腺体大部切除乳房成形术治疗重症乳腺增生合并巨乳症

重症乳腺增生合并巨乳症的治疗大都以中、西药物为主，疗效不甚满意，恶性病变的漏诊、误诊时有发生，局部腺体切除不能有效缓解病情。我们设计了“腺体大部切除乳房成形术”，治疗合并Ⅲ级巨乳症的重症乳腺增生，报告如下。     

乳腺区段切除联合乳房内成形术治疗乳头溢液65例分析

目的探讨乳头溢液的手术方法及其治疗效果。方法对65例乳头溢液患者行美蓝引导下乳腺区段切除,并对区段切除或者保乳手术的62例患者行广基带血管腺体组织瓣I期乳房内成形术,术后评估乳房美容效果并行短期随访。结果恶性病变13例。行乳房内成形术的62例患者均未出现切VI局部并发症,美蓝引导下乳腺区段切除能够完全切除病灶,广基带血管腺体组织瓣I期乳房内成形术使术后乳腺美容效果全部达优良。结论重视乳头溢液的病因诊断,美蓝引导下的乳腺区段切除保证乳头溢液的病因诊断和治疗,广基带血管腺体组织瓣I期乳房内成形术是区段切除和保乳术的重要辅助术式,具有良好的美容效果。     

巨大乳房纤维腺瘤切除后的乳房成形术

目的：寻求巨大乳房纤维腺瘤切除后合理重塑乳房外形的方法。方法：按缩乳术原则设计乳头、乳晕新位置，标记需切除的表皮区和全层皮肤区。切除部分表皮、皮肤及全部肿瘤，再按隆乳方法重塑因肿瘤的和乳腺切除而空虚的乳房外形。结果：经远期随访本组7例（1例除外）乳房大小，乳头及乳房的挺拔性、对称性，手感及乳头、乳晕的感觉和勃起程度均较满意。结论：该手术方法可以较好地一期解决因切除肿瘤而后遗的乳房缩小畸形。     

乳腺叶状囊肉瘤和巨纤维腺瘤诊治体会(附17例报告)

目的探讨乳腺叶状囊肉瘤和巨纤维腺瘤的诊断和治疗。方法回顾分析我院1985~2002年期间外科收治的9例乳腺叶状囊肉瘤和8例乳腺巨纤维腺瘤的临床资料。结果9例乳腺叶状囊肉瘤中行单纯乳房切除术4例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术1例,改良根治术3例;术后恢复良好,仅1例复发。8例乳腺巨纤维腺瘤中行单纯乳房切除术2例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术2例,单纯乳腺肿块切除术3例;术后恢复良好,术后2例复发。结论乳腺叶状囊肉瘤和巨纤维腺瘤临床上均表现为无痛性包块,除乳腺叶状囊肉瘤发病年龄较大、肿块范围大及易恶变外,二者主要依据病理检查结果相鉴别;均以手术治疗为主,根据患者年龄、肿块大小以及病理检查结果选择不同的手术方式。     

定位针引导下的乳管内隆起样病变切除术

目的评价乳管镜和乳腺定位针对乳管内隆起样病变的诊断和指导微创手术的价值。方法对103例不伴有乳腺肿块的乳头溢液病人行乳管镜检查,其中63例乳管内隆起样病变行乳腺定位针定位,乳晕弧形切口手术切除定位针及周围1cm腺体组织一并送术中冰冻,导管内单发乳头状瘤者结束手术,乳管内乳头状瘤病行单纯乳房切除术,导管内癌行单纯乳房切除联合一期腹壁下动脉穿支皮瓣(DIEP)自体再造术。结果冰冻及术后病理诊断导管内单发乳头状瘤59例(93.6%),乳管内乳头状瘤病2例(3.2%),导管内癌2例(3.2%)。59例导管内乳头状瘤术后3个月复查,无溢液症状及明显不适。结论定位针引导下的乳管内隆起样病变手术切除范围小,创伤小,乳房外形基本无改变,手术切除率和病理标本检出率高,误诊和漏诊少。     

