Mckissock和Skoog法治疗巨乳症及远期疗效比较观察

目的　观察Ｍｃｋｉｓｓｏｃｋ（Ｍ）和ｓｋｏｏｇ（Ｓ）法对中重度乳腺增生伴下垂引起的巨乳症的手术近期及远期效果。方法　采用Ｍｃｋｉｓｓｏｃｋ（Ｍ）和ｓｋｏｏｇ（Ｓ）两种方法分别对各８例３１～４７岁患有因中重度乳腺增生伴下垂的巨乳症患者施行手术,并根据乳房美容外观、乳房皮肤颜色和感觉、乳头和乳晕功能及其恢复时间判断手术效果,术后１～５年对患者本人及其丈夫进行了随访。结果　１６例均达到了医学美容的效果;１０例增生症状完全消失,Ｍ法４例、Ｓ法２例有轻微痛感;乳头乳晕功能恢复正常的时间：１个月内Ｍ法４例、Ｓ法６例,２个月内Ｍ法２例、Ｓ法１例,３个月各１例：随访：满意１４例,基本满意２例。无１例发生其他乳腺疾病。结论　两种方法的手术效果均达到了医学美容的设计要求,乳腺增生的部位和手术方法的选择相关。     

无纵行切口的巨乳缩小成形

巨乳症(Macromastia)是女性青春发育与哺乳后常见乳腺疾患之一。巨乳症矫治的要点是矫正乳腺组织量的增生与形态的悬垂,并尽可能保全乳腺的泌乳、哺乳功能。本文重点介绍我们矫治巨乳症的经验,对无纵行切口法从乳头定位及手术方法均介绍,特别对巨乳症术后常见的并发症及其预防问题进行讨论。从临     

巨乳缩小术常见手术方法的选择

目的:比较巨乳缩小术常用的临床手术方法,探讨各自的适应证。方法:对15例巨乳症患者行手术治疗,其中垂直双蒂法7例,双环法8例。观察术后乳头乳晕血运及乳房外形。结果:所有患者全部恢复良好,无乳头乳晕坏死,乳房外形均满意。结论:垂直双蒂法较适用于中重度巨乳症,双环法较适用于轻中度巨乳症。     

外侧上蒂式旋转乳房缩小成形术

目的:对女性巨乳症患者,采用一种矫正新术式,以达到乳房外形更加谐调完美的效果。方法:从1989年至2004年对26例52只女性巨乳症者,应用外侧上蒂式旋转乳房缩小成形术治疗。结果:术后随访26例患者6月至2年,乳房肥大下垂得到理想矫正,乳头勃起功能正常,未出现乳头乳晕感觉异常,切口瘢痕隐蔽不明显,整体外形美观。结论:通过该术式治疗实践,该法简单灵活、安全可靠、术后功能和形态满意。     

突发性青春期巨乳症的诊断和治疗(附4例报告)

目的 探讨突发性青春期巨乳症的命名,诊断和巨大乳房缩小手术的治疗方法.方法 对4例突发性青春期巨乳症,用改良垂直双蒂进行缩小手术.结果 4例患者术后乳头、乳晕及两侧皮瓣血运良好,术区一期愈合,效果满意.结论 突发性青春期巨乳症,手术治疗是最佳选择,因乳房巨大,为保证其乳头、乳晕血运及术后外形,采用改良垂直双蒂法乳房缩小是较好的手术方法.     

保留薄层乳腺组织的巨乳矫治术

目的:寻找一种更适合增生性巨乳症矫治的手术方法。方法:按下蒂法作术前设计,术中切除90%的乳腺组织,仅保留近下蒂组织瓣侧的薄层乳腺组织,保全了乳腺被膜层的血管网,使组织瓣血运更有保证。结果:临床效果良好,乳房外观满意,乳头感觉良好,无明显并发症。结论:此方法是治疗中重度伴有增生或要求行全乳腺切除的巨乳症的首选方法。     

