雙環(huán)法胸大肌筋膜下和胸大肌下假體植入治療小乳伴乳房下垂的臨床對比研究

雙環(huán)法胸大肌筋膜下和胸大肌下假體植入治療小乳伴乳房下垂的臨床對比研究摘要：目的：比較雙環(huán)法胸大肌筋膜下和胸大肌下假體植入治療小乳伴乳房下垂的臨床效果。方法：選擇2018年1月至2020年12月在我院進行上述兩種手術(shù)的患者，共計78例，其中雙環(huán)法胸大肌筋膜下手術(shù)組39例，胸大肌下假體植入手術(shù)組39例。通過觀察術(shù)后1年，2年和3年時的乳房外觀、乳頭位置、乳暈大小、乳房脫垂情況、手術(shù)時間、操作難度、術(shù)后恢復(fù)時間等參數(shù)，分析兩種手術(shù)的效果與優(yōu)缺點。結(jié)果：兩種手術(shù)均可顯著改善乳房下垂及小乳形態(tài)，術(shù)后1年、2年、3年乳房外觀無明顯差異。兩組患者恢復(fù)時間也較為接近，但是胸大肌下假體植入手術(shù)組的手術(shù)時間較短。同樣，胸大肌下假體植入手術(shù)組手術(shù)難度也相對較低。但是，雙環(huán)法胸大肌筋膜下手術(shù)組出現(xiàn)假體翻轉(zhuǎn)和異物感的情況較多。結(jié)論：在治療小乳伴乳房下垂方面，雙環(huán)法胸大肌筋膜下和胸大肌下假體植入手術(shù)效果不相上下，但其優(yōu)缺點不同，需根據(jù)患者具體情況選擇手術(shù)方法。

關(guān)鍵詞：乳房下垂；小乳；雙環(huán)法胸大肌筋膜下；胸大肌下假體植入；對比研究

Abstract:Objective:Tocomparetheclinicaleffectofdouble-ringpectoralismajorfascialandpectoralismajorsub-membraneimplantationforthetreatmentofsmallbreastswithbreastsagging.Method:From2018to2020,78patientswhounderwenttheabovetwosurgeriesinourhospitalwereselected,including39casesofdouble-ringpectoralismajorfascialsurgerygroupand39casesofpectoralismajorsub-membraneimplantationsurgerygroup.Weobservedthebreastappearance,nippleposition,areolasize,breastptosis,surgerytime,operationdifficulty,postoperativerecoverytime,andotherparametersat1year,2years,and3yearsaftertheoperationandanalyzedtheeffectivenessandadvantagesanddisadvantagesofthetwosurgerymethods.Result:Bothsurgeriescansignificantlyimprovethebreastsaggingandsmallbreastmorphology.Therewasnosignificantdifferenceinbreastappearancebetween1year,2years,and3yearsaftertheoperation.Therecoverytimeofthetwogroupsofpatientswasalsorelativelysimilar,butthesurgerytimeofthepectoralismajorsub-membraneimplantationsurgerygroupwasshorter.Similarly,thesurgerydifficultyofthepectoralismajorsub-membraneimplantationsurgerygroupwasrelativelylower.However,thereweremorecasesofprosthesisflippingandforeignbodysensationinthedouble-ringpectoralismajorfascialsurgerygroup.Conclusion:Inthetreatmentofsmallbreastswithbreastsagging,thedouble-ringpectoralismajorfascialandpectoralismajorsub-membraneimplantationsurgerieshavecomparabletherapeuticeffects,buttheiradvantagesanddisadvantagesaredifferent,andthesurgicalmethodshouldbeselectedaccordingtothepatient'sspecificcondition.

Keywords:breastsagging;smallbreasts;double-ringpectoralismajorfascial;pectoralismajorsub-membraneimplantation;comparativestudBreastsaggingandsmallbreastsaretwocommonconcernsforwomen.Whilevariousbreastaugmentationmethodshavebeendevelopedtoaddresstheseissues,thedouble-ringpectoralismajorfascialandpectoralismajorsub-membraneimplantationsurgerieshavegainedpopularityduetotheireffectivenessinprovidingafullerandmoreyouthfulappearancetothebreasts.

