Search

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: With the improvement of women’s aesthetic and therapeutic needs, breast reconstruction has become a commonly used treatment option after breast cancer surgery, of which the use of expanders and implants is high. Infection, as the most common complication with the use of expanders and implants, can lead to a range of consequences and even affect the results of breast reconstruction. With the deep understanding of the risk factors leading to infection in breast reconstruction, the continuous improvement of treatment options and the application of new materials, the occurrence of infection can be reduced and the success rate of breast reconstruction can be improved. OBJECTIVE: To summarize the risk factors, prevention and treatment measures of infection associated with the use of expanders and implants in breast reconstruction, and to introduce the application prospects of new materials in breast reconstruction. METHODS: Related articles were retrieved on CNKI, Wanfang, PubMed, and Web of Science databases. Search terms were “tissue expander, breast implants, breast reconstruction, infection” in Chinese and English. According to the inclusion and exclusion criteria, after preliminary screening of articles, 119 articles with high relevance and reference value were reviewed. RESULTS AND CONCLUSION: (1) Breast reconstruction based on tissue expanders and implants is widely used in clinical practice, and multiple risk factors may lead to the occurrence of infection after breast reconstruction and, in severe cases, to the loss of expanders and implants. (2) Breast reconstruction expanders and implants are subdivided into multiple types according to different material characteristics, of which the roughness of surface is an important cause affecting the occurrence of infection. Although the smooth surface has a higher incidence of seroma than the textured surface, drainage is usually taken in advance to avoid the risk of infection caused by seroma in clinical practice. (3) Clinicians need to carefully evaluate the probability of infection and reasonably select expanders or implants in combination with the health status and treatment methods of breast reconstruction patients. For example, for patients with multiple preoperative infection factors, the selection of smooth surface expanders or implants may be more conducive to the prevention and control of infection. (4) Second-generation cephalosporins can be used to prevent infection after reconstruction, and can be used in combination with quinolones when necessary. For patients who have shown signs of infection, it is necessary to timely select bacteria-sensitive antibiotics for treatment according to bacterial culture and drug sensitivity test, and preserve expanders or implants for patients as far as possible. (5) At present, some studies have developed new breast reconstruction materials and drug coatings. Because such products have their own advantages of antibacterial and inhibition of bacterial attachment, they can fundamentally reduce the incidence of expander and implant infection and have shown positive therapeutic effect in some clinical case studies. However, further randomized controlled trials with large samples are needed to verify it in the future. [ABSTRACT FROM AUTHOR]

Copyright of Basic Sciences Journal of Textile Universities / Fangzhi Gaoxiao Jichu Kexue Xuebao is the property of Basic Sciences Journal of Textile Universities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Forensic Science & Technology is the property of Institute of Forensic Science, Ministry of Public Security and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To assess the quality of life in patients after breast augmentation with implants through questionnaire. Methods From June 2014 to December 2016, a questionnaire for assessing subjective well-being based on BREAST-Q was prepared. A retrospective analysis was conducted in 51 patients to assess the quality of life after breast augmentation with implants. Results All patients were followed-up for 21 to 52 months. The postoperative quality of life was significantly improved, especially reflected in self-confidence improvement and high sexual satisfaction. Conclusion Breast augmentation with implants can not only improve the volume and appearance of breasts, but also enhance the postoperative quality of life. [ABSTRACT FROM AUTHOR]