巨乳合并重症乳腺增生症的腺体大部切除乳房成型术临床研究

目的 研究腺体大部切除乳房成型术治疗重症乳腺增生症合并巨乳症的临床治疗效果。方法 45例重痛乳腺增生合并Ⅲ级巨乳症患者，采用自行设计的“腺体大部切除乳房成型术”进行手术治疗，并观察疗效1～12年。结果 患者对成型后乳房的外形“很满意”者41例，“较满意”者4例，满意率100％。残余腺体中仍可触及结节样增生性病变者，3个月内为12例，1年后全部消失。手术后有月经前乳腺疼痛主诉者，3个月内为10例，1年后无主诉。残余乳腺组织中出现硬性团块者15例，其中6例经热敷、理疗后3个月缓解。28例术后1-2年内出现双侧乳房松软张力降低，钼靶X线摄片提示为“腺体退化表现”。全部病例术后1—4个月起，原“乳腺增生”无需应用药物治疗。结论 重症乳腺增生合并Ⅲ级巨乳症患者接受了本手术后，原增生性病变减轻；原乳腺钼靶X线片提示“腺体高密度阴影”、临床触及的“硬性腺体结节”，均有了可靠的病理。术后1～2年随访提示，成型乳房内余留的增生性结节明显软化，张力下降，组织松软，疼痛消失；成型后乳房外形符合女性生理形态，原赘重性巨乳缓解，近期及远期临床效果满意。     

单纯乳腺切除及乳腺内肿瘤切除后乳房成形术

目的 为了使单纯乳腺或乳腺内肿瘤切除术后患保持良好的胸部曲线及美学效果,探索新的手术方式并观察术式临床效果。方法 自1987年2月以来,采用横双蒂无垂直切口乳房成形术为13例女性24只乳房行保留乳头乳晕的单纯乳腺切除及乳腺内巨大肿瘤切除,并一期成形。结果 术后无一例发生感染、血肿,乳头、乳晕及皮瓣血运和感觉良好。结论 单纯乳腺切除或乳腺内肿瘤切除后采用本术式可保留女性的特点及曲线,是一种治疗乳腺良性病变及乳房下垂松驰较理想的手术方法。     

巨乳症的缩乳成形术(附12例报告)

巨大的袋状下垂乳房给病人在生理上及心理上均带来痛苦。过去常用双侧乳房切除治疗巨乳症,许多病人不堪忍受乳房的缺失。本文对12例巨乳症行缩乳成形术,实践结果证实这种术式安全可靠,设计简单合理,现将此术式介绍如下。     

应用垂直双蒂缩乳术治疗巨大乳房良性肿瘤

目的 应用垂直双蒂缩乳术治疗乳房巨大良性肿瘤，使术后乳房有较好形态。方法 应用垂直双蒂缩乳术原理，设计切除乳房肿瘤的切口，在切除乳房肿瘤的同时进行乳房整形手术。结果 1993年以来，为11例患乳房巨大良性乳腺囊性增生病和乳腺纤维病女性病人进行了这一手术，取得良好整形效果。结论 对影响乳房形态的巨大良性肿瘤，用经典的整形外科缩乳技术可以有效地保持乳房形态。     

经乳晕旁切口乳房后进路切除多发性乳腺纤维腺瘤

目的：探讨经乳晕旁切口及乳房后进路切除多发性乳腺纤维腺瘤的可行性及效果。 方法：回顾分析73例经乳晕旁切口乳房后进路手术切除多发性乳腺纤维腺瘤患者的临床资料。 结果：患者均顺利恢复,乳头无明显变形,乳房及乳头感觉良好,无术后切口感染;3例发生皮下积液,经穿刺抽吸治愈。随访6个月至6年,2例术后复发,1例对侧乳腺出现乳腺纤维腺瘤。乳晕处瘢痕随随访时间延长,瘢痕逐渐淡化,患者满意度为95.9%。 结论：经乳晕旁切口乳房后径路手术切除多发性乳腺纤维腺瘤既有利于彻底切除多发肿瘤,又可以减少术中肿瘤遗漏或术后复发,同时取得了较好维护形体美的效果。     

Recurrent macromastia after subcutaneous mastectomy

Management of sudden unrelenting breast growth in a young woman included use of antiestrogen hormone therapy and subcutaneous mastectomy. Later, massive breast growth again occurred during pregnancy, requiring a repeat postpartum subcutaneous mastectomy. The dramatic response to a specific antiestrogen agent and the subsequent massive regrowth of breast tissue after subcutaneous mastectomy suggests that breast tissue is extremely sensitive to circulating hormones in certain patients with macromastia. The unusual nature of this patient's recurrent macromastia warrants this review of reports of similarly affected patients and discussion of general concepts in the medical and surgical management of the disorder.     

