乳房重度下垂的直线切口法乳房成形术

目的 介绍应用直线切口法乳房成形术(Lejour法)治疗重度乳房下垂方法及效果.方法 按Lejour法设计手术切口.该类患者新乳头位置较正常人群可适当下移1～2 cm,新乳房下皱襞上移5～10 cm,通过适当下移新乳头位置及上移新乳房下皱襞达到缩短垂直切口距离.剥离乳腺组织,将下垂乳腺组织从乳腺深层固定于胸大肌第2、3肋水平.皮肤无张力缝合.结果 36例中乳房肥大者30例、体积基本正常者6例,经术后3个月至2年随访,无明显并发症,新乳房外形挺拔自然,患者满意.结论 本术式简便易行,远期效果好,可作为重度乳房下垂的术式之一.     

Short scar reduction mammaplasty in the bariatric patient

Reduction mammaplasty may be necessary even after massive weight loss. Patients typically present with unfavorable breast features such as significant loss of upper pole volume, inelastic skin, and severe ptosis. The most common approach in the United States has been the Wise-pattern inferior pedicle technique, emphasizing skin excision. This report presents the short scar vertical reduction mammaplasty approach for the bariatric patient population. It aims to demonstrate improved outcomes with less scar burden. The study included 15 women (n = 29 breast reductions) with mean age of 41.8 years. All the patients had undergone gastric bypass surgery, with mean weight loss of 109 pounds and mean body mass index of 33.3 kg/m(2). A modified superomedial pedicle vertical mammaplasty technique was used. New nipple position was placed lower than the inframammary fold in accordance with vertical lack of upper pole fullness. Suction-assisted lipectomy was used to contour the inferior pole of the breast before glandular resection. A full-thickness superomedial pedicle and median incision of the upper pole maximized pedicle safety. The mean breast resection was 605 g on the right side (range, 352-945) and 592 g on the left side (range, 360-908). Patient satisfaction was high, with pleasing and stable breast shape at long-term, and a mean patient-related aesthetic ranking of 4.3 of 5.0. No major complications were noted. It is shown that superomedial pedicle vertical reduction mammaplasty can be an alternative approach in bariatric patients, achieving long-term pleasing and stable results with significantly decreased scar burden.     

A new technique of reduction mammaplasty: dermis suspension and elimination of medial scars.

In the last decades new techniques of reduction mammaplasty significantly improved the results obtained and led to a reduced incidence of complications. However, some important problems like the loss of a natural submammary fold and alteration in the shape of the breast with time still remained mostly unsolved and the medial scars in the inverted T techniques are aesthetically unsatisfying. A new strategy for reduction mammaplasty has been developed based on a combination of advantages of other techniques. The principle of using de-epithelialized infra-areolar skin for dermis suspension prevents sagging of the remaining breast tissue behind the inframammary fold to create a long-lasting, natural shape of the reduced breast with an accentuated submammary fold. The central pedicle is favoured because of good modelling even in big reductions. Better vascular and nerve supply of the nipple-areola complex and the continuity of the lactiferous ducts are further advantages of the central pedicle. Secondary operations after reduction mammaplasty or augmentation usually dictate the use of a superior pedicle together with the dermis suspension technique. B-shaped skin incisions prevent medial submammary scars and can be used up to a 10 cm transposition distance of the nipple without disadvantage. The operative technique is described in detail. Examples are given for the primary procedure and the technique as a secondary correction. The principle of dermis suspension in combination with the prevention of a medial scar is applicable to reduction mammaplasty as well as mastopexy.     

Aesthetic Breast Surgery with Inverted-T Scar Placed above the Inframammary Sulcus

This article describes the inverted-T incision technique with the scar placed above the inframammary sulcus for cases of pexy, breast reduction, and augmentation–reduction mammaplasty. This technique preserves the inframammary fold as an important factor in natural breast suspension; the breast mound is easily shaped independent of the skin tension. The gland- and skin sutures are placed separately and independently. This technique has been used on 380 patients in the last 13 years.     

The short scar three-block L-wing technique

IntroductionNumerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular supply and sensitivity of the nipple areola complex (NAC), breast feeding, and an esthetically pleasing result.ObjectivesIn the present preliminary report, we introduce a new technique called the three-block L-wing reduction mammaplasty that addresses the aforementioned difficulties.Materials and MethodsThe three-block L-wing reduction mammaplasty with a thick hemispheric superiorly based NAC pedicle and a medial as well as lateral pillar was performed in a total of 60 patients.ResultsOur technique increases both, vascular safety and the sensory supply to the NAC, as it conceptually decreases the need for dissection of breast tissue and skin. The incidence of fat necrosis and wound healing disorders may be reduced with this technique. Because the ducts of the breast-gland underneath the NAC are not dissected, this technique also promises a higher probability of regular breast-feeding. Finally, our technique permits a cosmetically pleasing round-shaped mound of the breast.ConclusionThe three-block modification simplifies the procedure of the superior pedicle L-wing mammaplasty markedly. It may increase the esthetic as well as the functional outcome and decrease postoperative complications.     

