经乳头根部乳晕内双环形切口行乳晕缩小术

目的:总结分析经乳头根部乳晕内双环形切口行乳晕缩小术的临床效果。方法:回顾性分析2010年1月至2016年6月我科行乳晕缩小术的20例患者,均采用经乳头根部乳晕内双环形切口,保留真皮蒂,采用"荷包"缝合的方法收紧切口,间断缝合皮肤,术后10~14d拆线。结果:随访1~3年,20例患者对手术效果均满意,无乳头感觉减退及皮肤坏死等并发症;3个月后术区瘢痕不明显,早期乳晕皮肤有皱褶感显得不自然,但3~6个月后均恢复自然,乳晕颜色变浅,对乳房轻度下垂者有一定的改善作用,无复发者。结论:经乳头根部乳晕内双环形切口行乳晕缩小术,能有效纠正增大的乳晕,术后瘢痕不明显,无复发者,无乳头感觉减退,值得在临床上推广运用。     

乳晕内双环形切口乳晕乳头缩小成形术

乳晕过大及色泽加深者多见于妊娠及哺乳后妇女,且多伴有乳房和乳头过大或松弛下垂.以往的手术方法是采用乳晕外双环形切口切除乳晕外围环形皮肤或在乳晕外围皮肤横径方向的内外各切除一块三角形皮肤以缩小半径…,但会遗留比较明显的切口瘢痕,且无法解决部分乳头过大及乳晕色泽过深的问题.1996年7月至2006年7月我们自行设计完成乳晕内双环形切口乳晕乳头缩小成形术120例,效果满意.     

横双蒂加中央蒂真皮帽乳房缩小成形术

目的　介绍横双蒂加中央蒂真皮帽乳房缩小成形术的方法,并探讨其疗效。　方法　对8例(16只)乳房肥大病人施行手术治疗, 采用以乳头为中心的中央蒂真皮帽乳房缩小成形术, 设计双同心圆切口, 保留第4肋间神经径路乳腺组织的完整性, 切除多余乳腺组织, 环形切口缩拢缝合。结果　本组单侧切除组织量平均为(310±150)g,术后第2d查乳头乳晕感觉良好,反射存在,乳头乳晕无坏死,除1例伤口裂开行2期缝合外,余均无感染、血肿等并发症。随访6 (3 ~9)个月,外形满意,切口瘢痕不明显。　结论　横双蒂加中央蒂真皮帽乳房缩小成形术设计合理,形态好,可确保乳头乳晕的感觉及功能。     

微创切口不同术式治疗男性乳腺发育症的效果分析

目的寻求一种疗效佳且美观的治疗男性乳腺发育症(gynecomastia, GYN)的手术方式。方法自2015年6月至2018年12月,将收治的60例GYN患者分成单纯脂肪抽吸术(A组12例);脂肪抽吸联合乳晕小切口乳腺切除术(B组22例);乳晕缘切口乳腺切除术(C组26例)。比较3组在切口长度、手术时间、术后满意率和感觉方面的差异。结果 A组切口长度明显小于B、C组,其差异具有统计学意义(P0.05),B组和C组无明显差异;A组手术时间与B组无明显差异,但均明显长于C组,其差异具有统计学意义(P0.05);B组术后满意率与C组无明显差异,但明显好于A组,其差异具有统计学意义(P0.05);术后A、B、C组的乳头乳晕感觉异常率分别为8.3%、13.6%和11.5%。结论单纯脂肪抽吸术切口较小,瘢痕不明显,但手术时间相对较长,术后易复发,适合脂肪型GYN患者;乳晕缘切口乳腺切除术具有切口较隐蔽、疗效较彻底、手术时间较短等优点,适合各种分型的GYN患者,但有时结合脂肪抽吸术可达到更好的疗效。     