Gestational macromastia: a medical and surgical challenge

Gestational macromastia is a rare and complex disorder. Establishing an optimal medical and surgical management regimen has been challenging. Medical regimens have included tamoxifen, progesterone, bromocriptine, and testosterone. Surgical therapies have included reduction mammaplasty and mastectomy. This report will highlight the successful medical and surgical management in a woman with severe gestational macromastia.     

Reduction mammaplasty using superior pedicle in macromastia

SUBJECT: The authors present technical details, complications, morphologic and aesthetic results of 26 breast reduction mammaplasty for macromastia (breast reduction more than 1000 g) showing advantages and reliability of technique. MATERIALS AND METHODS: From January 2000 to December 2001, 223 patients underwent bilateral reduction mammaplasty with superior-based pedicled dermo-glandular flap. In 26 of them the weight of removed mammary tissue was over 1000 g in each breast. These 26 cases were evaluated, and the criteria adopted to analyse the results was morphologic and aesthetic evaluation of patient herself (very good, good, acceptable, unacceptable). RESULTS: Mean follow-up for all patients was 15 months. Twenty-six patients (mean age 33.2 years) underwent an average weight of 1131 g (930/2200 g) removed per breast. The following complications were observed: 1 Nipple Areolar Complex ischemia without necrosis; three infections (abscess); four delayed wound closure. The patient subjective evaluation of result was: "very good" in 19 cases (73%); "good" in 5 cases (19.2%) and "acceptable" in the others two cases (7.8%). No case was evaluated "unacceptable". CONCLUSION: Superior dermoglandular pedicle mammaplasty represent a very good and reliable solution for the treatment of macromastia, giving satisfactory cosmetics results with good nipple viability without necrosis. This technique is actually our first choice in the management of macromastia.     

An application of the LeJour vertical mammaplasty pattern for skin-sparing mastectomy: a preliminary report

An application of the LeJour vertical mammaplasty skin pattern for skin-sparing mastectomy is presented. The approach provides adequate access for the mastectomy, axillary dissection, and immediate breast reconstruction. The technique is ideal for patients with large or ptotic breasts undergoing a simultaneous contralateral breast reduction or mastopexy. It is particularly suitable for autogenous tissue reconstruction. Its use in mastectomies for cancer and prophylactic subcutaneous mastectomies is described.     

Reduction mammoplasty improves breast conservation therapy in patients with macromastia

BACKGROUND: Macromastia has been considered a contraindication to breast conservation therapy because of difficulties with radiation therapy. This study evaluates the feasibility of bilateral reduction mammoplasty as a component of breast conservation therapy for breast cancer patients with pendulous breasts. METHODS: Of 153 patients undergoing reduction mammoplasty at the University of Texas M. D. Anderson Cancer Center, 28 were identified as breast cancer patients with macromastia receiving breast conservation therapy. Median follow-up was 23.8 months. RESULTS: Median patient age was 55 years. Nearly all patients were described as obese. Median weight of the reduction mammoplasty specimen on the cancerous side was 766 g. One patient (4%) required completion mastectomy for inadequate margin control. Major postoperative complications occurred in 2 patients (7%). There were no major postradiation complications. Patient survey revealed a satisfaction rate of 86%. CONCLUSION: Bilateral reduction mammoplasty is a reasonable and safe option for breast cancer patients with macromastia who desire breast conservation therapy.     

