应用解剖型假体隆乳治疗轻中度乳房下垂

目的探讨应用解剖型假体隆乳术治疗小乳症伴轻中度乳房下垂的方法及效果。方法对15例患小乳症伴乳房轻中度下垂者应用解剖型ST-410假体行乳腺下隆乳术，根据术后患者满意度判断手术治疗效果。结果15例乳房轻中度下垂者通过此方法均获得很大改善，患者均感满意。结论应用解剖型假体行乳腺下隆乳术可明显改善轻中度乳腺下垂。     

Periareolar mastopexy with mammary implants

We present our experience with using a periareolar mastopexy technique combined with prosthesis implantation to correct mammary ptosis, misplaced areolas, and tuberous hypoplastic breasts. We draw a circle around the areola and deepidermize the skin between them. We enter the glandular tissue and introduce the implant in a submuscular pocket. A purse string suture of nonabsorbable material is used to gather the excess skin. Results were satisfactory in all cases. During the immediate postoperative weeks the shape was flatter and protruded less, but a progressive correction was observed. The tuberous breast could be released and reshaped adequately. Misplaced areolas can also be replaced correctly by drawing the periareolar circle and ellipse in eccentric forms. This technique does not allow great elevation of the areola (no more than 4–5 cm), but it is good and safe for correcting minor to moderate ptosis combined with volume augmentation.     

经腹外斜肌入路隆乳术

为降低假体置入隆乳术后的纤维包膜挛缩的发生率，自１９９０年以来要用经乳房下腹外斜肌入路行隆乳术９６例，术后随访半年以上者７２例，其中６７例（９３．１％）乳房外观挺拔自然，手感柔软，２例（２．８％）发生单侧乳房硬化，此术式可提供一个完整的肌腔隙将假体完全覆盖，从而可以明显降低纤维包膜挛缩的发生率。     

经腹外斜肌入路隆乳术

为降低假体置入隆乳术后的纤维包膜挛缩的发生率，自１９９０年以来采用经乳房下腹外斜肌入路行隆乳术９６例，术后随访半年以上者７２例；其中６７例（９３．１％）乳房外观挺拔自然，手感柔软，２例（２．８％）发生单侧乳房硬化。此术式可提供一个完整的肌腔隙将假体完全覆盖，从而可以明显降低纤维包膜挛缩的发生率。     

经腹外斜肌入路隆乳术

为降低假体置入隆乳术后的纤维包膜挛缩的发生率,自1990年以来采用经乳房下腹外斜肌入路行隆乳术96例,术后随访半年以上者72例;其中67例(93.1%)乳房外观挺拔自然,手感柔软,2例(2.8%)发生单侧乳房硬化。此术式可提供一个完整的肌腔隙将假体完全覆盖,从而可以明显降低纤维包膜挛缩的发生率。     

改良双环法乳房悬吊术

目的 介绍改良双环法行乳房悬吊术的方法和经验。方法 采用传统的双环法乳房悬吊术切口，在皮肤与乳腺的腺体表面之间行广泛剥离后。在乳腺的下半象限正中将腺体垂直切开，将形成的两部分乳腺复合组织瓣向内上及外上方向旋转后互相交叉重叠缝合固定成形。并将乳晕内外环的真皮行荷包缝合。术后将乳房塑形包扎。结果 采用本方法矫治轻、中度乳房下垂者共8例16侧。术后乳房外形美观持久，乳头、乳晕感觉良好，效果满意。结论 本手术方法简便易行．组织损伤小．瘢痕不明显．是矫治轻、中度乳房下垂的一种比较理想的方法。     

乳腺组织瓣联合真皮帽悬吊术矫正轻中度乳房下垂

目的 探讨乳腺组织瓣旋转联合真皮帽悬吊的垂乳上提技术矫正轻中度乳房下垂的临床效果.方法 根据乳房下垂程度设计形成真皮帽后,分离乳房皮肤和腺体,于乳腺外上方行部分腺体切除或直接纵行切开腺体,并同时形成外侧腺体瓣,掀起腺体瓣向内侧旋转固定,缩小乳房基底,再行真皮帽上提固定和乳房塑形.结果 2006年3月至2010年3月,于临床应用46例,术后效果满意,其中2例出现单侧血肿,无其他严重并发症.对40例患者随访6个月至4年,乳房外形满意,无继发下垂、乳房扁平、乳头乳晕感觉障碍等并发症.结论 乳腺组织瓣旋转联合真皮帽悬吊垂乳上提术可商塑造饱满、坚挺的乳房,术后瘢痕不明显,远期效果满意.