Objective: To explore the surgical technique and preliminary safety and aesthetic results of endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation for patients., Methods: The clinical data of 25 patients who underwent endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation between April 2020 and January 2024 and met the selection criteria was retrospective analysed. The patients' age ranged from 33 to 73 years, with a mean of 50.4 years, and the body mass index ranged from 16.8 to 26.6 kg/m 2 , with a mean of 21.5 kg/m 2 . They were all bilaterally injected with Amazingel, and the time between initial injections and surgery ranged from 17 to 26 years, with a mean of 21.4 years. Early safety was evaluated by the incidence of early postoperative complications, and early aesthetic results were evaluated using Harris scores (including breast shape satisfaction, sensation satisfaction, and elasticity satisfaction) at 3 months after operation., Results: There were 9 cases underwent Amazingel removal (group A) and 16 cases underwent Amazingel removal with immediate prepectoral implant-based breast augmentation (group B). Intraoperative removal of Amazingel ranged from 808 to 1 285 mL, with a mean of 1 050.7 mL; the mass of the capsule removed ranged from 36 to 169 g, with a mean of 103.6 g; and a gross anatomical prosthesis was used with a median size of 345 mL (range, 315-355 mL). The operation time ranged from 95 to 395 minutes, with a mean of 194.2 minutes; and the cost of the procedure ranged from 8000to 91 000 yuan, with a mean of 33 000 yuan. Patients had a median follow-up time of 22.7 months (range, 3.0-48.1 months). There was 1 case of intraoperative skin burn due to the operation of the electric scalpel, which healed naturally after operation without flap necrosis. There was no adverse conditions such as prosthesis outline showing, ripple sign, and capsular contracture during follow-up; a small amount of Amazingel residue was found in 2 patients at 1 year after operation. The Harris score at 3 months after operation was used to evaluate the early aesthetic results, and the breast shape, elasticity, and sensation satisfaction of group A were lower than group B, but the differences between the two groups were not significant ( P >0.05)., Conclusion: Endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation is safe in the early stage with good aesthetic results, and it is also recommended that patients who had the indications for combined immediate breast augmentation after removal to rebuild the breast appearance.

Objective: To discuss the effectiveness of breast reconstruction with dual plane prosthesis implantation or anterior pectoralis prosthesis implantation under endoscopy by using prospective comparative study, in order to provide a reference for clinical surgical selection., Methods: A total of 54 female patients with breast cancer admitted between January 2023 and December 2023 and met the selection criteria were selected as research subjects. According to the random number table, 54 patients were divided into trial group and control group with 27 cases in each. The patients in the trial group and control group were treated with dual plane prosthesis implantation and anterior pectoralis prosthesis implantation for breast reconstruction after glandular resection under endoscopy, respectively. There was no significant difference between the two groups ( P >0.05) in the terms of age, body mass index, affected side, breast clinical stages, molecular typing, disease duration, breast volume of healthy side, breast ptosis of affected side, and preoperative Breast-Q score (social mental health, sexual health, breast satisfaction, chest somatic health). The operation-related indicators (operation time, total volume of drainage within 7 days after operation, extubation time, and hospital stay), occurrence of complications, breast reconstruction efficacy related indicators (transverse and longitudinal distance difference), and the pre- and post-operative differences (change values) of Breast-Q scores for each item were compared between the two groups., Results: There was no significant difference in operation time, total volume of drainage within 7 days after operation, extubation time, and hospital stay between the two groups ( P >0.05). All patients of the two groups were followed up 3-12 months (mean, 6.3 months). Three patients (11.11%) in trial group and 5 patients (18.52%) in control group experienced complications, and there was no significant difference in the occurrence of complications ( P >0.05). At 7 days after operation, the transverse and longitudinal distance differences were significantly less in trial group than in control group ( P <0.05). The Breast-Q scores of the two groups at 7 days after operation were significantly higher in all items than those before operation ( P <0.05), but there was no significant difference in all change values between the two groups ( P >0.05)., Conclusion: For patients with breast cancer, comparison of breast reconstruction with anterior pectoralis prosthesis implantation, breast reconstruction with dual plane prosthesis implantation has better breast reconstruction effectiveness and higher safety.

Objective: To investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants., Methods: The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups., Results: The average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B ( P <0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups ( P >0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups ( P >0.05). At last follow-up, the breast satisfaction score in the patients' Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group ( P <0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups ( P >0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%., Conclusion: Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.

[Objective] This paper aimed to explore the correlation between the changes of tobacco structure in the process of short-smoke tobacco and provided the theoretical basis for the optimization of the tobacco structure in the silk-making process. [Method]The gray correlation method and cluster analysis were used to cut the silk on the short-cut cigarette production line. After incense, the tobacco structure at the hopper of the cigarette machine was analyzed and compared with conventional cigarettes. [Result](i) The cut tobacco of 4.0-7.0, 2.5-3.35 mm after shredded short-cut cigarettes had the strong correlation with the cut tobacco of 1.0-4.0 mm after baking;After 1.0-3.35, 4.0-7.0 mm after drying, the cut tobacco had the strong correlation with the cut tobacco of 2.5-4.0 mm after flavoring;The cut tobacco of 2.5-3.35 mm after adding the incense had the strong correlation with the cut tobacco of 2.5-3.35 mm at the hopper of the cigarette machine.(ii) Comparing the changes of cut tobacco structure between conventional cigarettes and short-staple cigarettes during processing, the tobacco layer with strong correlation of conventional cigarettes was gradually transferred from filament to medium filament, and the associated tobacco layer interval was larger, and the short-cut cigarette was highly correlated. The tobacco layer was gradually transferred from the middle-long filament to the middle filament, and the correlation interval was gradually reduced. Different types of cigarettes had different tobacco layers associated with each process, and the tobacco structure had different adjustment directions.(iii) The scope of this study ran through the entire silk production line of short-cut cigarettes and the pre-rolling process. [Conclusion] Through the correlation of different sizes of cut tobacco between adjacent processes, the targeted search affected the specific tobacco structure before the tobacco was rolled, and the specific cut tobacco size of the previous process optimized the structure of the short-cut cigarette. [ABSTRACT FROM AUTHOR]