经乳晕切口乳房松垂整形术的临床应用研究

目的探求对乳房松垂的整复治疗行之有效的手术方式。方法对正常体积的乳房松垂，选择新月形或双环形切口，将乳腺上缘固定于相应的胸壁上。对乳房松垂伴萎缩的，应用新月形切口，悬吊乳腺的同时行隆乳术。对乳房松垂伴巨乳的，采用双环切口行巨乳缩小乳腺悬吊术。结果38例受术者随访3—6个月，乳房挺拔，丰满，切口瘢痕不明显，未出现乳头乳晕坏死及乳晕增大，外缘放射状皮肤皱折于术后3～6个月均消失，医患双方均感满意。结论经乳晕切口乳房松垂整形术术式设计简单，血供及乳腺悬吊固定良好。切口隐蔽，术后瘢痕不明显。乳头乳晕感觉正常，乳房塑性好，是治疗乳房松垂的一种良好方法。     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术.方法用双环形切口,保留乳头乳晕深动脉和乳房下限的组织,对肥大的乳房进行缩小和重新塑形.结果 23例患者的乳头乳晕均无坏死,感觉良好,乳房形态自然.结论本手术设计简单,操作容易,术后瘢痕隐蔽,效果稳定,是修复各种肥大或下垂乳房的较好方法.     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术。方法用双环形切口，保留乳头乳晕深动脉和乳房下限的组织，对肥大的乳房进行缩小和重新塑形。结果23例惠者的乳头乳晕均无坏死，感觉良好，乳房形态自然。结论本手术设计简单，操作容易，术后瘢痕隐蔽，效果稳定，是修复各种肥大或下垂乳房的较好方法。     

垂直瘢痕上方蒂乳房缩小成形术矫治乳房肥大下垂

目的 探讨垂直瘢痕上方蒂乳房缩小成形术的方法和疗效.方法 经乳晕外周环形切口,切除乳房下部皮肤、乳腺组织,将乳头乳晕上方的真皮腺体蒂上提至合理位置后进行乳房塑形.自2005年9月至2010年5月,治疗了58例乳房肥大患者.结果 术后随访所有患者3～24个月,其中乳头乳晕坏死者1例,经小阴唇皮瓣再造后效果满意;切口缝线裂斤者2例,经引流降乐后愈合;余者均取得了良好的乳房形态,正面观仅见于乳房下部垂直瘢痕.结论 垂直瘢痕上方蒂乳房缩小成形术可有效地缩小乳房体积,并使乳房上提,且术后瘢痕较轻,是矫正乳房肥大下垂的良好术式.     

上方宽蒂垂直切口乳房缩小成形术

目的 探讨一种减少患者乳头乳晕坏死的上方宽蒂垂直切口乳房缩小成形术.方法 采用Lejour穹窿顶式手术设计,切除乳房下方的皮肤、腺体,乳头乳晕以上方真皮腺体组织宽蒂抬高到正常位置,进行乳房塑形,术后仅留有垂直瘢痕.结果 采用上方宽蒂垂直切口方法行乳房缩小成形术46例,其中4例为单侧乳房缩小,手术效果满意,乳房形态良好.14侧乳房切口部分裂开,其中3侧经清创缝合愈合,其余经换药后愈合,无乳头乳晕坏死发生.结论 上方宽蒂垂直切口乳房缩小成形术效果良好,减少了乳头乳晕坏死的危险,值得推广应用.     

乳房神经血管解剖学研究及在乳房缩小成形术中的意义

目的　探讨乳房的血供模式和神经支配走向 ,寻找适合各型乳房肥大的短小瘢痕乳房缩小成形术术式。方法　应用血管铸型、标本透明技术和大体解剖对 12具成年女性尸体的胸壁乳房血供模式和乳房的神经支配进行研究 ,并设计出改良的双环形切口乳房缩小成形术 ,用于 2 8例乳房肥大患者。结果　成年女性前胸壁软组织乳房或为两层血管构筑或为三层血管构筑 ,各层间均通过垂直穿支形成吻合并首先在胸肌筋膜表面形成致密的血管网 ,这些垂直穿支在乳房下部粗大 ,上部细小。乳头乳晕的神经支配以第 4肋间神经外侧皮支的深支为主 ,在下垂乳房于腺体内呈S形走行。 2 8例患者行乳房缩小成形术后外形满意 ,乳头乳晕完全成活 ,仅 1只乳房感觉减退或消失。结论　改良的双环形切口乳房缩小成形术是较为理想的术式 ,除具有原术式瘢痕不明显、乳房突出度好、效果持久等优点外 ,还最大限度地保留了剩余腺体的血供和乳头乳晕的神经支配     

Perinipple Round-Block Technique for Correction of Tuberous/Tubular Breast Deformity

A one-stage surgical correction of tuberous and tubular breast deformities is described. An intraareolar donut of pigmented skin is deepithelialized to correct the associated mega areola, allowing, at the same time, a port of entry for insertion of a retroglandular breast implant. The exposed areolar dermis is then telescoped inward and stretch-anchored to an imaginary circular line situated beneath the breast skin areola junction, thus pushing the breast tissue against the implant and the chest wall and correcting the deformity. The round-block technique is then utilized to approximate the skin edges, resulting in a minimal scar, totally inconspicuous, confined to the immediate perinipple area.     