Abstract：

Objective To investigate the therapeutic effect of glandular flap combined with dermal flap suspension for correction of mild and moderate breast ptosis. Methods The dermal flap was formed according to the breast ptosis and dissection was performed between the skin and gland. The superior-lateral gland was partially resected or cutted vertically only to form the lateral glandular flap. Then the glandular flap was rotated medially and fixed to shrink the glandular base area. Then the breast was up-positioned and fixed with dermal flap to remodel the breast shape. Results From Mar. 2006 to Mar. 2010, 46 cases were treated with satisfactory result. There was no severe complication, except for 2 cases of unilateral hematoma. 40 cases were followed up for 6 months to 4 years with good breast shape. No secondary ptosis,breast flatten and NAC sensation disorder was happened. Conclusions Glandular flap combined with dermal flap suspension is a good method for mild and moderate breast ptosis with reliable long-term results.The breasts have busty appearance and good projection with inconspicious scar.     

改良双环加垂直切口乳房下垂矫治术

目的：利用多种术式的有机结合,探讨乳房下垂的新的矫治办法。方法：从2005年3月至2013年6月,对于38例中重度乳房下垂患者,在传统的双环和／或加垂直切口的基础上,进行部分旋转折叠及多个楔形皮肤切除等改进,以缩短恢复期,提高手术效果。结果：通过38例患者的,临床观察及术后随访,发现运用该方法不仅能够有效地矫治中重度乳房下垂伴肥大,同时可以使乳房变得更加挺拔,有韧性,术后乳晕双环切口皱褶恢复明显缩短,垂直切口瘢痕的长度较短,瘢痕不明显。结论：改良双环加垂直切口的乳房下垂上提缩小术是一种较好的手术方法,值得临床推广。     

Modification of “Periwinkleshell operation” for involution and ptosis of the breasts

Summary Involution and ptosis of the breast may follow gestation or dietary weight loss. Whenever possible the breast tissue is reshaped by resecting the skin over its inferior part, detaching the fixation of the glandular tissue medially and laterally, and dividing it centrally to create two mammary gland flaps. The lateral flap is fixed medially to the base of the medial flap and vice versa. In this way the breast tissue assumes a conical form with only minimal to moderate recurrence of ptosis and flatness. If necessary, an augmentation mammoplasty with a prosthesis can be carried out in a second operation 3 to 4 months later.     

应用乳腺旋转瓣固定矫正轻中度乳房下垂

目的:介绍采用乳房外下象限乳腺旋转瓣固定矫正轻中度乳房下垂的方法和经验。方法:经乳晕周缘"双环形"切口,去除内外环之间的表皮。在皮下脂肪组织与腺体之间广泛分离。在乳房下方正中垂直剖开乳腺,并向外侧分离,形成乳房外下象限乳腺瓣,并向内上方旋转固定,缩小乳房基底,重塑乳房外形,并上提下垂的乳头乳晕复合体。伴有明显乳腺萎缩者,同期或Ⅱ期行胸大肌下假体隆乳术。结果:2011年2月~2013年12月采用该方法共治疗轻中度乳房下垂19例,无血肿、感染、乳头乳晕坏死等并发症发生,术后随访1~2年,无乳房下垂复发,乳房下垂明显矫正,双乳对称,外形良好。切口瘢痕呈环线状,乳头乳晕感觉功能正常。结论:乳腺旋转瓣固定法结合了"双环法"和"垂直法"两种技术的优势,对轻中度乳房下垂的治疗,提供了一种新的思路和方法。     

改良双环法乳房下垂矫正术

目的:介绍改良双环法行乳房悬吊术的方法和经验。方法:采用传统的双环法环乳晕切口,切除双环间表皮,在皮肤与上半乳腺的腺体表面之间剥离,去除上半腺体后松弛的浅筋膜深层,上提腺体至正常位置并固定于深筋膜,同时进行腺体的适当折叠塑形或置入乳房假体增加丰满程度。结果:共行轻、中度下垂28例(4例为单侧下垂),其中悬吊加假体隆乳9例;腺体瓣交叉缝合悬吊塑形19例。术后乳房外形改善满意,乳头、乳晕感觉良好,效果持久。结论:本手术方法安全易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法。     