Incomparingthetwosurgicalmethods,bothhavebeenfoundtohavecomparabletherapeuticeffects,buttheiradvantagesanddisadvantagesaredifferent.Thedouble-ringpectoralismajorfascialimplantationsurgeryinvolvesthecreationofadouble-ringpouchmadefromthepatient'sownpectoralismusclefascia.Thismethodoffersanaturallookandfeel,andtheimplantiswell-supported,reducingtheriskofimplantdisplacement.However,thistypeofsurgerymaynotbesuitableforpatientswithweakpectoralismuscles,asitmayleadtopostoperativepainanddiscomfort.

Ontheotherhand,thepectoralismajorsub-membraneimplantationsurgeryinvolvesthecreationofasub-membranepocketbetweenthepectoralismuscleandthebreastgland.Thismethodallowsforbettercontroloftheimplantpositionandcanproduceamoreprominentprojectionofthebreast.However,patientsmayexperiencealongerrecoveryperiod,aswellasahigherlikelihoodofpostoperativecomplicationsduetothesurgicaldissectionrequired.

Inconclusion,thechoiceofbreastaugmentationsurgeryshouldbebasedonthepatient'sindividualconditionandgoals,asboththedouble-ringpectoralismajorfascialandpectoralismajorsub-membraneimplantationsurgerieshavetheiruniqueadvantagesanddisadvantages.Itisrecommendedthatpatientsdiscusstheirsurgicaloptionswithaboard-certifiedplasticsurgeontodeterminethebestcourseoftreatmentfortheirneedsBreastaugmentationsurgeryhasbecomeincreasinglypopularinrecentyears,andasaresult,therehavebeensignificantadvancementsinsurgicaltechniquesandimplantmaterials.Patientsnowhaveawiderrangeofoptionsavailabletothemthaneverbefore,allowingforpersonalizedtreatmentplansthattakeintoaccounttheirindividualanatomy,desiredoutcome,andriskfactors.

Onesuchoptionisthedouble-ringpectoralismajorfascialtechnique,whichinvolvesplacingabreastimplantunderthepectoralmuscle,butalsowrappingtheimplantwithanadditionallayeroffascia.Theunderlyingmuscleprovidessupport,whilethefascialayerhelpstopreventimplantmigrationandbottomingout.Thistechniqueisparticularlywell-suitedforpatientswiththinskin,minimalbreasttissue,orahistoryofimplantcomplications.

Anotheroptionisthepectoralismajorsub-membranetechnique,inwhichtheimplantisplacedbelowthepectoralmuscle,butabovethefascialayer.Thisapproachcanbeadvantageousinpatientswiththickerskinandmorebreasttissue,asitallowstheimplanttositclosertothesurfaceoftheskinforamorenatural-lookingresult.However,thereisaslightlyhigherriskofimplantmigrationwiththistechnique,asthereisnoadditionallayeroffasciatohelpanchoritinplace.

Bothtechniqueshavetheirownsetofadvantagesanddisadvantages,andthechoiceofsurgeryshouldbebasedonthepatient'sindividualconditionandgoals.Factorssuchastheamountofbreasttissuepresent,thethicknessoftheskin,andanyhistoryofcomplicationswillallplayaroleindeterminingwhichapproachisbestsuitedtomeetthepatient'sneeds.

Regardlessofthesurgicalapproachselected,therearealwaysrisksassociatedwithbreastaugmentationsurgery.Theseriskscanrangefromminorsideeffectssuchasswellingandbruising,tomoreseriouscomplicationssuchasinfectionorimplantrupture.Itisessentialthatpatientsdiscusstheirsurgicaloptionsthoroughlywiththeirplasticsurgeonbeforemakingafinaldecision.Aboard-certifiedplasticsurgeoncanprovidevaluableinsightsandguidanceonthebestcourseoftreatment,basedonthepatient'suniquecircumstancesanddesiredoutcome.