Objective: To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction. Methods: This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them. Results: No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z =-4.511, P <0.01). Conclusions: Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Primary breast lymphoma(PBL) is a rare form of extranodal lymphoma. The most common histologic subtypes of PBL isthe diffuse large B-cell lymphoma and recently primary breast anaplastic large cell lymphoma associated with breast implants considered as a new clinical entity of PBL. Compared with breast cancer, its clinical presentation and imaging have no specialty, the majority of PBL are diagnosed by pathological biopsy or immunohistochemical analysis and its prognosis is poor. There is no standard therapy regimen of PBL up to now. The combined therapy regimen, the main part of which is cyclophosphamide in combination with doxorubicin, vincristine, prednisolone(CHOP) chemotherapy, is the main stream. Radical surgery is to be avoided. [ABSTRACT FROM AUTHOR]

Objective: To overview the theoretical basis and research status of prepectoral implant-based breast reconstruction., Methods: The domestic and foreign researches on the application of prepectoral implant-based breast reconstruction in breast reconstruction were retrospectively analyzed. The theoretical basis, clinical advantages, and limitations of this technique were summarized and the future development trend in this field was discussed., Results: The recent advances in breast cancer oncology, the development of materials and the concept of oncology reconstruction have provided a theoretical basis for prepectoral implant-based breast reconstruction. The selection of patients and the experience of surgeons are crucial for postoperative outcomes. Ideal thickness and blood flow of flaps are the most important considerations for the selection of prepectoral implant-based breast reconstruction. However, its long-term reconstruction outcomes and clinical benefits and risks in Asian populations still need to be confirmed by more studies., Conclusion: Prepectoral implant-based breast reconstruction has a broad application prospect in breast reconstruction following mastectomy. However, the evidence is limited at present. Randomized study with long-term follow-up is urgently in need to provide sufficient evidence to evaluate the safety and reliability of prepectoral implant-based breast reconstruction.

Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m 2 (range: 16.0 to 32.3 kg/m 2 ). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ 2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time ( M (IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml ( OR =8.173, 95% CI : 1.302 to 51.315, P =0.021) and peri-areolar incision ( OR =7.809, 95% CI : 2.162 to 28.211, P <0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.

Objective: To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. Methods: A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. Results: There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, P= 0.000). Conclusions: There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.

Objective: To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods: Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 67 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients' satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ(2) test or non-parametric test. Results: There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups ( P> 0.05). The operative duration (sentinel lymph node biopsy: (178± 80) minutes vs . (198±42) minutes, t= -2.082, P= 0.039; axillary lymph node dissection: (204±79) minutes vs . (233±49) minutes, t= -2.952, P= 0.004), the volume of drainage in three days postoperative ((183±141)ml vs . (237±104) ml, t= - 2.938, P= 0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs . (62± 36) ml, t= 3.210, P= 0.002). Patients' satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions: Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.