Breast-conserving surgery using an inframammary fold incision technique for breast cancer

Background: Breast-conserving surgery is an established alternative for the majority of women with early stage breast cancer. Consensus on negative margins (no ink on tumour) for invasive cancer makes mutilating extensive lumpectomies unnecessary. Several breast-conserving surgical methods are described in the literature. The aim of this study was to describe and evaluate a technique using the inframammary fold incision.

Methods: Twenty-seven patients with suspected breast cancer (stage I–II) underwent breast-conserving surgery using the inframammary fold incision. Data regarding tumour characteristics, margin status, complications, oncologic and aesthetic outcome was analysed retrospectively.

Results: After a median follow-up of 35 months, 23 of the 24 patients with breast cancer (95.8%) had no evidence of disease. Post-operative complications (as defined by infection requiring antibiotic treatment and/or seroma requiring drainage) were seen in three of the 27 patients (11.1%). The final pathological examination revealed a positive excision margin in four patients (16.7%). Post-operative evaluation with the BREAST-Q? BCT module showed a mean RASCH score of 72.5 regarding ‘Satisfaction with breast’. The aesthetic result with a hidden scar is exemplified.

Conclusion: Breast-conserving surgery using the inframammary fold incision seems to be a safe method with better cosmesis; however, further research is needed.     

Modified vertical reduction mammaplasty: ten years of experience

Background

Over the years, vertical scar breast reduction has gained more and more importance. This is due to the fact that this technique is associated with smaller scars and absence of scars in the inframammary fold. However, this technique also has some disadvantages, such as the pleating of the vertical scar during the first 6–12 months and final shape of the breast is achieved only after a year. It also cannot be applied to very large mammary hypertrophies. Herein, we present some modifications to the vertical scar breast reduction that allow long lasting results and reduced complications.

Methods

The modified vertical reduction was executed in 280 patients. Depending on the breast type and position of the nipple–areola complex (NAC) three different types of pedicles were used: superior, supero-medial and supero-lateral. Follow-up was carried out for at least 18 months and complications were recorded.

Results

Neither major complications nor bottoming out deformity were detected during follow-up. Maximum volume of tissue reduced was 1,600 g per breast.

Conclusion

By adding some modifications to the vertical scar breast reduction, the technique can be indicated in large mammary hypertrophies. A meticulous preoperative marking, minimum detachment of the breast, the suturing of mammary pillars, and a thin but large NAC pedicle are essential for obtaining a long lasting mammary shape and better results. Level of Evidence: Level IV, therapeutic study.     

The expanded inframammary fold triangle: Improved results in large volume breast reductions

Context:

The inferior pedicle, Wise-pattern reduction mammaplasty is the most popular technique for breast reduction because of its reproducible results and reliability. However, complication rates in super obese patients or patients receiving large volume reductions are high, ranging from 35 to 78%. These complications include delayed healing, infection, seroma, nipple-areolar complex necrosis, fat necrosis and development of hypertrophic scars.

Aims:

This study aimed to determine whether a modification to the standard Wise-pattern reduction technique, an expanded inframammary fold skin triangle, produces improved outcomes in high-risk large volume breast reduction patients. We report that this modification leads to improved outcomes by decreasing wound complications and improving aesthetic appearance.

Settings and Design:

Twenty-two patients received the inferior pedicle Wise-pattern reduction mammaplasty, which was modified to include an 8 cm wide inferior pedicle. This pedicle was de-epithelialized and an 8 × 3 cm² triangle of skin was preserved at the inferior base to reduce tension at the triple point, inverted T-closure.

Materials and Methods:

A retrospective review was performed on all patients who underwent reduction mammaplasty with the expanded inframammary fold (eIMF) technique as well as all patients who received the standard wise pattern technique.

Statistical Analysis Used:

A student t-test was performed for both reduction populations using SPSS software package. Statistical significance was defined as P < 0.05.

Results:

The average patient age was 32.25 years old (range 18-59), average BMI was 35.0, and average tissue mass removed per breast was 1378.39 g. The modified technique was found to produce a statistically significant (P < 0.05) increase in the amount of breast tissue removed (693.96 g increase in the left and 571.21 g in the right) as well as a statistically significant (P < 0.05) reduction in dehiscence (75% reduction) and post-operative infection (44.10%).

