结合肿胀吸脂术的中央蒂乳房缩小术

目的 探讨一种新的乳房缩小术。方法 对9例乳腺肥大患者采用肿胀吸脂技术去除皮下脂肪，经环绕乳晕的内，外两个环形切口形成真皮帽，楔形切除乳腺后用“真皮帽”固定塑形。结果 术后乳房外形良好，天乳头乳晕坏死，切口皮肤皱褶于3个月内逐渐自然消失。结论 结合肿胀吸脂术的中央蒂乳房缩小术对于乳房中度肥大是一个简单，安全，有效的乳房缩小方法。     

Patients' satisfaction with breast reconstruction and reduction mammaplasty

Patients' satisfaction is widely recognised as an important measure of the quality of care. This study measured patients' satisfaction with the outcome of breast reconstruction surgery and reduction mammaplasty and with the treatment received in hospital. A questionnaire about patients' reasons for having the operation and postoperative satisfaction was therefore sent to 137 patients after breast reconstruction and 142 who had had reduction mammaplasty. The response rate in the former group was 84% and in the latter 65%. In both groups of patients the main reasons for having the operation were difficulties with physical activities and in finding clothes to fit. Other factors were poor self-esteem and problems with body image. A total of 69% of the patients who had had reconstructions referred to problems with wearing an external prosthesis. In the reduction mammaplasty group one of the most important reasons for having the operation was pain, in particular neck, shoulder, and back pain. In the reconstruction group 94%, and in the reduction group 88%, thought the outcome of the operation was good or very good. They had no regrets about their decision to seek surgical treatment, even when the aesthetic outcome fell short of their expectations. The patients were generally satisfied with the treatment they had received. In the reconstruction group 97%, and in the reduction group 96%, of patients felt satisfied with their overall decision to have the operation. Our results confirm that these surgical procedures help to improve patients' quality of life. Among the patients who had had reconstructions, the resolved problems with body image were considered to be the main benefit of the operation. In the reduction group the main benefits were reduced neck, shoulder, and back pain. In both groups 91% of patients would have recommended the operation to a friend under similar circumstances. In the light of this evidence doctors should more readily recommend reconstruction to patients after mastectomy and reduction to women with heavy breasts.     

The Veronesi quadrantectomy: an established procedure for the conservative treatment of early breast cancer

A little more than 100 years ago Halsted pioneered a surgical approach that led, for the first time, to the cure of breast cancer in some patients. Veronesi's contribution was to offer the same possibility while considerably reducing the mutilation that went with cure. This article reviews the development of the conservative surgical approach in breast cancer and synoptically presents the results of large-scale clinical trials conducted by Veronesi's group in Milan in the 1970s and 1980s to demonstrate the efficacy of quadrantectomy, radiotherapy and axillary dissection (QUART) as conservative treatment for small size breast cancer. These studies set in motion the world-wide trend to conservative surgery in all forms of cancer. The article goes on to describe the surgical procedures of quadrantectomy and complete axillary dissection as developed by Veronesi, and outlines new indications for, and developments of this established conservative technique.     

Preoperative breast marking in reduction mammaplasty

A simple method of preoperative marking for reduction mammaplasty is described. This method may be used in macromastias when the technique chosen implies a postoperative scar with the shape of an inverted T. The marking sequence follows standard steps, but the drawing is always different because it is a consequence of the shape of the breast. This marking method reduces the chance of making mistakes due to excessive personal evaluations or to the use of standard drawing patterns that may be not suitable for all breast shapes.     

Patients' satisfaction with breast reconstruction and reduction mammaplasty.

Patients' satisfaction is widely recognised as an important measure of the quality of care. This study measured patients' satisfaction with the outcome of breast reconstruction surgery and reduction mammaplasty and with the treatment received in hospital. A questionnaire about patients' reasons for having the operation and postoperative satisfaction was therefore sent to 137 patients after breast reconstruction and 142 who had had reduction mammaplasty. The response rate in the former group was 84% and in the latter 65%. In both groups of patients the main reasons for having the operation were difficulties with physical activities and in finding clothes to fit. Other factors were poor self-esteem and problems with body image. A total of 69% of the patients who had had reconstructions referred to problems with wearing an external prosthesis. In the reduction mammaplasty group one of the most important reasons for having the operation was pain, in particular neck, shoulder, and back pain. In the reconstruction group 94%, and in the reduction group 88%, thought the outcome of the operation was good or very good. They had no regrets about their decision to seek surgical treatment, even when the aesthetic outcome fell short of their expectations. The patients were generally satisfied with the treatment they had received. In the reconstruction group 97%, and in the reduction group 96%, of patients felt satisfied with their overall decision to have the operation. Our results confirm that these surgical procedures help to improve patients' quality of life. Among the patients who had had reconstructions, the resolved problems with body image were considered to be the main benefit of the operation. In the reduction group the main benefits were reduced neck, shoulder, and back pain. In both groups 91% of patients would have recommended the operation to a friend under similar circumstances. In the light of this evidence doctors should more readily recommend reconstruction to patients after mastectomy and reduction to women with heavy breasts.     