Submuscular augmentation mammaplasty using a perinipple incision

The periareolar approach for submuscular augmentation mammaplasty sometimes shows a widened or hypertrophic scar and distorts the shape of the areolar-skin junction. The authors describe submuscular augmentation mammaplasty using a perinipple incision and muscle preservation techniques. The perinipple incision can be extended using a backcut within the areola according to the thickness of the index finger of the operator. The authors could reach the lateral edge of the pectoralis major and lift it while preserving anatomic continuity. The folded, smooth saline implant was introduced with a no-touch or minimal-touch technique. Implant volumes ranged from 175 to 325 mL. Ten to 25-mL volume was overfilled (within the recommended amount), particularly large volume was overfilled in patients who had a thin envelope to reduce the palpation of the edge of the implant. From August 2000 to December 2002, 306 patients underwent subpectoral augmentation mammaplasty via the perinipple approach. Eleven patients complained of rippling or a visible fold. There were 7 patients who required a partial capsulectomy through the perinipple incision again. The scar was well hidden but scar revision was needed in 17 patients as a result of skin slough on the areola flap. Of these cases, some were camouflaged using a medical tattooing procedure as well. Pain was reduced markedly compared with the axillary approach. In conclusion, the perinipple incision has a less visible scar in patients who have an ill-demarcated skin-areolar junction and provides a similar operative field compared with the periareolar incision. In addition, preservation of the normal skin-areola junction is cosmetically successful.     

乳晕切口巨乳缩小整形术

目的行巨乳缩小整形手术后不遗留明显瘢痕。方法采用以乳头为中心的双同心圆切口,去除表皮,同时切除以外上象限为主的乳腺组织,最后环形缩拢缝合。结果采用此法手术8例16侧,取得了仅有乳晕切口痕迹的满意效果。结论本术式行巨乳缩小简单、实用、易于掌握,值得推广应用。     

乳晕切口巨乳缩小整形术

目的行巨乳缩小整形手术后不遗留明显瘢痕。方法采用以乳头为中心的双同心圆切口，去除表皮，同时切除以外上象限为主的乳腺组织，最后环形缩拢缝合。结果采用此法手术８例１６侧，取得了仅有乳晕切口痕迹的满意效果。结论本术式行巨乳缩小简单、实用、易于掌握，值得推广应用。     

A new scarless oncoplastic breast-conserving surgery: Modified round block technique

Round block technique (RBT) is often utilized in breast-conserving surgery, but has problems of late-onset scar widening and changes in the shape or the position of the areola. We have modified RBT (MRBT) to resolve those problems.A circumferential incision was made without excision of the periareolar skin, and subcutaneous dissection was extended to the entire breast. The wound could be widened and moved onto the distant tumor by application of a wound retractor. Partial mastectomy was then performed under direct vision. The wound was easily closed without tension.Forty breast cancer patients were treated with MRBT. The median distance between the nipple and the tumor was 5.2 cm, and the median areolar size was 2.8 cm. Cosmetic results were satisfactory with minimal scar formation. There were neither subsequent changes in the shape nor the position of the areola.MRBT is a useful oncoplastic technique in patients with small areolae, and/or when the tumor location is distant from the nipple.     

Purse-string nipple areolar reconstruction

We present a surgical technique of nipple areolar reconstruction that uses a purse-string to increase areolar projection while reducing loss of nipple projection. A permanent purse-string is used around a modified CV flap to advance tissue centrally to the base of the nipple reconstruction. Two opposing hemiareolar island flaps are advanced toward the base of the nipple to add tissue volume. The resulting circumareolar full thickness skin is closed using a permanent purse-string suture. Synching the purse-string suture produces an effect similar to that of a periareolar mastopexy and enhances areolar projection. Eighty-two patients underwent 108 nipple areola reconstructions. Ninety-six percent of the patients achieved good results without any flap loss or suture infections. Revision surgery was necessary in 4 patients for minor problems including asymmetry or loss of projection. The purse-string nipple areolar reconstruction method described results in a high rate of maintenance of projection and patient satisfaction.     

