Objective To evaluate the therapeutic effect of autologous fat grafting in secondary cleft lip.Methods Grafting of autologous fat granules was applied to correct lip under-capacity.The technique was used in 40 patients with secondary cleft lip from June 2011 to December 2015.The ratios between the point of upper lip peak to vermilion height and to white lip height on the affected side were measured by Photoshop CS6.Results Satisfactory results were achieved with all 40 patients;the lip contour and morphology improved.The preoperative ratio was 0.417±0.190 and the postoperative ratio was 0.499±0.197, which increased average 26.02%, with statistically significant (P<0.05).Conclusions Autologous fat grafting to correct lip under-capacity with secondary cleft lip is a safe, effective and micro-invasive method which can be sustained over a lengthy period.

Objective Secondary deformities are common in people born with unilateral cleft lip and palate.In recent years,more and more attempts and efforts have been directed toward the restoration of normal muscle anatomy.The authors present a new method of orbicularis oris repair in secondary cleft lip repair.Methods From July 2009 to December 2011,24 patients underwent this procedure in the authors' department.Muscle reconstruction was divided into three units that dealed with the nasal base,white lip and red lip.Common anatomic pathologies including the displacement of upper lip,flared ala,blunted ala-facial groove,depressed nasal floor,lateral bulge,lack of philtrum column,free border deficiency and unapparent vermilion tubercle were corrected in a single operation.Results The average follow-up period was 16.79±6.23 months.No major complications occurred.All the patients were satisfied with their nasolabial appearance.Conclusions "Three-unit" muscle repair has found to be effective and practical in secondary repair.Favorable results demonstrate that improved aesthetic and functional results can be achieved with this comprehensive procedure.

Objective To explore the features of magnetic resonance imaging (MRI) and removal procedures of the polyacrylamide hydrogel (PAAG) injections from the breast.Methods From January 2015 to December 2016,113 continuous cases of breast PAAG implants were involved into this study.Features of MRI,characteristics of PAAG and tissue changes around PAAG were recorded and analyzed.Results The PAAG was demonstrated high T2 signals on MRI that was consistent with the surgical findings.In total of 226 breasts,the PAAG injected implants were removed with peri-areolar incision approach,and PAAG in free state was squeezed and capsular or infiltrated tissues were dissected.In 15 breasts,capsules were thin with no infiltrated tissue.In other 211 breasts,a lot of PAAG infiltrated tissues were observed and these infiltrated tissues included gland,fat tissue,pectoralis major muscle,pectoralis minor muscle or intercostal muscles.Conclusions In these cases,PAAG has been injected into breasts for 7 to 20 years.For such long period,PAAG infiltrated tissues present a lot of difficulties and more complicated to remove.Dissection is the strategy we recommend.

Objective:To explore the effect of decision-making assistance during the implantation selection of breast augmentation patients to provide a reference for improving decision-making aids.Methods:From June 2018 to June 2020, the decision-making assistance programs were used in the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People＇s Hospital for prosthesis selection in 51 breast augmentation female patients, aged 23 to 42 years, with an average of 31 years old. The BREAST-Q scale was applied to assess the postoperative results of augmentation patients. Postoperative breast satisfaction was also evaluated by the physicians.Results:With decision-making assistance, breast augmentation patients＇ satisfaction with breasts was (80.27±11.45) points, satisfaction with surgical results (83.41±12.29) points, social and psychological status scores (87.24±7.62) points, and sexual life status scores (85.49±7.90) points, physical condition score (73.94±8.98) points. There was no statistical difference in the scores of breast size between physicians and patients ( P>0.05). In the satisfaction score and total score of breast shape and feeling, physicians＇ scores were higher than patients＇ self-report scores, and the difference was statistically significant ( P<0.05). Conclusions:The patient self-reported postoperative outcomes are at a high level under the application of decision aid program. We can further improve the decision aid program for breast augmentation patients, adjust patient＇s surgical expectation, and realize shared decision making.