The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention

BACKGROUND: Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival METHODS: Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected RESULTS: Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. CONCLUSION: CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.     

Maximizing breast projection with combined free nipple graft reduction mammaplasty and back-folded dermaglandular inferior pedicle

Standard technique for free nipple reduction mammoplasty was described by Thorek in 1922. In contrast to its effectiveness, late postoperative results included insufficient projection of the breast and the nipple-areola region. We describe a modification of this well recognized technique in order to increase central mound projection and improve nipple-areola projection by suturing the dermaglandular flap to the pectoralis major muscle by back-folding the pedicle. Twenty macromastia patients were subjected to free-nipple-graft reduction mammoplasty in combination with inferior pedicled dermaglandular reduction mammaplasty of a total of 40 breasts with this technique between years 2000 and 2004. Preoperative planning for inferior pedicled dermaglandular flap was made using the "Wise" pattern for large breasts. The variation of the technique comes from using the back-folded deepithelialized inferior pedicled dermaglandular flap for increasing the breast mound projection by fixating the demaglandular flap with absorbable sutures to the underlying pectoralis major muscle fascia and the costal cartilage pericondrium. By applying this technique, increased projection during the early preoperative and late postoperative periods are achieved, compared with patients who only underwent free-nipple- graft reduction mammoplasty.     

改良乳晕双环法巨乳缩小术的临床体会

目的 探讨乳晕双环法巨乳缩小术的临床应用疗效.方法 对23例患者行改良乳晕双环法巨乳缩小,手术设计方法简单,真皮帽处理避免张力过大,腺体塑形采用旋转腺体组织获得较好的突度,乳房上限的乳腺组织须包裹固定、悬吊,以达到较理想的手术效果.结果 本组患者23例,手术切口均Ⅰ期愈合.随访3～12个月,无乳头乳晕坏死等并发症发生.结论 改良乳晕双环法巨乳缩小术适用于轻、中及重度患者,是一种有较高满意度的手术方式.     

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。     

Sclerosing lobular hyperplasia of the breast after reduction mammaplasty

Sclerosing lobular hyperplasia is a uncommon benign fibroproliferative lesion of the breast similar to a fibroadenoma. It usually presents as a mass in the outer quadrant of the breast of younger women. The authors report an atypical case of sclerosing lobular hyperplasia that presented as bilateral breast masses in an elderly woman after a reduction mammaplasty. Breast masses that develop after reduction are often a result of fat necrosis, internal scarring, or organizing hematomas. Those that do not resolve warrant open biopsy because they may represent malignant or benign neoplasms.     

伴有乳房良性病变的巨乳缩小术27例

目的 探讨乳房肥大下垂同时伴有良性病变的巨乳缩小术的方法。方法：1980年11月～2001年12月，共收治乳房肥大下垂伴乳腺良性病变的患者27例52侧，根据乳腺病变的性质、部位、大小以及乳房肥大下垂的程度，选择下述不同的术式，行下方垂直蒂瓣法9例(17侧)，垂直双蒂瓣法16例(3l侧)，双环形切口乳房缩小术2例(4侧)。结果 术后外观评价良25例49侧占94．2％，差2例3侧占5．8％。术后乳房疼痛改善率为95．8％，肩、背痛，睡眠明显改善为100％，乳房下皱襞湿疹、皮炎未再发生为100％，27例患者术后着装均满意。结论 乳房缩小整形手术是治疗乳房肥大下垂，同时伴有乳腺良性病变的首选治疗方法。     

Occult breast carcinoma in patients undergoing reduction mammaplasty

Seven patients who had breast reduction surgery and whose preoperative physical examinations were unremarkable were found to have brest carcinoma. In the five in whom mastectomy was performed, most closures were difficult, and in one patient bilateral mastectomy was complicated by wound dehiscence. In only one of these seven was it possible to obtain information regarding the hormonal binding status of the tumor cells. These and other sequelae would not have occured had the tumors been diagnosed before operation. Because physical examination alone is not sufficiently sensitive for the diagnosis of breast cancer, we suggest that mammography be included in the evaluation of patients consulting surgeons for breast reduction.     

内上方蒂法与吸脂术在乳房缩小成形术中的联合应用

目的 探讨结合脂肪抽吸法的内上方真皮腺体蒂乳房缩小成形术对乳房肥大伴下垂进行修复的疗效.方法 对8例乳房肥大伴下垂的患者,行结合脂肪抽吸法的携带Würinger＇s乳房水平中隔内上方真皮腺体蒂乳房缩小成形术进行修复.结果 8例患者术后均未出现血肿及乳头乳晕复合体坏死等并发症.1例发生小段切口裂开.均获随访6～18个月,新乳头乳晕感觉良好,切口瘢痕不明显,新乳房外形满意.结论 联合应用脂肪抽吸法和内上方真皮腺体蒂术可使肥大伴下垂的乳房进一步得到良好的塑形,疗效满意.     

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。