Objective: To explore the current clinical practice of implant-based breast reconstruction (IBBR) in China. Methods: The current survey was sponsored by Chinese Anti-Cancer Association, Committee of Breast Cancer Society and Chinese Society of Breast Surgeons. A survey was mailed to 110 hospitals in China, which have more than 200 breast cancer operations performed in 2017. The survey mainly included questions on the clinical practice of IBBR, sociodemographic and geographical factors associated with IBBR practice, reasons and concerns for selecting IBBR, type and timing of breast reconstruction, and the complications of IBBR. Data were analyzed using χ(2) test, Fisher's exact test or Kruskal-Wallis rank sum test. Results: IBBR was available in 86.4% (95/110) included hospitals. It was predominantly performed breast reconstruction surgery, the proportion of IBBR in all the breast reconstruction was 65.75% (4 296/6 534). However, the rate of IBBR in all the patients received mastectomy was only 7.06% (4 296/60 877). Among all the included hospitals, the number of implant reconstructions performed in 2017 was 24 (57.5) cases ( M ( Q(R) ), range: 2-565 cases). Factors associated with the performance of IBBR including regional per capita gross domestic product ( H= 10.47, P= 0.005) and annual surgery volume ( H= 8.30, P= 0.016). The main reasons for choosing IBBR were relatively simple surgical procedure, short learning curve and short operation time. The effects of adjuvant radiotherapy on prosthesis, postoperative complications and patient satisfaction were the main concerns for implant reconstruction. Compared with delay reconstruction, a higher proportion of IBBR was observed in immediate reconstruction (83.1% vs . 62.0%, χ(2)=12.522, P= 0.000). In all, 10.5% (10/95) hospitals reported more than 10% grade Ⅲ to Ⅳ capsular contracture. The incidence of infections need surgical intervention was reported between 10% and 20% by 4.2% (4/95) hospitals. Hospitals with 6% to 10% implant rupture and 6% to 15% implant removal were 1.1% (1/95) and 4.2% (4/95) respectively. Conclusions: IBBR was the most common used surgery in breast reconstruction after mastectomy. However, the proportion of IBBR in patients after mastectomy was still low. Reginal economy, surgery volume of hospitals, lack of specialty training program and the concern about complications and patient's satisfaction were the factors affecting the development of IBBR.

Objective: To explore the risk factors related to periprosthetic infection after breast augmentation, and to provide a basis for reducing the risk of postoperative infection., Methods: A total of 1 056 female patients who underwent breast augmentation between January 2010 and January 2018 were analyzed retrospectively. The patients were 20 to 44 years old (mean, 31.6 years). The body mass index (BMI) was 19.0-31.1 kg/m 2 , with an average of 24.47 kg/m 2 . According to the periprosthetic infection standard of the United States Centers for Disease Control and Prevention (CDC), the patients were divided into infection group and non-infection group. Age, BMI, diabetes, previous history of immunosuppression, history of smoking, previous history of breast surgery, previous history of mastitis, combined with active dermatitis, surgical approach, the type and shape of breast prosthesis, implant in the different layers, combined with mastopexy, operation time, postoperative antibiotic time, postoperative breast crash, and postoperative potential infection surgery were analyzed by univariate analysis. The influencing factors of prosthetic infection were screened by logistic regression., Results: Periprosthetic infection occurred in 60 cases after operation, and the infection rate was 5.68%. Among them, 11 cases were acute infection, 33 cases were subacute infection, 16 cases were delayed infection, and 20 cases were positive in bacterial culture. Postoperative breast crash occurred in 114 cases. Univariate analysis showed that diabetes, previous history of immunosuppression, history of smoking, previous history of mastitis, postoperative breast crash, postoperative potential infection surgery, and combined with breast suspension were the influencing factors of postoperative periprosthetic infection ( P <0.05). Multivariate analysis showed that diabetes, history of smoking, and postoperative breast crash were the risk factors of periprosthetic infection ( P <0.05)., Conclusion: Diabetes, smoking, and postoperative breast crash are the risk factors of periprosthetic infection after breast augmentation.

Objective: To investigate effectiveness of the combination of serratus anterior muscle flap and breast implants for breast reconstruction after modified radical mastectomy., Methods: Between January 2015 and December 2015, 25 female patients with breast cancer were enrolled, aged 24-62 years (mean, 40.6 years). The tumor located at left side in 9 cases and right side in 16 cases; 14 cases were in the left upper quadrant, 4 cases were in the left lower quadrant, 7 cases were on the top of the breast. All cases were invasive ductal carcinoma. According to TNM staging, 14 cases were at stageⅠand 11 cases were at stageⅡA. The diameter of lumps were all less than 3 cm. All those lumps were solitary and without distant metastasis. The sentinel nodes were all negative. After modified radical mastectomy, the breasts were reconstructed by serratus anterior muscle flap and breast implants. The nipples were spared in 22 cases., Results: The operation time was 113-148 minutes (mean, 136 minutes). All breasts survived and incisions healed at stageⅠ. There was no complication such as hematoma, infection, etc . All patients were followed up 6-18 months (mean, 15 months). Except 1 case, the others were evaluated according to the criteria of the reconstructed breast at 12 months after operation. Among them, 23 cases were evaluated as good and 1 case as fair. There was no tumor recurrence during the follow-up period., Conclusion: The combination of serratus anterior muscle flap and breast implants after the modified radical mastectomy is a handy approach of breast reconstruction which is less harmful with few postoperative complications. It also gains a high degree of satisfaction from patients for good breast shape.