Breast reduction as an alternative treatment option for early breast cancer in women with macromastia

Macromastia has been considered a relative contraindication to breast conservation therapy because of difficulties with postoperative radiation therapy and cosmesis. This study evaluates the feasibility of the inferior pedicle reduction mammaplasty as a component of breast conservation therapy for patients with early breast cancer. A retrospective review identified 6 patients with macromastia receiving oncologic treatment of breast cancer and simultaneous breast reduction. Mean age was 43.5 +/- 8.7 (mean +/- SD) years, and all breast cancers were stage I or II, averaging 2.3 +/- 1.5 cm in size. All patients underwent a Wise-pattern inferior pedicle breast reduction after cancer extirpation and received postoperative radiation as part of their treatment. They were evaluated for postoperative complications, esthetic outcome of the breasts, and local recurrence. Patients in this series were followed for an average of 30.3 months, with no significant postoperative complications and recurrences. Breast reduction incisions healed primarily and adjuvant radiation was completed without a delay. All patients were pleased with the esthetic result and had improvement of their symptoms related to macromastia. Thus, we believe that breast reduction is a reasonable and safe option for early breast cancer patients with macromastia who desire breast conservation therapy. Our combined oncologic and reconstructive approach may improve the outcome of this group of patients with early breast cancers.     

The circulation in the nipple-areola complex following subcutaneous mastectomy in breast cancer.

To evaluate the decrease in circulation in the nipple-areola complex after subcutaneous mastectomy and immediate implantation of a submuscular prosthesis, the blood flow was studied by both fluorescein flowmetry and laser Doppler flowmetry in 24 patients with invasive breast cancer. In 14 patients a lazy-S-shaped horizontal lateral incision was used, and 10 underwent a subcutaneous reduction mammaplasty. After subcutaneous mastectomy with a lazy-S incision there was no significant decrease in blood flow in the nipple-areola complex compared with that in the untreated contralateral breast. In the breasts in which reduction mammaplasty had been done, the blood flow was reduced by 74% as measured by fluorescein (p less than 0.01), and 70% by laser Doppler flowmetry (p less than 0.05), compared with the contralateral breast. Five patients had partial or complete epidermal, and one patient had total dermal, necrosis of the complex, but there was no deep necrosis. No fluorescence was seen within the areas in which necrosis later developed in any of these six cases. The laser Doppler signal in the corresponding areas, however, was not reduced. The results show that the circulation in the nipple-areola complex is reduced more after subcutaneous reduction mammaplasty than after subcutaneous mastectomy with a lazy-S incision.     

Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia

BACKGROUND: Bilateral reduction mammoplasty has been described as a surgical option for treatment of breast cancer in women with large, pendulous breasts. Using this technique can provide unique surgical oncologic challenges. METHODS: Retrospective chart review. RESULTS: Thirty-seven patients were identified. The average weight of tissue removed was 653 g. Tumor size ranged from 0.6 to 5.2 cm. One patient had microscopically positive surgical margins on final pathology. The tumor bed was not marked, and completion mastectomy was required. Two patients had unexpected malignancy in the contralateral breast. One patient required completion mastectomy for positive nonoriented margins. In another patient, tissue from the contralateral side was oriented, and mastectomy was avoided. CONCLUSIONS: Bilateral reduction mammoplasty with lumpectomy is an ideal option in women with macromastia. We recommend marking the tumor bed on the flaps and pedicle as well as orienting tissue removed from the contralateral side as maneuvers that will decrease need for completion mastectomy.     

Therapeutic mammoplasty is an appropriate option in a patient with breast cancer and macromastia

Bilateral reduction mammaplasty in women with breast cancer and macromastia allows appropriate oncological surgical treatment with functional and cosmetic benefits and facilitates postoperative radiation therapy. The surgical approach carried out in three patients with breast cancer and macromastia is discussed.     

The Hall-Findlay mammaplasty pattern for skin-sparing mastectomy: case report

We present an application of the Hall-Findlay mammaplasty skin pattern for skin-sparing mastectomy (SSM). This is a simplified vertical reduction mammaplasty. Vertical reduction mammaplasty is the procedure advised for patients with moderator or large ptotic breasts, who wish to have a simultaneous contra-lateral breast reduction/mastopexy at the time of SSM for cancer or prophylactic mastectomy. It is particularly suitable for breast reconstruction with autologous tissue in the form of free transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric artery perforator (DIEP) and extended latissimus dorsi (ELD) flaps.