Overview 1. In 1899, Gesun reported serious complications with liquid paraffin augmentation: paraffinoma, granuloma, rupture, fistula and cellulite-like view. 2., In the early 20th century, foreign doctors used liquid silicone rubber to inject breast augmentation, and complications similar to paraffin occurred: including encapsulation formation, nodules, silicone rubber wandering embolism and hepatitis, and occasionally death. 3.In the 1950s, foreign experts applied free dermal fat grafting and upper abdominal rotary flap for breast augmentation. Due to the limitation of the amount of tissue in the donor area and the complexity and trauma of the surgery, the implanted fat was liquefied and absorbed or partially fibrotic, and was gradually abandoned. The current development of various musculocutaneous flap grafts applied to breast augmentation after mastectomy 4, 1954 reported the use of creamy white sponge made of filler breast augmentation. Breast augmentation with silicone implants was reported in 1963 and has been used to date. Causes of female microtia: Mostly due to congenital dysplasia or glandular atrophy after breastfeeding, low estrogen levels, a few due to trauma, inflammation and glandular destruction. Indications 1. Breast dysplasia or breast atrophy after delivery 2. Breast atrophy due to weight loss 3. Breast dysplasia due to adolescent breast tissue lesions 4. Early breast cancer after mastectomy or modified radical treatment to preserve the pectoralis major muscle 5. Inflammation of tissues or skin inflammation near the surgical incision 2. Infected lesions in other parts of the body or lesions in important organs such as heart, liver and kidney 3. Scarred body 4. Patients who require breast augmentation with insufficient psychological preparation or unrealistic requirements 5. Patients with schizophrenia or mental abnormalities 6. Patients with immune system or hematopoietic system diseases 7. Patients with recurrence or metastatic tendency after breast cancer surgery Prosthesis 1, medical silicone rubber performance: (1) in a wide range of temperature can retain many of the required performance, in a moderate temperature life infinite. (2) has a certain inert, non-toxic, tasteless, does not cause immune rejection, non-carcinogenic, teratogenic, mutagenic effect, not easy to aging, chemical resistance, a certain mechanical properties, and the body has good tissue compatibility. (3) Silicone rubber is a dielectric body, the surface is prone to electrostatic, dust, sand flocculation is easily adsorbed, if brought into the tissue, can cause a foreign body reaction, B ultrasound does not show. 2, prosthesis evaluation 1963 application of silicone rubber prosthesis, millions of women around the world did such surgery, in 1992 the U.S. FDA announced that silicone gel prosthesis harmful to the human body, will cause immune system disorders, resulting in a variety of autoimmune diseases, such as scleroderma, rheumatoid arthritis, lupus erythematosus, vasculitis, the U.S. magazine called “American disease The American journal called “American disease”. Later, American and European medical scientists made a large number of research studies, suggesting the following conclusions: 1, there is strong evidence that silicone rubber breast implants do not cause cancer. 2 .Theoretically, it is presumed that breast implants will affect the early detection of breast cancer (especially post-glandular placement) now by the doctor or the patient’s own examination, the risk is low. 3. There is insufficient evidence of immune and rheumatic diseases. 4, After surgical treatment of the prosthesis, it has been proven that most of the abnormalities of body tissues described in the past together with the prosthesis cannot be determined. 5.Experimental evidence: silicone gel does not cause the spread of immune-related and toxicity-related substances. 6, Experimental proof: There is no unexplained disease caused by prosthetic implants. 7. There is no evidence that silicone gel is teratogenic or mutagenic. 8, There is no evidence of silicon in breast milk. 9.The silicone gel inside the prosthesis will not spread to distant areas even after the prosthesis ruptures. Currently it is common to use single lumen silicone gel prosthesis and saline injected silicone gel body. Prosthesis type: glossy prosthesis external valve type hairy double-layer prosthesis, hairy prosthesis, glossy saline injection prosthesis and hairy saline injection prosthesis. Surgery 1. Placement of the prosthesis and its volume selection Remodeling breast standards: normal location, beautiful shape, moderate volume. Standards of beautiful breasts: 1) Aesthetically, hemispherical and cone-shaped breasts are considered to be ideal in shape. 2) The distance between the nipples is between 22-26 cm with a slight natural slope. 3) The breasts are slightly upward, about 8-10 cm behind. 4) The size of the areola is no more than a dollar coin, the color is rosy and pink, with a clear demarcation line with the breast skin and brown pigmentation after marriage. 5) Nipples should be prominent, not sunken, the size of the areola diameter of 1/3. 6) Chinese women’s perfect bust size in relation to height: height × 0.53 (calculated as such) bust ÷ height (cm) ≤ 0.49 bust size = (0.5-0.53) standard ≥ 0.53 aesthetic > 0.6 too large bust That is, a mature woman of 1.60 meters, her standard bust should be 84.8cm, 1.70m mature woman, her standard bust circumference is 90.1cm. Beautiful breasts should have a proper proportion with the body, the shape of a hemisphere or cone, full and firm, elastic. 2, location: 2-6 intercostal, flow to the outside when lying down, sitting a few standing is a drop hanging in the chest wall, the inner side can be squeezed to the parasternal line, the outer side is located in the anterior axillary line, lying form is hemispherical, the volume should be in 350ml. The size of the prosthesis can be based on the size of the original breast, height, width of the chest and chest skin muscle condition. 3. Placement level: generally under the pectoralis major muscle, occasionally under the mammary gland. 4.Anesthesia: 1) General anesthesia: intravenous anesthesia, suitable for patients who are mentally and psychologically stressed. 2) High epidural anesthesia: safer and easy to master. 3) Local anesthesia: operated by the patient, preoperative dulcolax, finasteride (promethazine), diazepam (Valium) are available. a. Intercostal block anesthesia: 1% lidocaine. Complications: pneumothorax, hematoma, infection and neuralgia. b. Local infiltration anesthesia: safe, effective and with few complications. 0.5% lidocaine or 0.25% lidocaine 80-120ml + 0.375% bupivacaine 5ml can be used to anesthetize the operating area. 5.Incision design: Commonly used incisions: axillary transverse crease incision, axillary anterior crease incision, subareolar incision and inframammary crease incision. In the past, there were anterior axillary line incisions. 6. Separation of the cystic cavity: the nipple as the center, peel the cavity diameter 15-16cm, peel the corresponding range. 7. Placement of prosthesis: check the cystic cavity without bleeding, inject gentamicin 160,000 U and dexamethasone 10 mg, check the prosthesis without leakage and foreign body adhesions, place it in the cavity, and place negative pressure drainage tubes in the respective incisions. 8, postoperative treatment: suture the layers of tissue in accordance with the layers, thick dressing, elastic bandage fixed, routine use of antibiotics for 5-7 days, use of hemostatic drugs as appropriate. The stitches are removed 7 days after surgery, avoid upper limb activities for one month, and regular breast massage (six months) to prevent sclerosis (fiber capsule formation).