乳晕环状切口垂乳上提巨乳缩小术

自１９９０年５月，应用乳晕环状切口行垂乳上提及巨乳缩小术２２例，术后乳房形态自然美观，乳头乳晕感觉不受影响，切口位于乳晕与正常皮肤交界处，痕迹不明显，消除了传统术式倒Ｔ字瘢痕，手术损伤小，设计简单。     

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。     

肿胀法双环巨乳缩小术

目的:探讨能够减少瘢痕的治疗巨乳症及乳房下垂的手术方法。方法:在使用肿胀技术的基础上,经绕乳晕的内、外两个环形切口入路形成真皮帽,结合去除部分脂肪和乳腺组织。结果:手术均Ⅰ期愈合,经6～12个月随访,乳房形状好,瘢痕不明显。结论:双环法巨乳缩小术对于治疗巨乳症及乳房下垂,是一种理想的手术方法。     

乳晕环状切口垂乳上提巨乳缩小术

自１９９０年５月，应用乳晕环状切口行垂乳上提及巨乳缩小术２２例，术后乳房形态自然美观，乳头乳晕感觉不受影响，切口位于乳晕与正常皮肤交界处，痕迹不明显，消除了传统术式倒Ｔ字瘢痕，手术损伤小，设计简单。     

乳晕环状切口垂乳上提巨乳缩小术

自1990年5月,应用乳晕环状切口行垂乳上提及巨乳缩小术22例,术后乳房形态自然美观,乳头乳晕感觉不受影响,切口位于乳晕与正常皮肤交界处,痕迹不明显,消除了传统术式倒T字瘢痕,手术损伤小,设计简单。     

探索适用于国人的巨乳缩小术

肥大乳房(macromatia)或巨大乳房(gigantomatia)是整形外科医师经常遇到的女性乳房畸形.单侧体积大于400 ml时称为肥大乳房,当单侧体积超过1500 ml时则称为巨大乳房[1].女性乳房代表着女性的第二性征,其功能和形态(特别是形态)倍受女性的重视.由于黄种人皮肤瘢痕明显的特点,决定了这一手术是我国整形外科医师必须面对的严峻挑战.     

改良Mckissock法巨乳缩小术

目的:探讨重度乳房肥大下垂的理想术式。方法:应用改进的Mckissock术式行乳房缩小术。结果:17例(32只)重度乳房肥大下垂术后外观挺拔,无乳头乳晕坏死发生和其他并发症。结论:改进的Mckissock法乳房缩小整形术手术方法简便,术后乳房外观良好,并发症少,值得推广。     

几何法乳晕设计在下蒂瓣巨乳缩小术中的应用

下蒂瓣法巨乳缩小成形术由Robbins在1997年设计并应用于临床。1998年起我们应用几何原理进行受区乳晕和新乳晕的设计，并改进了Robbins术式。共治疗中，重度乳房肥大者38例，取得了满意效果。     

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。     

竖直切口内上蒂巨乳缩小术的临床应用

目的 根据巨乳缩小术的手术原则,探讨一种既能保证乳房血供和功能,又能保持良好乳房外观的手术方式,并观察其临床疗效.方法 本组共10例乳房肥大症患者,采用竖直切口结合内上蒂法行乳房缩小术.根据术前设计,去除内上蒂表皮,形成腺体蒂,再切除外下象限多余的皮肤及腺体,重塑乳房形态.结果 术后无皮肤坏死、脂肪液化、乳头乳晕感觉减退、血肿和感染等并发症发生,切口均Ⅰ期愈合.术后随访3～12个月,患者对术后乳房外观形态及功能均表示满意,能接受术后瘢痕.结论 竖直切口内上蒂巨乳缩小术操作简单、安全,对轻、中度,特别是中度乳房肥大患者特别适用,术后和远期均能达到满意疗效.     

乳房缩小成形术37例体会

本文报告了过去11年中我整形中心开展的37例乳房缩小成形术的经验和教训,统计了术前术后测量的有关数值,在复习有关文献的基础上讨论了手术适应证、病理变化、手术术式的选择以及手术设计和操作中的注意事项。     

Nipple reconstruction using a two-step purse-string suture technique

Formation of an aesthetic nipple areola complex with lasting projection remains a challenging final step in breast reconstruction. Despite the many techniques that have been described, no single approach has emerged as the gold standard. The current study presents a novel technique in nipple areola complex reconstruction. In a two-step fashion, the nipple and areola are reconstructed independently. This aims to create a lasting projection of the nipple while maintaining a natural contour among the nipple, the areola complex and the surrounding breast tissue. With more than 15 years of experience using this technique, the authors believe that it is a straightforward procedure and is reliable in providing satisfactory results to both the surgeon and the patient.     