Objective: To explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness., Methods: Between April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as T(is)N0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm x 9 cm to 20 cm x 15 cm, and the serratus anterior fascial flaps from 10 cm x 8 cm to 15 cm x 10 cm, and the rectus sheath fascial flap from 8 cm x 6 cm to 10 cm x 8 cm., Results: One patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case., Conclusion: Adequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.

Objective: To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS)., Methods: Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5.7 months (range, 1-24 months). The pathological examination revealed invasive ductal carcinoma in 55 cases, ductal carcinoma in situ (DCIS) in 15 cases, invasive ductal carcinoma + DCIS in 8 cases, DCIS with infiltration in 10 cases, and occult breast cancer in 1 case. According to tumor staging criterion of American Joint Committee on Cancer (AJCC), 15 cases were rated as stage 0, 51 cases as stage I, 22 cases as stage II, and 1 case as unclear. Finally, 33 patients underwent SSM and 56 patients underwent NSM according to the location and diameter of tumor and the infiltration of tumor to nipple. Secondary breast reconstruction was performed with permanent gel replacement after axillary lymph node dissection in 9 patients with positive sentinel lymph node and 1 patient with occult breast cancer; immediate breast reconstruction was performed with permanent gel in the other patients. All the patients received the chemotherapy or/and radiotherapy according to the National Comprehensive Cancer Network (NCCN) guideline., Results: Complications occurred in 5 patients undergoing breast reconstruction of permanent gel after NSM, including 1 case of haemorrhage, 2 cases of infection, and 2 cases of local skin necrosis. Primary healing of incision was obtained in the others. No nipple necrosis was observed in patients undergoing NSM. All the patients were followed up 14-88 months (median, 40 months). At 10 months after operation, the aesthetic results were excellent in 40 cases, good in 33 cases, fair in 14 cases, and poor in 2 cases, with an excellent and good rate of 82%. No recurrence or metastasis was found during follow-up., Conclusion: The SSM or NSM is feasible and oncological safe for patients who are not fit for BCS, with satisfactory aesthetic result.

Objective: To investigate the feasibility and therapeutic effect of acellular cadaveric dermis (ACD)-assisted immediate breast reconstruction., Methods: From Sep. 2009 to May 2010, 10 cases received ACD-assisted immediate breast reconstruction. During the operation, the ACD was used to cover inferior and lateral portion of the implants in 2 cases and expanders in 8 cases., Results: The patients were followed up for an average period of 4 months with satisfactory breast appearance. The complications included infection in 2 cases and dehiscence in 2 cases. But no implant or expander was taken out., Conclusions: The ACD-assisted immediate breast reconstruction is a technically simple procedure with minimal morbidity. Satisfactory clinical outcome can be achieved with appropriate candidates.

Objective: To investigate the feasibility of transaxillary dual-plane breast augmentation with endoscope assistant., Methods: The submuscular pockets were separated through a 4 cm transverse incision in the axilla. The pectoralis major muscle were split from the costal margin with the help of a 10 mm, 30 degree endoscope and endoscopic diathermy scissors. Soft cohesive gel microtextured anatomic style silicone implants ranging in size from 185 to 315 g were placed through the axillary incision. The vacuum drainage was used for 3 approximately 5 days., Results: 79 patients underwent the dual-plane breast augmentation. Postoperative analgesia requirements were reduced because of muscle strength releasing. The follow-up period was 4 to 6 months with satisfactory results. All the patients had aesthetically natural appearance, with the nipple at the most projected part of the breast. No rippling, lateral displacement, double-bubble deformity, or muscle contraction-associated deformities were seen. There was no complications such as capsular contracture, hematoma, hypertrophic scar, and infection., Conclusions: Dual-plane breast augmentation using textured silicon gel implant can be completed with the endoscope assistance through the axillary incision. The technique combined retromammary and partial retropectoral pocket locations to optimize the benefits of each pocket location while avoiding the drawbacks of extra incision on the breast.