Conclusions:

This method is an easily reproducible and reliable technique that produces a favourable cosmetic outcome with acceptable, sustainable results in high-risk reductions in obese patients.KEY WORDS: Inverted T-closure, breast reduction, Wise pattern mammaplasty     

乳房下皱襞上提法治疗巨乳缩小后乳房畸形

为矫正倒 T 形切口巨乳缩小术后常出现的乳头乳晕过高、乳房呈上小下大畸形,应用下胸皮瓣上推,使乳房下皱襞上提与深面肋骨膜、肋软骨膜或肋间筋膜固定的方法,共治疗4例7侧乳房,矫正良好。认为本方法是矫正 T 形切口巨乳缩小术后畸形的良好方法。     

No-vertical-scar inferior pedicle breast reduction using the dermal suspension sling

Background

The authors previously presented favorable outcomes with the use of the horizontal dermal suspension sling and plication of the inferior pedicle in reduction mammaplasty surgical cases. We propose a modification to this technique tailored to patients with moderate to severe ptosis. The modification avoids the vertical scar inherent to the inverted T pattern.

Methods

The surgical technique utilizes portions of the dermal suspension and plication technique previously described by the authors. Minor modifications were made to take advantage of the vertical excess of skin found in patients with moderate to severe macromastia and ptotic breasts. The modification leads to a superior skin flap that drapes the inferior pedicle and newly constructed breast mound, resulting in a single inframammary scar.

Results

Thirty-eight women have undergone breast reduction using the vertical scarless inferior pedicle with horizontal dermal suspension and plication surgical technique. Breast projection and shape were sustained during follow-up with positive aesthetic results; the median follow–up time was 7 months.

Conclusions

The modifications to our surgical technique allowed for an improved appearance in the postoperative breast scar and in the overall cosmetic outcome in patients who underwent large-volume breast reductions. Level of Evidence: IV, therapeutic study     

乳房下皱襞上提法治疗巨乳缩小后乳房畸形

为矫正倒Ｔ形切口巨乳缩小术后常出现的乳头乳晕过高、乳房呈上小下大畸形，应用下胸皮瓣上推，使乳房下皱襞上提与深面肋骨膜、肋软骨膜或肋间筋膜固定的方法，共治疗４例７侧乳房，矫正良好。认为本方法是矫正Ｔ形切口巨乳缩小术后畸形的良好方法。     

上方宽蒂垂直切口乳房缩小成形术

目的 探讨一种减少患者乳头乳晕坏死的上方宽蒂垂直切口乳房缩小成形术.方法 采用Lejour穹窿顶式手术设计,切除乳房下方的皮肤、腺体,乳头乳晕以上方真皮腺体组织宽蒂抬高到正常位置,进行乳房塑形,术后仅留有垂直瘢痕.结果 采用上方宽蒂垂直切口方法行乳房缩小成形术46例,其中4例为单侧乳房缩小,手术效果满意,乳房形态良好.14侧乳房切口部分裂开,其中3侧经清创缝合愈合,其余经换药后愈合,无乳头乳晕坏死发生.结论 上方宽蒂垂直切口乳房缩小成形术效果良好,减少了乳头乳晕坏死的危险,值得推广应用.     

Seventeen Years of Experience with Reduction Mammaplasty Avoiding a Vertical Scar

BACKGROUND: It is important to reshape the breast with the least scar possible. This has led us to develop a technique for large breasts where the vertical scar was eliminated. METHODS: The new nipple is positioned at 19-21 cm. The level of the new inframammary line (IML) is marked 6 cm below the new areola. All the area between the marked IML and the present sulcus is de-epithelialized. The upper flap is undermined beginning from the new IML. The tissue excision is performed medially and laterally leaving a central pedicle that also carries the nipple-areola complex (NAC). The dermoglandular pedicle is shaped conically with breast-shaping sutures. The NAC is passed under the upper apron flap through its new opening. RESULTS: We retrospectively reviewed 145 patients who were operated on over the past 17 years. The mean age of the patients was 41 years. The mean distance preoperatively from midclavicle to nipple was 35.3 cm. The average weight of breast tissue excised was 1073 g per side. Seventeen patients (11%) suffered from minor complications. CONCLUSION: This technique works especially well in breast reduction cases where a large mass excision is required. The horizontal scar is obvious only when the patient is lying down and cannot be seen by the patient herself. There is no risk of destroying the circular feature of the areola, which is pulled inferiorly by the vertical scar in the other techniques.     