乳晕切口巨乳缩小整形术

目的 行巨乳缩小整形手术后不遗留明显瘢痕。方法 采用以乳头为中心的双同心圆切口，去除表皮，同时切除以外上象限为主的乳腺组织，最后环形缩拢缝合。结果 采用此法手术８例１６侧，取得了仅有乳晕切口痕迹的满意效果。结论 本术式行巨乳缩小简单、实用、易于掌握，值得推广应用。     

Periareolar reduction mammaplasty utilizing the inferior dermal pedicle

The critical points which should not be overlooked when performing reduction mammaplasty are to minimize scar on the breast and to ensure a sufficient blood supply for the viability of the nipple–areolar complex. Periareolar reduction mammaplasty has been widely used because it left only one scar around the areola. However, with the typical periareolar reduction mammaplasty technique, it is difficult to remove a large amount of breast tissue and mobilize the remaining breast tissue. It may result in necrosis of the nipple–areolar complex in some cases. To overcome these limitations we combined the periareolar incision with the inferior dermal pedicle, which has a relatively good blood supply. This new technique was employed in 22 consecutive women (44 breasts) with hypertrophy and a varying degree of ptosis. Infiltration of a tumescent solution and liposuction were performed in all cases. After periareolar incision, dissection of the skin was performed, and the breast was elevated from the fascia of the pectoralis major muscle, leaving the inferior dermal pyramidal pedicle. An adequate amount of tissue was resected in the superior, medial, and lateral areas. After mastopexy, closure was done with a purse-string suture. The amount of tissue resected ranged from 180 to 1510 g per breast, and the mean was 466.1 g. The mean length of elevation of the nipple was 10.6 cm along the meridian of the breast. There were a few complications which needed revision operation: hematoma collection in one breast (2.3%), wound dehiscence in one breast (2.3%), and fat necrosis in one breast (2.3%). There was no necrosis of the nipple–areolar complex. With this new technique of periareolar reduction mammaplasty utilizing the inferior dermal pedicle, we were able to minimize the scar, preserve the nipple–areolar complex, and improve the motility of the breast tissue. But we also observed a flat or square appearance in the case of a large amount of resection in the patients with poor skin elasticity. This technique is safe and versatile and produces aesthetically acceptable results in selected patients.     

Modified round block technique for peripherally located early cancer breast,a technique that fits for all quadrants

Round block technique (RBT) is an oncoplastic technique used in periareolar lesions, particularly in breasts with moderate ptosis or hypertrophy. However, it has some drawbacks including the possibility of late‐onset scar widening, change in areolar shape, and asymmetry of the breasts. Moreover, it is hard to be performed with tumors located in periphery of breast. Modified round block technique (MRBT) is a new technique described to overcome these problems. A circumferential periareolar incision was made around the areola followed by subcutaneous dissection to the entire breast. Wide local excision (WLE) could then easily be performed with a good field of view, the breast tumor was excised with an acceptable macroscopic safety margin, and specimens were marked with orienting sutures for intraoperative frozen section. Remodeling of the breast was done, a close suction drain was placed, and the wound was narrowed with a nonabsorbable purse‐string suture and attached to the NAC with continuous subcuticular absorbable suture. This study was conducted on 144 female patients diagnosed with breast cancer. The median size of the tumor was 2 cm, the majority of the patients (66.7%) had moderate breast size (cup B) and the median distance of the tumor from NAC was 7 cm. Patients' satisfaction was assessed according to Harvard scale and good to excellent results were found in 88.8% of the patients. There were no postoperative changes in areolar shape or position. Complications in the form of hematoma, wound dehiscence, and infection were encountered in 25% of the patients. Modified round block technique is an oncoplastic technique that permits excision of peripherally located breast cancer without excision of periareolar skin and it is suitable for all quadrant tumors. It also avoids the scar which occurs after ordinary breast‐conserving surgery.     

Circumareolar Mastectomy in Female-to-Male Transsexuals and Large Gynecomastias: A Personal Approach

Breast reduction or amputation in female-to-male surgery presents a specific surgical problem: obtaining a good breast shape of the masculine type. Over a 2-year period, 17 patients (12 female-to-male transsexuals and 5 extreme gynecomastias) were operated on using the circumareolar approach for subcutaneous mastectomy. The nipple-areola complex was left on a very wide deepithelialized dermal pedicle, and the final closure of the wound was performed using a round-block technique followed by numerous fine sutures to reduce wrinkling. This technique provides naturally flat masculine breasts, leaving sufficient dermal vascularization for the nipple-areola complex which is of the utmost importance. All the patients were very satisfied with the result because of the periareolar scar only. Two areolar necroses occurred due to perforation of the thin vascular dermal pedicle: one superficial which epithelialized spontaneously in a short period of time and one deeper which required skin grafting.