乳腺良性肿瘤隐匿性美容切口142例疗效分析

目的:观察乳腺良性肿瘤采用美容切口手术治疗的临床效果。方法:142例乳腺良性肿瘤患者分为两组,治疗组82例分别应用乳晕切口、乳房下皱襞切口、腋窝切口隐匿性切口切除良性肿瘤。对照组60例采用传统放射状切口手术治疗。对比分析两组患者手术时间、乳房对称情况、患者满意度进行比较。结果:治疗组术后切口均甲级愈合,平均手术时间29.57±7.23min。54例患者术后乳房较为对称,48例患者较为满意。对照组切口甲级愈合。平均手术时间26.01±8.56min。41例患者术后乳房较为对称,36例患者较为满意。结论:隐匿性美容切口切除乳腺良性肿瘤,对乳房外观破坏小,在乳腺良性肿瘤切除手术中有较好应用价值。     

乳晕入路切除乳腺良性肿瘤的效果分析

目的观察经乳晕入路切除乳腺良性肿瘤的治疗效果。方法将48例乳腺良性肿瘤患者随机分为2组,各24例。观察组采用乳晕入路肿块切除术,对照组采用传统切除手术,比较2组的手术效果。结果观察组在手术出血量、切口愈合时间、疤痕大小及平均住院时间等方面与对照组比较差异有统计学意义(P<0.05),2组患者均无并发症发生,全部治愈出院。结论经乳晕入路切除乳腺良性肿瘤,切口美观,手术出血少,患者恢复快,并发症少,值得临床推广应用。     

环乳晕切口乳腺良性肿瘤切除450例临床分析

目的:研究环乳晕切口行乳腺良性肿瘤的临床应用价值。方法:将我院2008年1月～2012年6月收治的乳腺良性肿瘤患者450例,采用环乳晕切口行乳腺良性肿瘤切除术的应用情况进行分析。结果:临床应用450例全部取得了良好的效果,既可以完整切除乳腺良性肿瘤,又可以保持乳房的外观,隐匿手术疤痕。结论:在先进的辅助彩超检查及娴熟的外科技术操作等条件下,开展环乳晕切口行乳腺良性肿瘤切除是非常好的一种手术方法,既可以完整的去除病灶,又可以使得女性乳房外形保持完美的要求。     

经乳晕及乳晕缘弧形切口切除乳腺纤维腺瘤79例分析

女性乳腺良性肿瘤是临床常见病,占乳腺肿瘤的80％,并且乳腺良性肿瘤有恶变的可能,手术是治疗的主要方法。传统的手术方法是在肿瘤表面作放射状切口,术后瘢痕明显,影响乳房美观。我院2009年1月至12月采用经乳晕及乳晕缘切口切除乳腺纤维腺瘤79例,治疗效果满意,现报告如下。     

乳腺良性肿瘤手术改良切口及其对乳房表面美观的影响

目的探讨乳腺良性肿瘤手术改良切口的方法及其对乳房表面美观的影响。方法选取2010年1月至2011年2月收治的乳腺良性肿瘤择期手术患者86例,设为对照组,于病灶处行开放性切口或放射状切口进行乳腺良性肿瘤切除手术：选取2011年3月至2012年6月收治的乳腺良性肿瘤择期手术患者93例,设为观察组,选用环乳晕缘弧形切口进行乳腺良性肿瘤切除手术。比较两组患者的围手术期情况,进行乳房表面美观评分（BSBs）,比较患者满意度,随访1年观察乳房良性肿瘤有无复发或新发。结果两组均顺利完成手术,按预期完整、彻底的切除了肿瘤,两组在手术切除肿瘤效果、术后并发症、复发（含新发）率等方面比较,差异均无统计学意义（P〉0．05）。观察组患者术后乳房形状、切口瘢痕、色素沉着、乳头乳晕感觉及BSBs,患者对术后乳房外观的满意程度均优于对照组,差异具有统计学意义（P〈0．05）。结论乳腺良性肿瘤手术改良切口能够完整、彻底切除肿瘤,且术后瘢痕不明显,保存了乳房较好的表面美观效果,术后乳房更美观,且未增加并发症以及术后复发率,更能满足年轻女性的审美要求,患者对手术的满意度高,值得临床广泛推广应用。     