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。     

纵形皮下组织双蒂法乳房缩小整形术的初步经验

作者应用纵形皮下组织双蒂乳头提升乳房缩小整形术治疗5例巨乳症伴乳房下垂患者,取得满意的近期效果。本文讨论了乳头定位、术后并发症及手术指征。     

八瓣法乳头内陷矫正术

乳头内陷是正常乳头位置发生凹陷。内陷的乳头内部有纤维束牵拉乳头至乳腺组织以及乳腺导管发育不良。多为双侧，也有单侧。既有先天性，也有外伤、手术、肿瘤及乳腺炎后纤维增生引起。本组均为先天性。乳头内陷的矫正既要恢复乳头的形态，又要保留乳头乳晕的感觉及哺乳功能。基于这点，１９９２年至１９９６年为１０例１７侧（７例双侧，３例单侧）先天性乳头内陷者行八瓣法矫正术，效果满意。本文对该手术方法进行了较详细的描述，讨论了先天性乳头内陷的形成原因，临床应用解剖乳头乳晕的血供，术中术后预防乳头再回缩的方法以及介绍了现行矫正乳头内陷的方法。     

直线法乳房成形术的临床应用

目的介绍直线法乳房成形术(Lejour法)及其改进方法。方法按Lejour法设计手术切口,剥离乳腺组织,仅保留上部蒂营养乳头、乳晕,去除部分肥大下部及基底乳腺组织,将剩余腺体组织的乳腺基底层固定于第2、3肋水平。重新塑形乳腺组织,皮肤无张力缝合。对于部分乳房肥大明显患者可以首先抽吸脂肪,主要减少乳房腺体内、外侧及侧胸部皮下脂肪。结果采用此法矫治巨乳症、单纯乳房下垂共48例,其中辅助脂肪抽吸13例,术后乳房外形美观,术后3个月随访,3例有修整乳晕瘢痕或乳房下皱襞瘢痕。结论本术式简便易行,且远期效果好,乳房外形挺拔,可作为乳房缩小悬吊术的可行术式之一。     

单纯型和复杂型巨乳症的诊断及治疗

目的：探讨单纯型和复杂型巨乳症的临床特点,诊断要点及治疗方法,方法：回顾性分析1990－2000年民治21例巨乳症（37个乳房）,包括单纯型巨乳症16例29个乳房,复杂型巨乳症（巨乳症合并纤维腺瘤病等广范围病变者）5例8个乳房的临床,病理资料,结果：患者平均年龄23岁,21例均行手术治疗,16例单纯巨乳症者施以常规缩乳术,5例复杂型巨乳症中,2例为双乳腺纤维腺瘤病合并巨大型巨乳症,采用皮下腺体切除一期乳房成形术,2例几乎占据全乳的单乳巨纤维腺瘤并巨乳症,1例行皮下肿瘤切除,1例行肿瘤切除乳房成形术;1例双乳腺腺有块样物形成者行选择性腺体大部分切除乳房成形术。经随访至今患者乳房外形满意无肿瘤复发,结论：巨乳症好发于青春发育少女和青年妇女,诊断时应注意区别单纯型巨乳症和复杂型巨也症,术前B超,术中仔细探查及快速病检是必要的,单纯巨乳症常规缩乳术即可,复杂型巨乳症则应区别对待,彻底切除病变,一期乳房成形获得满意疗效,乳腺纤维腺瘤病合并巨乳症者,可采用皮下乳腺切除,真皮及皮下组织蒂一期乳房成形术。     

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.     

缩小整形与保乳术相结合在乳腺癌伴巨乳症病人中的临床应用

目的：评估对乳腺癌伴巨乳症病人行双侧乳房缩小整形术与保乳手术的可行性。方法：我院对105例巨乳症病人作了缩小整形术，对其中9例同时患乳腺癌病人在保乳基础上同时行双侧乳房缩小整形术，中位随访时间为14．2个月。结果：平均年龄45岁，平均切下含肿瘤一侧乳房标本重量为561g，肿瘤大小0．5～3cm。其中1例因切缘阳性行乳房全切除。本组术后没有出现明显的并发症，病人随访显示满意率达87％。结论：对于希望行保乳术的乳腺癌伴巨乳症病人，双侧乳房缩小整形术是可行且安全的一种方法，将是对乳腺肿瘤外科的一种挑战。     

Macromastia and Carpal Tunnel Syndrome: Is There an Association?

