- 期刊
Pectoral Fascia in Subfascial Augmentation Mammaplasty-A Histological and Biomechanical Study
胸大肌肌膜於肌膜下隆乳手術－臨床解剖學及生物力學研究
摘要
背景：胸大肌肌膜下隆乳於西元2000年開始被提出，這個隆乳方式結合了乳腺下及胸大肌下隆乳的好處如：恢復快、較佳的乳房外型、較少的莢膜攣縮，同時也減少的兩者的合併症如：表面水波紋、義乳扭曲等。雖然有這麼多的好處，但其中的原理仍未探究清楚。目的與目標：研究胸大肌肌膜的組織解剖學及生物力學特性，藉此驗證胸大肌肌膜下隆乳手術的理論基礎。材料及方法：利用17位病患的18個改良式乳房根除手術之標本，取上緣及下緣的胸大肌肌膜和部分乳房組織，一部分經H&E和Masson's trichrome染色後做組織學檢查，另一部分則利用MTS Tyron 250做張力測試。結果：胸大肌肌膜不論在胸部上下緣皆為一構造完整的纖維組織，厚度0.11至0.87公釐，平均最大張力於上下緣分別為1.25和0.98MPa。胸部上下緣的胸大肌肌膜在不論厚度或是張力都沒有明顯的分別。肌膜和乳房組織被由脂肪組織和血管構成的乳後空間所分隔，但在停經前女性標本可發現乳房腺體較靠近乳後空間和肌膜（停經前女性6/8，停經後女性1/10）。結論：胸大肌肌膜的張力特性可發現，肌膜可能如繃帶般繞於義乳上，使胸大肌肌膜下隆乳手術後的乳房外型較佳，義乳上緣較不易被看見或觸摸到。同時，相較於乳腺下隆乳手術，肌膜下隆乳手術在義乳上方加上乳後空間和肌膜以分隔乳腺組織，可能為較少莢膜孿縮的原因之一。
關鍵字
無資料並列摘要
Background:The subfascial plane of PM was introduced as a pocket for mammary implants in 2000. This approach appears to combine the advantages of both the subglandular and subpectoral planes with rapid recovery, satisfactory breast shape and lower fibrous capsular contracture, and also reduces complications such as rippling, implant deformation or distortion, and postoperative pain. Though some plastic surgeons regard this technique as superior to available alternatives, however questions remain that need to be addressed.Aim and Objectives:This purpose of this study was to analyze the histological anatomy and tensile properties of the pectoral fascia for subfascial augmentation mammaplasty by bag.Materials and Methods:In 18 breast specimens of 17 patients undergoing modified radical mastectomy for breast cancer, the upper and lower pectoral fascia and part of the overlying breast tissue were harvested. After hematoxylin and eosin staining and Masson's trichrome staining, the anatomical structures were examined microscopically, and pectoral fascia thickness was measured. Tensile properties of fascia in 12 of 18 specimens were assessed by the Tytron 250 Microforce Testing System.Results:The pectoral fascia is a well-organized fibrous structure with thickness ranging 0.11-0.87 mm, with a mean ultimate tensile strength of 1.25 and 0.98 Mpa for the upper and lower pectoral fascia, respectively. There is no significant difference in tensile strength and thickness between the upper and lower pectoral fascia. The fascia is separated from the breast tissue by the retromammary space, composed of adipose tissue and vessels. The deep layer of the superficial fascia of the breast is less organized. In premenopausal females, glandular tissue was more often found close to the fascia of the pectoralis major muscle (6 of 8 premenopausal versus 1 of 10 postmenopausal specimens).Conclusion:The tensile strength of the pectoral fascia makes it equivalent to a bandage wrapped around the prosthesis, resulting in a better breast contour after subfascial breast augmentation, especially the upper pole.