| Objective1.analysis removal of polyacrylamide hydrogel in breast:(1) establish a method to estimate the volume of PAHG on the basis of MRI scans and monitor the reliability and precision of it;(2) get to know the effectiveness of the method for removal of PAHG by using an inferior periareolar arc incision under the direct visualization and analysis the removal degrees of PAHG injected in different layers.2.investigate the repair strategies for breast secondary deformities:(1) determine the frequency and pattern of repair timing and method after the removal of PAHG in breast in our center;(2) analysis the layers of PAHG injected based on repair timing and type;(3) evaluate the rates of complications based on repair timing and type;(4) further refine our repair strategies for breast secondary deformities.Methods1. establishment of a method to estimate the volume of PAHG:The MRI of ten randomly chosen patients were imported to the Mimics software. And the volumes were gotten after three-dimensional reconstruction of injected PAHG. Three residents estimated the volumes of PAHG10times for each patient using this method to check the precision and observer independency of this method.2. Fifty patients (99breasts) for the removal of PAAG were randomly selected.On the basis of the preoperative and postoperative MRI, the patients were divided into four groups according to whether the PAAG infiltrated to the subcutaneous tissue and muscles or not. Group S0G1M0:PAHG did neither infiltrate into the subcutaneous tissues nor the muscles. Group S1G1M0:PAHG infiltrated into the subcutaneous tissues but not into the muscles. Group S0G1M1:PAHG infiltrated into the muscles but not into the subcutaneous tissues. Group S1G1M04:PAHG not only infiltrated into the subcutaneous tissue but also into the muscles. In each group, the volumes of PAHG before and after the removal were calculated to analyze the removal amount of PAHG injected in different layers.3. We performed a retrospective review of all patients who underwent breast deformity repair after removal of PAHG at our center between2005and2012. Data collected from the medical records included patient age, duration of PAAG, distribution of the injected PAAG, repair timings, repair methods, types of the implants (round or anatomic), and volume of fat and times of injection. And a breast was the unit of analysis for all statistics. Our primary outcome of interest was the occurrence of a postoperative complication. A complication was very liberally defined to include any adverse postoperative event as a direct consequence of repair that required additional treatment beyond the initial surgery.Results1. There is no significantly difference between the3observers about the calculated volume of the PAHG injected (p=0.173).The intra-observers correlation coefficient is0.9642. The mean volume of injected PAHG was264.81ml.The mean volume of residual PAHG was9.18ml.The mean percentage of the removal PAHG was96.49%.There was no significantly difference in preoperative volume of injected PAHG among different groups (p=0.992). There was significantly difference in postoperative volume of residual PAHG after removal among different groups (p=0.000)3. There were200breasts which underwent breast deformity repair,38breasts underwent immediate breast deformity repair. Repair of secondary deformities was more commonly performed with implants (p=0.000).There was significantly difference between immediate and delayed repair (p=0.000). The rate of complications of immediate repair was6.88times of delayed repair. There was no significantly difference among the complications relative to different methods of delayed repair.Conclusion1. Calculation of volume of PAHG using magnetic resonance imaging (MRI) in combination with Mimics software appears to be a precise method.2. PAHG injected for breast augmentation and degenerated tissue could be removed using the direct visualization method to obtain successful removal of the great amount of PAHG. The PAHG without infiltrated to the subcutaneous tissue and muscles was most easily removed.The infiltration of the subcutaneous tissue and muscles increased the difficulty of the removal the PAHG.3. The secondary deformities varied from each other after remove of PAHG Repair of breast secondary deformities should be based on the layers of PAHG, residual volumes of PAHG after remove, tissue thickness and other individual situation. The rate of complications after immediate repair was higher than delayed repair, immediate repair should be avoided.。... |
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