Macromastia is a disorder commonly reported by women. The prevalence of electrophysiologically confirmed, symptomatic carpal tunnel syndrome is 3% among women. A consecutive series of 31 patients with macromastia requesting breast reduction between August 2002 and April 2003 was recruited. The physical characteristics recorded included age, body mass index, and breast size. Clinical and electrophysiologic assessments of the upper limb were performed. Electrophysiologic testing showed that 7 (22%) of the 31 women had a prolonged median nerve latency conduction time longer than 0.40 ms. Age, chest circumference, and the ratio of nipple-to-inframammary line to chest circumference was associated with carpal tunnel syndrome. The prevalence of carpal tunnel syndrome among patients with macromastia was shown to be higher than in previous epidermiologic studies investigating the prevalence of carpal tunnel syndrome among women. Age, chest circumference, and breast size, but not body mass index, have a positive correlation with the increased prevalence of carpal tunnel syndrome in macromastia cases. Presented orally at the British Society of Clinical Neurophysiology Scientific meeting, Royal Victoria Hospital, Newcastle, UK, 19 March 2004     

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.     

Breast necrosis following left internal mammary artery harvest: a case series and a comprehensive review of the literature

Breast necrosis is a rare complication following coronary artery bypass grafting, as the blood supply to the breast is abundant. Internal mammary artery (IMA) harvest has been cited as a risk factor for breast necrosis following cardiac procedures. We retrospectively reviewed 3 cases of breast necrosis following IMA harvest, performed a comprehensive literature review, and noted risk factors. Obesity, macromastia, diabetes, hypertension, and end-stage renal disease were present in all cases. Two of 3 patients had pathology suggestive of calciphylaxis. Despite a rich blood supply, breast necrosis following use of the IMA for cardiac revascularization may occur in a subset of patients. Our review suggests that obese patients with macromastia and end-stage renal disease may be at increased risk for breast necrosis following IMA harvest. As the prevalence of obesity increases, we may see an increase in this previously uncommon complication.     

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.     

Breast reduction in the irradiated breast: evidence for the role of breast reduction at the time of lumpectomy

Given the high incidence of breast cancer in our society, it is common to encounter patients with macromastia who desire breast reduction after breast-conserving therapy by lumpectomy and radiation. We hypothesize that radiation leads to a significant increase in postoperative complications after breast reduction. All patients with a history of unilateral breast lumpectomy and radiation who subsequently underwent bilateral breast reduction by a single surgeon from 2004 to 2008 were retrospectively reviewed. Outcomes including cellulitis, wound breakdown, seroma, and need for repeat operations were compared between the radiated and nonradiated breast. The Fisher's exact test was used for statistical analysis. Twelve patients (mean age, 57 years) underwent bilateral breast reduction a mean of 86 months after unilateral lumpectomy and radiation. The nonradiated breasts had no complications postoperatively. The radiated breasts had a significant increase in complications with a total of five breasts (42%, p<0.04) having postoperative complications including cellulitis in two breasts, seroma requiring drainage in five breasts, two cases of fat necrosis, and one case of wound dehiscence. This resulted in two admissions for intravenous antibiotics and two repeat operative procedures. Additionally, three patients had significant breast asymmetry or contour deformities after reduction requiring operative revisions. Breast reduction after radiation leads to a significant increase in complications. Given this data, patients with macromastia undergoing breast conservation therapy for cancer should be considered for reduction at the time of lumpectomy and prior to radiation.     

Symptomatic Macromastia: A Quality of Life Evaluation after Reduction Mammaplasty

Abstract: The aim of this retrospective study is to present the severity of symptoms and clinical signs attributed to macromastia and the extent to which reduction mammaplasty relieves them. We studied, both by specially designed questionnaires and review of their clinical records, 92 patients, aged 18–64 years, who underwent bilateral reduction mammaplasty for symptomatic macromastia. The most common symptoms were breast pain and discomfort, shoulder grooving and pain, back and neck pain, intertrigo, and in one case, ulnar paraesthesia. The mean weight of removed tissue from each breast was 720 g. The complication rate was 11%, the most frequent being postoperative infection. The mean follow-up period was 27 months. Postoperatively 88 patients presented with significant improvement of symptoms, whereas in 3 patients the breast discomfort persisted apparently due to residual fibrocystic elements. The majority of patients would recommend the operation to friends and relatives with macromastia. The significant degree of symptom recess supports the reconstructive value of reduction mammaplasty.