经乳晕切口行乳腺良性肿块切除术的临床应用

目的探讨经乳晕外缘做弧形切口行乳腺良性肿块切除的可行性及临床应用。方法经乳晕外缘做弧形切口,钝性分离皮下组织造隧道达乳腺肿块组织表面以远,用电刀整块切除乳腺肿块。结果经乳晕弧形切口成功完成乳腺良性肿块切除367例,共427个肿块,手术出血少,术后不需放置引流。无发生严重并发症病例。结论经乳晕弧形切口行乳腺良性肿瘤切除,安全、可靠、瘢痕隐蔽,术后乳房保持原有的自然形态。     

乳房皮下切除与自体组织即刻乳房再造

目的探索乳房皮下切除与几种方法的乳房再造术，即腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣等即刻再造乳房的方法。方法选择乳腺导管内原位癌10例和巨大乳腺良性肿瘤5例，顺乳晕切口活检，病理检查确立诊断后，采用经乳腺切口行乳癌或巨大肿瘤的乳房皮下切除术，若乳癌或良性肿瘤体积较大，另于腋窝部加做顺腋下皱襞的附加切口，以便于取出切除的组织及切除乳腺的腋尾部，同时可以切取腋淋巴结行冰冻切片活检。然后，应用腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣即刻行再造乳房，充填乳房切除后的空间，仅以少量的肌皮瓣皮肤修复乳头、乳晕切除后的缺损，并在此转移皮瓣上再造乳头、乳晕。结果经过多专科协作共完成15例，随访结果良好，无肿瘤复发。此法再造的乳房易与健侧乳房对称，保留了原有乳房皮肤的良好感觉，外观形态自然，再造乳房瘢痕较少，且手术切口瘢痕隐蔽。结论在严格选择手术适应证防止乳腺癌复发的前提下，乳房皮下切除与即刻乳房再造法，对乳腺导管内原位癌和巨大乳腺良性肿瘤患者I期完成肿瘤切除和乳房再造术，具有积极有效的意义。     

乳晕切口手术治疗乳房轻度下垂并乳腺良性肿物

目的:探讨通过乳晕切口既矫正乳房轻度下垂,又摘除乳腺良性肿物的手术方式。方法:对正常体积的轻度乳房下垂,选择乳晕旁月牙形或双环形切口,采用真皮帽技术,矫正乳房下垂。其间,对患有乳腺良性肿物者,在相应部位皮下,沿大乳腺管走向潜行剥离至肿物的上方,再切除肿物。结果:对56例患者随访6~18个月,乳房挺拔、丰满,感觉良好,切口瘢痕不明显。结论:经乳晕切口手术治疗轻度乳房下垂并乳腺良性肿物,乳房下垂得以矫正,乳腺良性肿物完全切除,形态和位置改善,乳头感觉和勃起正常,不明显的切口瘢痕在新的乳晕边缘隐蔽良好。     

乳晕弧形切口切除乳腺良性疾病切口大小的临床分析

目的:乳晕弧形切口切除乳腺良性肿物,对切口长度与术后效果进行回顾分析。方法:88例乳腺良性疾病患者,进行乳晕弧形切口切除乳腺良性肿物,按照切口长度分为小切口组(≤3cm,48例)和大切口组(>3cm,40例),观察术后愈合状况、乳头乳晕感觉以及复发情况。结果:88例患者术后愈合状况、乳头乳晕感觉以及复发情况无统计学差异。结论:采用乳晕弧形切口,在5cm以内是安全可行的,切口大小不影响愈合状况、乳头乳晕感觉以及复发情况,是目前临床上乳腺良性肿物一种值得推广的手术方法。     