保留乳腺横膈内上蒂垂直切口瘢痕乳房缩小术

目的 探讨保留乳腺横膈内上蒂垂直切口瘢痕乳房缩小术的临床效果.方法 采用Lejour穹窿顶式手术设计,切除乳房下方多余的皮肤、腺体,将乳头和乳晕以内上方真皮、腺体组织蒂抬高到正常位置,术中保护乳腺中隔神经、血管蒂.采用不吸收缝线缝合乳房下极腺体,适度修薄乳房下部皮肤,以便于皮肤回缩,减轻瘢痕.结果 共行手术27例,53侧乳房,其中1例为单侧乳房缩小术,手术效果满意,乳房形态良好.术后6例8侧乳房切口部分裂开,均经换药后愈合,无1例发生乳头、乳晕坏死.结论 保留乳腺横膈的内上蒂垂直切口瘢痕巨乳缩小术效果良好,提高了乳头、乳晕移位的安全性.     

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。     

A personal technique: mammaplasty with J scar

Mastopexy and reduction mammaplasty techniques have evolved with time, pursuing the aim of an effective and reliable technique that produces a well-shaped breast and reduces the amount of scarring. The authors believe that the L mammaplasty achieves the best results in terms of a short scar and a good, stable shape. They present their technique of a modified L mammaplasty with a resulting scar in the shape of a J, which implies a central breast resection with the nipple-areola complex transposed on a superior pedicle. The correct execution of the preoperative markings and the shaping of the gland tissue are mandatory to obtaining the desired result. The technique has been used during the past 7 years on 326 patients, providing satisfactory results with short scars and virtually no complications.     

内上方真皮腺体蒂乳房成形术在多种乳房畸形中的应用

目的探讨内上方真皮腺体蒂乳房成形术对乳房肥大及乳房假体、聚丙烯酰胺水凝胶取出后的乳房畸形进行修复的疗效。方法对36例乳房肥大及乳房假体、聚丙烯酰胺水凝胶取出后乳房畸形的患者,行携带或不携带Wfiringer乳房水平中隔内上方真皮腺体蒂乳房成形术修复。结果36例患者,术后胸骨上凹至乳头距离为（20．10±1．94）cm,平均上提乳头7．5cm（4～13cm）,并且均未出现血肿及乳头、乳晕复合体坏死等并发症。2例发生小段切口裂开（发生率为5．56％）,其余均为I期愈合。28例获随访6～18个月,乳头、乳晕感觉良好,切口瘢痕不明显,乳房外形满意。结论应用内上方真皮腺体蒂术式可使乳房得到良好的塑形,同时又能充分保留乳头、乳晕复合体的血运及感觉功能,疗效满意。     

单纯抽吸法巨乳缩小术

目的以往巨乳缩小术以倒“T”形手术为代表，术后遗留明显的瘢痕，为了减少手术瘢痕，应用抽吸法进行巨乳缩小术。方法 选择合适的患者，采用肿胀麻醉，经乳房下皱襞5mm小切口，用细管抽吸整个乳房和皮下脂肪组织，进行乳房缩小。结果 采用抽吸法巨乳缩小术治疗11例，手术效果满意，乳房形态良好，质地有所改善。1例发生血清肿，经多次穿利抽吸治愈。结论 抽吸法巨乳缩小术，对乳房下垂不明显以脂肪增生为主的中、轻度巨乳患者，是一种操作简便、效果良好的手术方法，特别适用于未婚女性，手术后瘢痕不明显，值得推广应用。     

Breast Sculpturing: Overcoming the Limits of Traditional Approaches in Breast Reduction

Background  A technique based on original refinements of the vertical breast reduction was developed in our department. The aim of the technique was the safe and aggressive sculpture of an attractive breast mound with minimal scarring and long-lasting results that is easy to perform and suitable for teaching purposes in a surgical training unit. Methods  Fifty consecutive patients who were to undergo bilateral breast reduction were prospectively enrolled in the study. Accurate standard anthropometric measurements and photographs were taken preoperatively and postoperatively at 2, 6, 12, 24, and 36 months. A selective breast liposuction plus a superior pedicle breast reduction with a vertical scar skin pattern was performed in all cases. Results  Nipple lifting ranged from 5 to 14 cm; reduction of the distance between the inframammary fold and the nipple ranged from 0.5 to 7 cm; breast base width reduction ranged from 0 to 7 cm. Conclusion  This technique further contributes to vertical mammaplasty refinements, enhancing the key role of selective liposuction prior to surgical dissection of the breast. The basic principle is to convert a large breast into a middle-sized one, making vertical scar breast reduction the most appropriate technique for all cases. A thorough and selective liposuction of the breast mound reduces the breast cone base width safely and with virtually no limitations, thus breaking a taboo of traditional breast reduction techniques.