Objective:To evaluate incision scars of transaxillary breast augmentation by different methods of scar assessment.Methods:A retrospective study was carried out on 30 patients (age range 20 to 50 years, with mean age of 32 years) who underwent endoscopic assisted transaxillary type Ⅰ dual plane breast implant augmentation by a same surgeon from August 2014 to November 2016. Scars were estimated by 3 methods which included Vancouver Scar Scale (VSS), Visual Assessment Scale (VAS) and patients' questionnaire.Results:VAS score for left side scars ranged from 0 to 8 and the median was 1. VAS score for right side scars ranged from 0 to 8.3 and the median was 1. A total of 48 scars were scored in the 0-2 point range, representing 80% of the 60 total. VSS score for left side scars ranged from 0 to 11.6 and the median was 0.8. VSS score for right side scars ranged from 0 to 11.3 and the median was 1.2. A total of 46 scars were scored in the 0-2 point range, representing 76.7% of the total 60 breats. The scores between VSS and VAS had significant statistical differences ( P<0.001). 80.0% of our patients regarded scars as unconspicuous or basically invisible in our questionnaire. Conclusions:The majority of transaxillary incision scars recover in favorable status with high patients satisfactory rate. VAS is a practical tool for evaluating transaxillary incision scars. The VSS score is not equivalent to the VAS score when grading scars only by photos.

Objective:To present a new method of vermilion tubercle reconstruction in secondary cleft lip repair.Methods:39 secondary cleft lip repair patients underwent the operation of vermilion tubercle reconstruction with a vermilion flap transferred vertically. The procedures of the reconstruction mainly included three processes, restoring the vermilion tubercle tissue in the cleft area, widening the vermilion with the vermilion flap, and augmenting the volume of the tubercle with the muscle tissue underlying that vermilion flap. The width of the vermilion and the projection of the vermilion tubercle were measured before and after operation, and then two sets of data were analyzed with paired-samples t test. A patient satisfaction survey was performed postoperatively to evaluate the effect of the reconstruction.Results:The reconstructions of vermilion tubercle were successful in all patients and no complications occurred. The most of new vermilion tubercles located in midline and appeared plump. Follow-up had been completed in 28 patients and the average follow-up period was (9.71±5.02) months. The effective vermilion width increase was from (5.32±0.91) mm, (3.98±0.89) mm, (4.30±0.86) mm before operation to (6.35±0.87) mm, (7.75±1.03) mm, (7.48±0.97) mm after operation in the midline of lip, the peak of cleft side and the midline of short arm, respectively. The postoperative width of vermilion in the cleft side was widened significantly. The projection of the tubercle was increased significantly from (0.38±0.46) mm to (0.83±0.51) mm. 96.4% (27) patients achieved satisfied results of vermilion tubercle reconstruction after operation.Conclusions:The vermilion flap transferred vertically has been found to be an effective method of vermilion tubercle reconstruction in the secondary repair of cleft lip.

Objective:To evaluate the morbidity and causes of long-term abnormal sensation of breasts after typy Ⅰ dual-plane breast implant augmentation via endoscopic assisted axillary approach.Methods:A retrospective analysis was conducted on 53 patients who underwent endoscopic assisted transaxillary type Ⅰ dual plane breast implant augmentation by a same surgeon from July 2014 to December 2016. All patients were followed up for more than 18 months. Hyperesthesia, hypoesthesia and numbness of nipple-areola complex and imframammary fold and breast pain were accessed.Results:According to the palpation and consultation of the surgeon, a total of 10 patients presented with post-operative long-term abnormal sensation of breasts, of which 6(11.3% of the total number) patients presented with hypoesthesia of nipple-areola complex, 1 patient (1.9% of the total number)presented with hyperesthesia of nipple-areola complex, and 2 patients (3.8% of the total number)presented with hypoesthesia of inframammary fold region. One patient (1.9% of the total number) had long-term postoperative breast pain. According to the questionnaire designed to assess breast sensation, a total of 33 patients (64.7%) presented with long-term postoperative breast pain, a total of 12 patients (23.5%) presented with post-operative long-term hyperesthesia of nipple-areola complex, another 5 patients (9.8%) presented with transient hyperesthesia of nipple-areola complex.Conclusions:It is clear that the incidence of post-operative long-term abnormal breast sensation following endoscopic assisted transaxillary type Ⅰ dual-plane breast implant augmentation is comparatively low and controllable.And the main reason for this complication is the peripheral nerve innervation of the nipple areolar complex.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma. Despite the scarcity of reported BIA-ALCL cases in Asia, it is imperative to research early diagnosis. The crucial diagnostic criteria for BIA-ALCL include the presence of ALK - and CD30 + T cells exceeding 10% in the delayed seroma fluid. Furthermore, laboratory tests, such as histological examination of capsulectomies and analysis of clonal T-cell receptor (TCR) gene rearrangements, serve as important auxiliary diagnostic indicators. This article reported the case of a 56-year-old female patient who underwent bilateral breast augmentation with implants over 20 years ago. She presented with hardness, enlargement, and mild discomfort in her left breast. She was admitted to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in January 2023. MRI suggested implant rupture. Therefore, bilateral implant removal surgery was performed on February 2, 2023. Pathological examination of the fluid within the capsule of the left implant revealed a small number of ALK - and CD30 + T cells, with monoclonality observed in TCRγ gene rearrangement, indicating early changes suggestive of BIA-ALCL. Long-term follow-up is needed. The authors suggest that patients suspected of BIA-ALCL should undergo TCR gene rearrangement testing in addition to cytological and immunological examinations, which can provide guidance for the diagnosis, treatment, and necessary long-term follow-up of these patients.