超声引导下安珂微创旋切术与乳晕环切口手术治疗乳腺良性肿瘤效果比较

目的比较超声引导下安珂微创旋切术(旋切术)与乳晕环切口手术治疗乳腺良性肿瘤的效果。方法选取方城县人民医院2014-09—2016-07间收治的98例乳腺良性肿瘤患者,根据不同手术方法分为2组,各49例。对照组行乳晕环切口手术,观察组行超声引导下旋切术。比较2组的手术指标及并发症发生率。结果观察组手术时间、术中出血量、切口愈合时间、瘢痕长度明显小于对照组,并发症总发生率明显低于对照组,差异均有统计学意义(P0.05)。结论超声引导下旋切术治疗乳腺良性肿瘤,效果显著、并发症发生率低。     

乳晕边缘小切口切除乳房多发或巨纤维腺瘤

目的探索采用乳晕边缘小切口切除乳房多发或巨大良性纤维腺瘤,达到既切除病灶又能起到美容目的的可行性。方法2006年1月～2008年2月选择46例乳房多发良性纤维腺瘤和2例巨纤维腺瘤（〉7cm）,根据多数肿瘤或巨大肿瘤存在的部位,选择不同象限的乳晕边缘切口,切口长度不超过乳晕周长的1/2。对于多发乳房良性肿瘤,在皮下脂肪和腺体之间潜行游离到肿瘤表面,放射状切开肿瘤表面的腺体,将肿瘤完整切除;对于巨大良性肿瘤,同法切开腺体至肿瘤表面,将肿瘤分块全部切除。结果46例多发乳房纤维腺瘤共计切除肿瘤165个,其中1例双侧乳房肿瘤数量达19个,均完整切除;乳房巨纤维腺瘤2例,肿瘤最大直径8cm,也将肿瘤完整切除。乳晕边缘切口长度〈3.5cm,术后均未发生乳头坏死。48例随访1～24个月,平均14.4月,11例切口瘢痕不明显,26例注意观察才能发现切口瘢痕,9例比较容易看到切口瘢痕,2例因瘢痕体质切口瘢痕明显。结论乳晕边缘小切口切除乳房多发或巨纤维腺瘤,手术方法简便易行,可达到较好的美容效果,值得推广。     

乳晕缘切口治疗乳腺良性肿瘤的临床疗效研究

目的探讨乳晕缘切口在治疗乳腺良性肿瘤中的疗效与临床应用。方法将符合标准的120例乳房良性肿瘤患者,随机分成观察组60例与对照组60例,观察组患者使用乳晕缘切口进行治疗,对照组患者使用传统放射状切口进行治疗。比较两组患者的治疗效果。结果观察组的切口愈合时间为（9.3±2.8）d,显著性低于对照组的（13.5±3.1）d（P〈0.05）。观察组患者切口甲级愈合、术后乳房对称、瘢痕可接受以及术后患者满意分别为95.0%、93.3%、85.0%与90.0%,均显著性高于对照组的80.0%、75.0%、65.0%与71.7%（P〈0.05）。两组患者在局部血肿、切口感染、乳晕感觉异常以及术后复发等并发症上差异无统计学意义（P〉0.05）。结论使用乳晕缘切口治疗乳腺良性肿瘤安全有效,操作简单,患者恢复快,满意度高,值得在临床上推广使用。     

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

BackgroundNipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR.MethodsWe retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis.ResultsData from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis.ConclusionsCompared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple.     