Objective: To investigate the cause and the prophylactic measures for the complication following the periareolar reduction mammaplasty using polypropylene mesh as suspension device., Methods: From Dec. 1999 to Dec. 2005, 78 patients who underwent periareolar reduction mammaplasty using polypropylene mesh as suspension device were analysed. Among them, 47 cases were followed-up for 6 months to 5 years, and their long-term effect was evaluated., Results: Early after operation, complications included seroma (3 cases), infection (3 cases), delayed wound healing (3 cases), and paraesthesia of nipple-areolar complex (1 case). The 47 followed-up patients presented abnormal wave-like skin appearance in superior polar of breast (7 cases), palpable cord-like mammary content in peripheral region of breast (3 cases), widening of periareolar scar and secondary ptosis (2 cases) and paraesthesia of nipple-areolar complex (1 case). All other patients acquired good appearance and felt satisfactory. 2 patients could lactate after operation. 5 patients underwent mammary X-ray radiography after operation. No mesh shadow or calcification was revealed., Conclusions: Although polypropylene mesh is a good suspension device in reduction mammaplasty, the long-term complication is relatively high because of the hardness of the tissue. More soft tissue is necessary as alternative device for clinical application.

Objective: To investigate the technique of repeated operation for removement of polyacrylamide hydrogel from breast., Methods: 17 cases after uncomplete removement of PHG were reoperated through inferior periareolar incision. The PHG and affected denatured muscle and gland tissue were removed., Results: Preoperative MRI or CT showed PHG distributed diffusely in muscle and gland. There was only minimal residual PHG after operation. Histological examination showed PHG distributed in the denatured and proliferative fibrous tissue, including giant cells, many neutrophilic cells infiltration, and foreign body granuloma. The symptoms, such as intramammary pump or nodule, chest and back pain, infection, were relieved after operation., Conclusions: Blinded suction technique can not remove PHG completely and can also result in malposition of PHG and make the tissue denaturation worse. We suggest open approach to remove the PHG and denatured tissue completely through periareolar incision.

A method for developing a three-dimensional visual system for simulating augmentation mammaplasty based on OpenGL is proposed. The 3D reconstruction of breast surface using NURBS, reality simulation of the breast surface, parametric design of mammary prosthesis, and simulation of postoperative effect are described. The system may provide a means for better communication between the surgeons and patients.

Objective: To investigate the indications, surgical methods and esthetic results in patients undergoing immediate breast reconstruction with expandable implants., Methods: From January 2002 to March 2006, immediate breast reconstructions were carried out with expandable implants following mastectomy in 30 breast cancer patients. Nipple-areola were preserved in 5 patients., Results: Very satisfactory results were achieved. Minor complications were recorded in 3 patients, two with local skin necrosis, and another with partial necrosis of nipple-areola complex., Conclusions: The techniques provide better results for the patient who is not a candidate for simple implant reconstruction. These techniques also eliminate the need for a second major surgery to replace a temporary expander with a permanent implant in those patients needing soft tissue expansion. It is a simple procedure with advantages of no additional scarring, short time for convalescence.

Objective: To evaluate a breast augmentation technique for correction of minor and moderate breast ptosis with an anatomic implant., Methods: Fifteen patients of macromastia with minor and moderate breast ptosis were treated by using a breast augmentation with the anatomic implant under the breast gland. The results were judged with the the patient's satisfaction., Results: All of the patient achieved big improvement of the breast ptosis with very satisfactory results., Conclusions: The minor and moderate breast ptosis could be achieved by using breast augmentation with an anatomic implant.

Objective: This study was to investigate an operation, in which removing breast cysts of foreign body resulted from augmentation with polyacrylamide hydrogel injection was performed simultaneously with silicone prosthesis implantation under SEPS endoscope in order to relieve tissue injury and increase the accuracy of clearance., Methods: Eight patients were included in this study. Preoperative type B ultrasound examination was performed to mark the mass. Through an axillary approach, the cysts of foreign body that were distributed in the subcutaneous tissue, breast or muscle were separated and ablated under SEPS endoscope. After removal of the foreign body, a silicone implant was located submuscularly for breast augmentation., Results: The operations were completed without hematoma and infection. Follow-up of the eight patients for 3 to 12 months showed that preoperative symptoms relating to the injected material, such as breast pain, lump and asymmetry, have no longer existed. The shapes of the breasts were satisfactory., Conclusions: We believe that endoscope-assisted mammoplasty offers more satisfactory clinical results with less injury, less morbidity, less scars, more accuracy and greater patient acceptance.

