假体,假体取出后未行包膜切除或切开。用直径2.5 mm三孔品字形钝头吸脂针低负压(-60 kPa)吸脂,4℃生理盐水清洗后,用棉垫法浓缩脂肪,以直径2.5 mm的单孔钝头注脂针行脂肪移植。术后定期随访,从并发症、乳房大小、患者满意度及第三方医生评价(总分均为4~20分)等方面对手术效果进行评估。结果26例患者均顺利完成手术,左侧乳房取出的假体体积为(216.2±54.6)ml,右侧为(217.9±53.1)ml。左侧乳房每次移植脂肪为(256.8±55.8)ml,右侧为(258.1±55.7)ml。术后随访(13.5±5.7)个月,B超显示2例(7.7%)患者出现小结节,但乳房触诊未触及,未发现其他并发症。术后胸围较术前减少(1.1±0.8)cm,减小不到一个罩杯。患者满意度评分为(16.8±2.0)分,医生评分为(16.4±1.6)分。结论对于因各种原因需要取出乳房假体的患者,在假体取出后即刻行自体脂肪移植隆乳术,可以安全而有效地恢复乳房体积。

Objective To report our clinical experience in simultaneous implant exchange with fat(SIEF)for breast augmentation and reshaping.Methods The medical records of 26 patients who received SIEF in our department from January 2013 to June 2019 were reviewed.All patients were female,aged(35.2±8.3)years.The prosthesis was removed through axillary approach,inframammary approach or radial incision at the junction of lateral breast and chest wall.Capsulectomy was not performed after implant removal.Fat was harvested using a blunt liposuction cannulas with the diameter of 2.5 mm and 3 side holes,with a negative pressure of-60 kPa.After washing with 4 degree physiological saline,the fat was processed with the cotton pad filtering technique,then a diameter 2.5 mm,1-hole blunt cannula was used to place the fat.The evaluation of postoperative improvements included breast size,incidence of complications.Patient satisfaction and physician satisfaction were assessed by two independent surgeons(the full score ranged from 4 to 20).Results All patients completed the study.The volume of implants in the left breast was(216.2±54.6)ml and that in the right breast was(217.9±53.1)ml.Grafted fat volume for the left breast was(256.8±55.8)ml each time and that for the right breast was(258.1±55.7)ml.The mean follow-up time was(13.5±5.7)months.Small nonpalpable nodules were detected in two patients(7.7%)by ultrasound.No other complications were documented during the study period.The average chest circumference was decreased by(1.1±0.8)cm which was less than one cup according to Chinese Industrial Standards.Patient satisfaction and physician satisfaction were(16.8±2.0)and(16.4±1.6),respectively.Conclusions SIEF is an effective and safe method to restore breast volume after implant removal.