Objective:To evaluate the morbidity and causes of long-term abnormal sensation of breasts after typy Ⅰ dual-plane breast implant augmentation via endoscopic assisted axillary approach.Methods:A retrospective analysis was conducted on 53 patients who underwent endoscopic assisted transaxillary type Ⅰ dual plane breast implant augmentation by a same surgeon from July 2014 to December 2016. All patients were followed up for more than 18 months. Hyperesthesia, hypoesthesia and numbness of nipple-areola complex and imframammary fold and breast pain were accessed.Results:According to the palpation and consultation of the surgeon, a total of 10 patients presented with post-operative long-term abnormal sensation of breasts, of which 6(11.3% of the total number) patients presented with hypoesthesia of nipple-areola complex, 1 patient (1.9% of the total number)presented with hyperesthesia of nipple-areola complex, and 2 patients (3.8% of the total number)presented with hypoesthesia of inframammary fold region. One patient (1.9% of the total number) had long-term postoperative breast pain. According to the questionnaire designed to assess breast sensation, a total of 33 patients (64.7%) presented with long-term postoperative breast pain, a total of 12 patients (23.5%) presented with post-operative long-term hyperesthesia of nipple-areola complex, another 5 patients (9.8%) presented with transient hyperesthesia of nipple-areola complex.Conclusions:It is clear that the incidence of post-operative long-term abnormal breast sensation following endoscopic assisted transaxillary type Ⅰ dual-plane breast implant augmentation is comparatively low and controllable.And the main reason for this complication is the peripheral nerve innervation of the nipple areolar complex.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma. Despite the scarcity of reported BIA-ALCL cases in Asia, it is imperative to research early diagnosis. The crucial diagnostic criteria for BIA-ALCL include the presence of ALK - and CD30 + T cells exceeding 10% in the delayed seroma fluid. Furthermore, laboratory tests, such as histological examination of capsulectomies and analysis of clonal T-cell receptor (TCR) gene rearrangements, serve as important auxiliary diagnostic indicators. This article reported the case of a 56-year-old female patient who underwent bilateral breast augmentation with implants over 20 years ago. She presented with hardness, enlargement, and mild discomfort in her left breast. She was admitted to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in January 2023. MRI suggested implant rupture. Therefore, bilateral implant removal surgery was performed on February 2, 2023. Pathological examination of the fluid within the capsule of the left implant revealed a small number of ALK - and CD30 + T cells, with monoclonality observed in TCRγ gene rearrangement, indicating early changes suggestive of BIA-ALCL. Long-term follow-up is needed. The authors suggest that patients suspected of BIA-ALCL should undergo TCR gene rearrangement testing in addition to cytological and immunological examinations, which can provide guidance for the diagnosis, treatment, and necessary long-term follow-up of these patients.