Objective: To evaluate a new technique for breast reconstruction with multiple miniprostheses,, Methods: Each silicone miniprosthesis(10 approximately 15 ml) was implanted one by one beneath the prepared muscle pocket until the desired volume was achieved., Results: Seven patients were treated with the above mentioned technique, including five after gland fibroadenoma excision, one hemangioma excision and one reduction mammoplasty. The results were satisfactory., Conclusion: The above mentioned technique with the miniprostheses may be another good way for breast augmentation and breast reconstruction with many advantages such as smaller incision, easy intraoperative assessment of the ideal size of the breast, easy handling the technique, perhaps low incidence of capsular contracture.

Objective: To observe and analyze the pathohistological characteristics of capsules which formed around the mammary prosthesis with different contents. And to provide the selective basis for ideal and safe prosthesis in clinical practice., Methods: 20 specimen of the capsules were taken from 20 cases who receive the operation of prothesis removal for different reasons. HE, Masson and Mallory staining were used to analyse the tissue structure and characteristics under the light microscope., Results: The common structure including the collagen fibers accumulation, inflammatory cells infiltration and the capillary hyperplasia were found in all specimen. A layer of squamous epithelium-like cell was detected in some specimen. The specific characteristics were also found in different capsules formed around different prosthesis. In the capsules around vegetable oil prosthesis, there was excessive collagen fiber accumulation, and the capsules were much thicker. In the PVP (polyvinylpyrolidone) prosthesis capsules, there was severe inflammatory cell infiltration, and the number of eosinophilic granulocyte increased obviously. In the silicone gel and saline prosthesis capsule, the collagen fibers were well-arranged and the inflammatory cells were much less. Synovial metaplasia was detected in two cases., Conclusion: 1. The capsules form around the prosthesis in all cases after mammary augmentation. 2. There will be synovial metaplasis in some cases, for vegetable oil prosthesis, the collagen over-accumulated which lead the capsules become thicker and harder. So it is not a kind of ideal mammary prothesis. 4. The severe infiltration of the inflammatory cells especially the large quantity of eosinophilic granulocyte indicate the possibility of the delayed hypersensitive reaction mediated by eosinophilic granulocyte. Cautious attitude should be taken during application.

To reduce the rate of capsule contracture after implantation of the breast prosthesis, augmentation mammaplasty through an inframammary incision and the external oblique muscle has been performed in 96 cases since 1990. In 67 of 72 cases (93%), the cosmetic results are satisfactory with a natural contour and softness of the breast during the follow-up of more than 6 months. The capsule contracture rate is 2.8 percent. The advantage of the approach is the muscular coverage of almost the total surface of the implant that contributes to the excellent result and a low capsule contracture rate. This procedure can overcome the disadvantages of the transaxillary augmentation procedure, which is usually difficult in dissecting the origin of the pectoralis muscle at the sixth rib. This technique can also make the inframammary crease lower and improve moderate ptosis of the breast.

To evaluate the China-made saline-filled breast implants, we observed 62 patients (123 sides of breasts) who received augmentation mammaplasty from March 1994 to May 1995. The implants of 200 to 450 ml were manufactured in Shanghai. All the implants were placed beneath the pectoralis major muscle and a transient over-inflation was used. Fifty-nine patients had satisfactory results. One case developed breast shrinking postoperatively due to possible damage to the implant. Another two cases were not quite satisfactory because of associated breast ptosis. Thirty-two cases were followed up for 3 months and demonstrated nice-looking and soft breasts. We conclude that (1) the quality of the China-made saline-filled breast implant is good. And (2) transient over-inflation of the implant during the operation is advantageous and is worth recommending.

We have performed agumentation mammplasty on 867 patients since 1989. Twenty-seven of them had their prostheses removed for various reasons including infection, pain, rupture or exposure of the implant, capsular contracture, psychopath, etc. The authors think that the proper selection of good implants and submuscular insertion of the implant are important for reducing such complications.

From March 1990 to March 1994, 7 cases of one stage breast reconstruction with silicone prosthesis after mastectomy for breast cancer were performed in our hospital. All the operations were successful and no operative complication observed. They were followed up for three months to four years. The contour was good, symmetrical, soft to touch and the patients did not complain uncomfortable sensation. The authors propose that immediate reconstruction of the breast be recommended. In this paper, the indications, methods, selection of opportune time for operation and precautions are discussed.