Serra-Renom JoseMaría, Garrido Manuel Fernández, Yoon TaiSik
Department of Plastic and Reconstructive Surgery, University Clinic Hospital, University of Barcelona Medical School, Aesthetic Surgery Institute Dr. Serra-Renom, Barcelona, Spain.
Plast Reconstr Surg. 2005 Aug;116(2):640-5. doi: 10.1097/01.prs.0000173558.52280.6e.
Many augmentation mammaplasty techniques have been developed paying special attention to incision location and pocket plane to achieve more natural-looking breasts.
The authors' technique of choice in patients with mammary hypoplasia, empty breasts following a diet program, or more than one lactation episode causing skin flaccidity without ptosis is the placement of an anatomical implant using a transaxillary approach in a subfascial plane with endoscopic assistance. Thus, ideal patients are those presenting mammary hypoplasia, empty breasts following two or more lactation episodes, and breast skin flaccidity without ptosis, with the nipple-areola complex placed above the inframammary fold. The technique and its indications are presented thoroughly.
Forty-five patients were operated on using this technique from May of 2001 to October of 2003. One-year follow-up results showed highly rated patient satisfaction. One patient underwent an implant exchange because of implant size dissatisfaction.
The authors prefer subfascial plane implants to submuscular ones. Possible rotation of anatomic implants and the subsequent asymmetry when contracting the pectoral muscle are avoided. Pectoral muscle is not detached from its insertions, resulting in less postoperative pain. Likewise, the authors prefer a subfascial to subglandular pocket since the weight of the subglandular pocket and the glandular weight itself are borne by the skin envelope leading to breast ptosis development over time. On the other hand, fascia provides additional support to the subfascial implant, thus eliminating ptosis development and achieving good filling of the upper pole similar to the filling provided by subglandular implants.
已经开发出许多隆乳技术，特别关注切口位置和腔隙平面，以实现更自然的乳房外观。
对于乳腺发育不全、节食后乳房空虚或多次哺乳导致皮肤松弛但无下垂的患者，作者选择的技术是在内镜辅助下经腋窝入路在筋膜下平面植入解剖型假体。因此，理想的患者是那些存在乳腺发育不全、两次或更多次哺乳后乳房空虚、乳房皮肤松弛但无下垂，乳头乳晕复合体位于乳房下皱襞上方的患者。本文详细介绍了该技术及其适应症。
2001年5月至2003年10月，45例患者采用该技术进行手术。一年的随访结果显示患者满意度很高。1例患者因对假体大小不满意而进行了假体更换。
作者更喜欢筋膜下平面假体而非胸大肌下假体。避免了解剖型假体可能的旋转以及胸大肌收缩时随之而来的不对称。胸大肌未从其附着处分离，导致术后疼痛减轻。同样，作者更喜欢筋膜下腔隙而非腺体下腔隙，因为腺体下腔隙的重量和腺体本身的重量由皮肤包膜承担，随着时间的推移会导致乳房下垂。另一方面，筋膜为筋膜下假体提供了额外的支撑，从而消除了下垂的发生，并实现了上极的良好填充，类似于腺体下假体提供的填充效果。