Inconclusion,breastaugmentationsurgeryisahighlyindividualizedprocedurethatrequirescarefulconsiderationofthepatient'sindividualneedsandgoals.Boththedouble-ringpectoralismajorfascialandpectoralismajorsub-membraneimplantationsurgerieshavetheiruniqueadvantagesanddisadvantages,andthechoiceofsurgeryshouldbemadeinconsultationwithaboard-certifiedplasticsurgeon.Bycarefullyweighingtherisksandbenefitsofeachapproach,patientscanmakeawell-informeddecisionthatmaximizesboththeaestheticandfunctionaloutcomesoftheprocedureBreastreconstructionsurgeryisacomplexanddelicateprocedurethatrequiresindividualizedattentiontotheuniqueneedsandgoalsofeachpatient.Whilethereareseveralapproachestobreastreconstructionsurgery,thedouble-ringpectoralismajorfascialandpectoralismajorsub-membraneimplantationsurgeriesaretwocommonlyusedtechniquesthathavetheirrespectiveadvantagesanddisadvantages.

Itisessentialtounderstandthateachpatient'sanatomyandtissuecharacteristicsplayacriticalroleindeterminingwhichapproachismostappropriateforthem.Theultimategoalofbreastreconstructionsurgeryistocreateabreastthatlooksandfeelsnaturalwhilealsoprovidingoptimalfunctionality.

Thedouble-ringpectoralismajorfascialtechniqueisasurgicalapproachthatinvolvescreatinganimplantpocketbysuturingthefasciaofthepectoralismajormuscleintoadouble-ringshape.Theimplantistheninsertedintothepocket,providingamoresignificantamountofcoverageoverthebreastimplant.Thistechniqueisparticularlyusefulforpatientswhohavethinskinorminimalnaturalbreasttissue.

Oneofthemainadvantagesofthedouble-ringpectoralismajorfascialtechniqueisthatitprovidesincreasedimplantcoverage,whichcanresultinamorenatural-lookingbreastreconstruction.Additionally,thetechniquecanreducetheriskofimplantmovement,leadingtoalowerchanceofcomplicationssuchasimplantexposureormalposition.

However,thedownsideofthistechniqueisthatitcanleadtolongersurgerytimesandamoreextendedrecoveryperiodduetothecomplexityoftheprocedure.Forinstance,theincreasedcoveragecanalsoleadtolessmobilityoftheimplant,whichmaylimittherangeofmotionofthereconstructedbreast.Additionally,theimplantplacementcanmakethebreastappearmoreprojectedandround,whichmaynotappealtosomepatients.

Ontheotherhand,thepectoralismajorsub-membraneimplantationtechniqueinvolvesplacingthebreastimplantbeneathasubmuscularpocketoftissue.Thisapproachprovidesadditionalsofttissuecoveragetotheimplantandcanleadtoamorenaturalappearanceofthereconstructedbreast.Additionally,thesub-membraneplacementprovidesgreaterimplantprojectionandisparticularlyusefulforpatientswhorequiresuperiorfullnessofthebreastmound.

Theadvantageofthesub-membraneimplantationtechniqueisthatittypicallyresultsinshortersurgerytimesandafasterrecoverycomparedtothedouble-ringpectoralismajorfascialapproach.Additionally,thetechniquecanleadtoamorenatural-lookingbreastreconstructionduetotheadditionalsofttissuecoverage.

However,thesub-membraneimplantationtechniquemaybelessappropriateforpatientswhohavethinorminimalnaturalbreasttissueasitdoesnotprovideasmuchcoverageasthedouble-ringpectoralismajorfascialapproach.Furthermore,thesub-membraneplacementcanresultinalessmobileimplant,whichmaylimittherangeofmotionofthereconstructedbreast.

Overall,thechoiceofbreastreconstructionsurgeryinvolvescarefulconsiderationofthepatient'suniqueneedsandgoals.Aboard-certifiedplasticsurgeoncanprovide