Relationship of Incision Choice to Capsular Contracture

Background Capsular contracture can be an ongoing problem in breast augmentation even with good surgical technique. In the author’s practice, a higher incidence of capsular contracture was observed with the use of a periareolar incision than with an inframammary incision. Methods A review of breast augmentations performed from November 2004 through June 2006 was conducted. This analysis included the incision used, the procedure performed, and the development of capsular contracture. Results The incidence of contracture was 0.59% in the inframammary group and 9.5% in the periareolar group. This increase in capsular contracture with a periareolar incision was statistically significant. Capsular contracture occurring with augmentation performed at the time of a periareolar mastopexy was 8%, which was statistically significant compared with the inframammary group. The difference in contracture rates between a periareolar incision alone and a periareolar mastopexy was not statistically significant. Conclusions Breast augmentation through a periareolar incision has a higher incidence of capsular contracture than observed with an inframammary incision. This most likely occurs due to an increase in contamination of the breast pocket with intraductal material colonized by bacteria. The periareolar incision is, and will remain, a standard of care. Therefore, this information can help clinicians make a more informed decision regarding incision placement for breast augmentation. Presented at the annual meeting of the Texas Society of Plastic Surgeons, September 30, 2007.     

Periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle.

The goals of reduction mammoplasty are to reduce the volume of a breast, to create an aesthetic shape that is stable over time, to maintain blood supply and innervation to the areolar complex, and to make fine limited scars. The present authors used periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle. To minimise the scar, periareolar incision was performed. To reduce the volume of breast and to preserve blood supply and innervation to the nipple-areolar complex, a central or an inferior pedicle technique was used. To prevent areolar widening, a purse-string suture was used. A total of 82 breasts in 41 patients with very large breasts were operated on between July 1998 and June 2004. The mean age was 39, and the mean resection amount was 389 g per breast (right 413 g, left 364 g) with an average follow up of 28 months. Most of the patients were satisfied with the fine periareolar scar, the size of the breasts and the sensation of the nipple-areolar complex. The present authors have applied this procedure to all kinds of macromastia. Although the advantages of the periareolar reduction mammoplasty are an inconspicuous limited scar, a preservation of sensation to the nipple-areolar complex and a short operation time, 24 breasts (29%) showed areolar widening. There were persistent periareolar wrinkles in eight breasts (10%) and poor sensation to the nipple-areolar complex in 12 breasts (15%), in which more than 500 g of breast tissue was removed per breast. In conclusion, the periareolar reduction mammoplasty is optimal for patients who require a reduction of less than 500 g per breast. In severe macromastia with or without ptosis, the inverted T-incision is more preferable to periareolar incision, and periareolar incision can be modified by adding a wedge resection of the outer excess in skin flap inferiorly, which results in periareolar and vertical scars below the nipple-areolar complex.     

经乳晕切口处理聚丙烯酰胺水凝胶注射隆乳术后并发症

目的 分析30例聚丙烯酰胺水凝胶隆乳术后并发症发生原因及处理措施.方法根据并发症表现的不同加以分类.所有并发症者均采用经乳晕切口的显露刮吸、部分腺体及肌肉切除,只有1例同时通过腋窝切口行即刻乳房硅凝胶假体置入,5例半年后行乳房硅凝胶假体置入.结果 所有病例的术前症状基本消失.结论 聚丙烯酰胺水凝胶用于隆乳应非常慎重,目前必须进行严格的双盲随机病例对照研究,采用经乳晕切口的方法可以最大程度取出聚丙烯酰胺水凝胶.     

Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation – A case report

IntroductionFibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5–2% of all fibroadenomas.Presentation of caseIn this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan.DiscussionSurgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases.ConclusionThe diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.     

Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases

Six patients with breast cancer in the upper inner quadrant underwent endoscopy-assisted partial mastectomy. The tumor was removed with a 2-cm-wide surgical margin through a periareolar semicircular incision using a special retractor and endoscope system for plastic surgery. Another small incision was made in the axilla for total lymph node dissection or sentinel lymph node biopsy. The average of total operation time in five patients who underwent partial mastectomy was 241 minutes (range, 190-315 minutes), and the average time for the procedure of partial mastectomy in six cases was 84 minutes (range, 69-113 minutes). The cosmetic outcome was excellent. Transareolar endoscopic partial mastectomy can be considered as an alternative surgery option and can offer great cosmetic advantage for patients with small cancers in the inner quadrants of the breast.