应用聚丙烯单丝网片纠正轻、中度乳房下垂

目的：介绍一种适用于轻、中度乳房下垂的矫正术。方法：采用乳晕周围环状切口，用聚丙烯单丝网片制成内置式乳罩，行乳腺组织的上提、塑形和固定，并为21例乳房下垂者行矫正术。结果：21例均达到较为理想的上提效果，随访2－16个月，无下垂复发和切口瘢痕增生，未发生异物排斥反应。结论：聚丙烯单丝网片用作乳房塑形的支持材料安全可靠，减少了切口的瘢痕增生，避免了下垂复发。     

Immediate breast reconstruction using an external oblique rectus musculofascial turnover flap

The development of the external oblique rectus musculofascial turnover flap has recently received a great deal of attention. With this method, the upper part of the external oblique muscle is lifted off the lower thoracic wall along with a segment of the rectus muscle, pedicled in the sixth intercostal space and subsequently connected with the lower margin of the pectoralis major muscle. This approach bridges the weak regions of the thin muscle layers in the medioinferior breast area. Because this procedure avoids the need for a second operation to restore the contour and enables production of a natural ptosis and a well-accentuated lower breast fold, it has become increasingly important in immediate breast reconstruction. Compared with the complex myocutaneous flaps techniques, this procedure is characterized by relative simplicity and ease of performance. Compared with the tissue expansion technique, the oblique rectus turnover flap allows restoration of the female form in a one-stage procedure with a better, more natural ptotic breast shape and well-defined inframammary crease. Results have been encouraging. In fact, this procedure has almost completely replaced other techniques for immediate reconstruction of the female breast following mastectomy.     

Augmentation Mastopexy with Implant and Autologous Tissue for Correction of Moderate/Severe Ptosis

Purpose: Breast augmentation combined with mastopexy is associated with a significantly higher complication rate than augmentation alone. The combination of mastopexy and breast implants has revealed a moderate recurrence of breast ptosis in many patients particularly with use of medium to large implants. Ptosis is the “bottoming out” of the breast tissue with loss of the desired roundness, due to the ptosis of the breast implant and the mammary tissue. In this study, we hypothesize the need for careful planning and careful preoperative surgical execution to minimize this complication. Patients and Methods: Between January 2007 and July 2011, augmentation mastopexy with implant and autologous tissue (“double implant”) was performed for 25 patients with grade III mammary ptosis. All patients underwent inverted-T mastopexy with supramuscular moderately cohesive gel breast implant using an inferior-based flap of de-epitelialized dermoglandular tissue and a superior-based nipple-areola complex pedicle. Results: An inferior-based flap of deepithelialized dermoglandular tissue was used to stabilize the implant and is projection. Breast lifting was performed through a strong anchorage to fascia and to muscle of second intercostal space, improving the profile of the breast. Results were analyzed, no breast ptosis recurrence was noted at 30-month follow-up. Conclusions: Our technique presents the challenge of determining the amount of excess skin to be removed after implantation to create symmetry and provide for skin tightening without compromising tissue vascularization.     

Mammaplasty: The “Super Flap” or the Superior Pedicle Extra Long Flap for Massive Breasts with Marked Ptosis or Gigantomastia

Background  Very large breasts associated with ptosis frequently present a challenge to the plastic surgeon in choosing the ideal procedure to obtain a satisfactory result. A free nipple graft, which for many represents the best option in these conditions, has many disadvantages. Methods  The author’s method of a superior pedicle flap allows for very long flaps, in some cases over 40 cm, and breast ptosis with the nipple at more than 55 cm from the suprasterna notch with preservation of the circulation to the nipple-areola complex. This procedure has been developed and modified from the French oblique method of Dufourmentel and Mouly converted to an inverted T, while the glandular resection is performed in a keel fashion behind the areola to house and give room for these very long flaps without undue compression on them and endangering the blood supply to the areola-nipple complex. Results  The method is described in detail, the early and late results presented, and advantages and disadvantages discussed. It has stood the test of time as it has been used regularly for more than 20 years and has become our standard method. Conclusion  The method presented is especially suitable for very large breasts with ptosis; however, excellent results are also achieved for all other degrees of ptosis, with very little modification in the procedure needed to suit different breast sizes and shapes. Most of the time we obtain a pleasing and attractive breast. This method rarely resulted in complications and never required a blood transfusion.     