保留乳头乳晕感觉功能的改良双环法巨乳缩小术

目的探讨改良双环法巨乳缩小整形手术的方法，以提高疗效，减少手术并发症。方法以乳头为中心做近似双同心圆切口，滚轴取皮刀去除两同心圆之问的表皮，切除外环以外，包括外上象限、内上象限、内下象限肥大的腺体组织，保留外下象限和中央的乳腺组织，以便保持第4肋间神经对乳头乳晕的支配和充足的血供。将去表皮的真皮帽边缘与乳腺基部的筋膜紧密缝合固定在胸壁上，重塑乳房外形。以可吸收线荷包式缝合外环皮下组织，收紧荷包缝线将外环切口缩小到与内环相近，直接缝合切口。结果本组患者31例，术后乳房形态自然挺拔、质感柔软；乳头乳晕对称，感觉正常；瘢痕隐蔽并且有效地保留了乳房的泌乳功能。结论本法术后乳房形态良好，功能正常，是一种较理想的巨乳缩小整形方法。     

乳房外上真皮乳腺单蒂瓣巨乳和垂乳缩小整复术

目的　探讨乳房缩小美容术保持乳头乳晕血运感觉的方法。方法　采用宋氏巨乳缩小术方法设计切口,以乳头乳晕上方及外侧真皮乳腺单蒂供应乳头乳晕血运和神经支配,完成乳腺整形。１９９６ 年１ 月～１９９８ 年１２ 月对１８ 例３０ 侧巨乳和１２ 例２２ 侧垂乳进行手术。结果　新乳房外形满意,乳头乳晕血运感觉保留好。结论　该法切口瘢痕小、乳头乳晕血运感觉良好,适合于不同轻重程度的巨乳垂乳,可作为乳房肥大或松垂的重要手术方法     

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.     

巨乳症的手术疗效比较

目的探讨不同手术方式对巨乳症的治疗效果. 方法 1993年11月～2003年11月,我科共收治巨乳症患者33例66侧,根据乳腺病变的性质、部位、大小、乳房下垂的程度,选择下述不同的术式:垂直双蒂瓣法6例,无垂直切口的横双蒂瓣法12例,双环形切口乳房缩小术15例. 结果术后外观评价:优良27例53侧,中7例13侧;术后乳房疼痛改善率96.8%(30/31),肩背痛及睡眠明显改善100%(31/31,25/25),乳房下皱襞湿疹、皮炎治愈率100%(15/15),术后着装满意率100%(33/33).结论乳房缩小整形术是治疗巨乳症的首选方法,应根据乳房肥大、下垂的程度选择不同的术式.     

The Crossed Dermal Flaps Technique for Breast Reduction

Background More than100 techniques and variations of breast reduction have been published. In most, the principal differences involve the method of transpositioning the nipple–areola complex and the pattern of skin resection. Skin resection inevitably causes scarring, which has given rise to an ongoing debate over long scar techniques and short scar techniques. The debate would be mute if only the extent of the scar was evaluated: ideally, the shorter the better. However, this limitation of scar extension conditions other elements to be evaluated in the results. On the other hand, there is a great variety of clinical cases in which not only the volume must be considered, but also the degree of ptosis, the quality of the skin, the age, and, most importantly, the wishes of the patients.Objectives The objective of the crossed dermal flaps procedure was to obtain optimum volume, position, and shape of the breast; well-located good-quality scars as short as possible; and early satisfactory and long-lasting results.Methods Between June 1986 and June 2003 136 women underwent this procedure, performed under controlled hypotension (median arterial blood pressure, 60 mmHg). The technique is based on Wise-type skin marking associated with glandular resection in the lower and lateral poles, and transpositioning of the nipple–areola complex with a superior medial dermoglandular pedicle. Two rectangular areas under each cutaneous vertex are delimited, which will correspond with the future dermal flaps. These flaps are crossed, then fixed to the musculoaponeurotic chest wall, and the rest of the wound is sutured by planes in a conventional manner.Results Two patients (1.4%) experienced minimum cutaneous epidermolysis without dehiscence at the union of the vertical and horizontal sutures, which later healed by second intention without interference with the aesthetic result. Three cases (2%) showed partial and superficial necrosis of one of the areolae, but healed during the following 3 weeks without secondary surgery. In three patients (2%), hematomas developed, which were drained in the dressing room with no complications. One patient experienced thickening of the scar. No infections were observed.Conclusions The authors believe the cross dermal flaps technique is safe and applicable to an extensive variety of cases. It is easy to execute and to teach, and therefore, those who are beginning to use inverted T techniques such as that described, can, from the beginning, diminish the incidence of short- and long-term complications such as dehiscence that lead to scarring at the convergence of the flaps and bottoming out of the inferior pole, with the horizontal scar displaced upward and an increase in the distance between the later and the nipple areola complex.     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上,设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过10例20只乳房的临床应用,取得了满意效果。