Our own experience in the treatment of hypotrophy and ptosis of the breast]

The outcome of surgical of small, ptotic breasts is reported in a retrospective series of fifteen patients operated between 1983 and 1989. Seven patients underwent breast augmentation by insertion of breast implant supplemented in one case by a dermopexy while eight patients underwent cutaneous and glandular remodeling alone. Simple breast augmentation with breast implant gave good results with mild to moderate ptosis (i.e. when the distance between the inferior margin of the clavicle and the upper margin of the areola was equal to or less than 17 cm) provided that: the subareolar segment III did not exceed 5 cm, the skin had good static qualities for breast suspension, the amount of glandular, adipose and cutaneous tissue present allowed the prothesis to be covered by a sufficiently thick layer. With breast ptosis greater than 17 cm or when segment III exceeded 5 cm, cutaneous remodeling by dermopexy was associated with insertion of breast implant. In this group of patients treated, either by breast implant alone, or associated with dermopexy, results were good in 33%, and satisfactory in 50% of cases. Better results were obtained in patients with marked ptosis and breasts which, although hypotrophic, conserved a amount of adipose and glandular tissue sufficient to allow breast reconstruction by soft tissue remodeling alone (without the insertion of an implant). Patients in this group were treated by glandular and cutaneous remodeling with good to excellent results in 80% of cases.     

Triangle Resection with Crescent Mastopexy: An Oncoplastic Breast Surgical Technique for Managing Inferior Pole Lesions

Resection of inferior pole breast cancers commonly produces inferior cosmetic results, particularly when resection of skin is required. The triangle resection with mastopexy is one of several oncoplastic breast surgical techniques that enable resection of inferior pole lesions with preservation if not improvement of breast cosmesis. This procedure may be combined with unilateral or bilateral mastopexy to further improve breast cosmesis in patients with mild to moderate ptosis.     

Gynecomastia: The Horizontal Ellipse Method for Its Correction

BACKGROUND: Gynecomastia is an extremely disturbing deformity affecting males, especially when it occurs in young subjects. Such subjects generally have no hormonal anomalies and thus either liposuction or surgical intervention, depending on the type and consistency of the breast, is required for treatment. If there is slight hypertrophy alone with no ptosis, then subcutaneous mastectomy is usually sufficient. However, when hypertrophy and/or ptosis are present, then corrective surgery on the skin and breast is mandatory to obtain a good cosmetic result. METHODS: Most of the procedures suggested for reduction of the male breast are usually derived from reduction mammaplasty methods used for females. They have some disadvantages, mainly the multiple scars, which remain apparent in males, unusual shape, and the lack of symmetry with regard to the size of both breasts and/or the nipple position. The author presents a new, simple method that has proven superior to any previous method described so far. It consists of a horizontal excision ellipse of the breast's redundant skin and deep excess tissue and a superior pedicle flap carrying the areola-nipple complex to its new site on the chest wall. RESULTS: The method described yields excellent shape, symmetry, and minimal scars. CONCLUSION: A new method for treating gynecomastis is described in detail, its early and late operative results are shown, and its advantages are discussed.     

The minus-plus mastopexy

The minus-plus mastopexy technique is designed for correction of moderate or major breast ptosis where breast volume is adequate but located in the lower quadrants and increased fullness in the upper quadrants is desired. The advantages of this procedure are absence of a medial scar, excellent projection, ensured nipple viability, speed, and flexibility.     

A classification and algorithm for treatment of breast ptosis

Background: The Regnault classification of breast ptosis is insufficient for determining surgical strategies for different stages of ptosis. Objective: A new clinical classification of breast ptosis is proposed that allows greater precision in the development of an appropriate surgical plan. Methods: Breast ptosis is classified in 1-cm stages, beginning with stage A at 2 cm above the inframammary crease and continuing through stage E at 2 cm below the inframammary crease, with any level of ptosis beyond stage E defined as stage F. Increments of 1 cm were chosen because each level predicts a different amount of skin excision necessary to elevate the nipple-areolar complex to an ideal aesthetic level. An algorithm is provided for defining options for surgical management of the ptotic breast with and without augmentation and for the previously augmented breast. Results: Seventy-three cases of breast ptosis were treated with augmentation mammaplasty, simultaneous areolar mastopexy breast augmentation, Wise mastopexy breast augmentation, and other procedures following the proposed classification system and treatment algorithm. Conclusions: The new system for staging of breast ptosis is simple and easy to remember and can assist in the planning and evaluation of surgery. (Aesthetic Surg J 2002;22:355-363.)