蒂在上的乳房缩小术

乳房缩小术是治疗巨乳症及乳房下垂的整形手术,1985年以来我们以蒂在上的手术为7例年青患者做了乳房缩小术。经观察随访近期效果满意,现介绍如下。     

应用乳晕双环切口的经验总结

目的 归纳总结乳晕双环切口在乳房手术中的应用,探讨手术方法及其理论基础.方法 针对巨乳症6例与单纯乳房下垂的10例患者,采用乳晕双环切口分别行巨乳缩小与垂乳悬吊术,以恢复乳房的正常形态.结果 3例切口延迟愈合,经Ⅱ期瘢痕修复愈合.16例获随访6个月,乳头及乳晕功能正常.结论 乳晕双环切口可用于垂乳悬吊和巨乳缩小,但仅适应于轻、中度病例,对重度病例也可应用.该手术方法设计简单,操作灵活,切口隐蔽,外形恢复较好.     

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。     

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.     

乳晕切口手术治疗乳房轻度下垂并乳腺良性肿物

目的:探讨通过乳晕切口既矫正乳房轻度下垂,又摘除乳腺良性肿物的手术方式。方法:对正常体积的轻度乳房下垂,选择乳晕旁月牙形或双环形切口,采用真皮帽技术,矫正乳房下垂。其间,对患有乳腺良性肿物者,在相应部位皮下,沿大乳腺管走向潜行剥离至肿物的上方,再切除肿物。结果:对56例患者随访6~18个月,乳房挺拔、丰满,感觉良好,切口瘢痕不明显。结论:经乳晕切口手术治疗轻度乳房下垂并乳腺良性肿物,乳房下垂得以矫正,乳腺良性肿物完全切除,形态和位置改善,乳头感觉和勃起正常,不明显的切口瘢痕在新的乳晕边缘隐蔽良好。     

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。     

巨乳缩小与乳房悬吊术:整形外科医师的试金石

巨乳症及乳房下垂是整形外科领域常见的乳房畸形。绝大多数患者都迫切需要矫正这类畸形,然而所能做到的还远不能满足患者的预期。为此现从手术设计、乳头乳晕复合体血运来源、瘢痕的预防及如何获得良好远期效果进行讨论,并通过回顾解决这些问题为例,说明巨乳缩小与乳房悬吊术是整形外科医师的试金石。     

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。     

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。     

体形指数分型指导下选择手术方式治疗巨乳症的疗效分析

目的 探讨应用体形指数分型选择手术方式治疗巨乳症的可行性.方法 将我科自2001年6月至2008年1月收治的26例(52侧乳房)巨乳症患者,按体形指数行分型归类.包括:纤细型5例,采用单纯抽吸部分腺体切除法;中等型10例,采用改良真皮帽双环法;肥胖型11例,采用改良垂直双蒂法.观察术后乳头乳晕血运、乳房外形及瘢痕大小.所有患者随访6～32个月(平均20个月).结果 本组患者26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 按不同分型选择不同的手术方法,是一种具有临床指导意义的科学方法,值得推广使用.     

双环法缩乳技术的改进

目的：寻找一种设计简单、易于掌握且切口瘢痕较隐蔽的巨乳缩小整形手术方法。方法：将传统双环法缩乳术加以技术改进，使内外环的设计定位合理、简单。结果：临床应用此方法为32例63只乳房行巨乳缩小或乳房下垂矫正，仅1例部分切口学期愈合，无乳头乳晕坏死或乳头感觉受损等并发症发生，效果满意。结论：改良后的双环法缩乳术具有设计容易、效果理想的     

改良双环法乳房缩小整形术

目的：探讨双环法乳房缩小整形术的一些技术改进。方法：在双环法乳房缩小整形术的基础上,从设计、操作上加以技术改良。结果：本组17例33侧,术后乳房外形满意,手术切口瘢痕不显;乳头、乳晕血运良好,感觉正常。结论：本方法设计合理、操作便捷,切除乳腺量大,术后效果理想,不仅适用于轻中度乳房肥大症,也适用于较重度乳房肥大症。     

乳房肿胀吸脂在双环法缩乳术中的临床应用

目的：探讨乳房肿胀吸脂在双环法缩乳术中的临床优点和推广应用。方法：在109例双环法缩乳术中首先行乳房肿胀吸脂（单纯乳腺组织增生,皮下脂肪少者除外）,而后行缩乳术。结果：乳房肿胀吸脂后行缩乳术,比原缩乳术有明显优点：手术时间明显缩短;出血明显减少;乳腺组织切除定量准确;解剖层次清晰;缩乳效果明显。结论：乳房肿胀吸脂后双环缩乳术,是对原术式的进一步改良,值得临床推广应用。     

改良双环法巨乳缩小术

目的：探讨双环法缩乳术的技术改进。用双环形切口，切除外上象限适量乳腺组织对肥大乳房进行缩小和重塑，恢复乳房正常形态。结果：23例46侧术后瘢痕不明显，乳头乳晕无坏死，感觉良好，效果满意。结论：本术式设计简单，满意度高，是治疗巨乳的好方法，有更好的应用前景。     

Wineglass Pattern for Vertical Mammaplasty

The ideal reduction mammaplasty technique should create a pleasing breast shape with minimal scarring. The long and conspicuous scar associated with the classic inverted ``T' pattern mammaplasty techniques are not acceptable for many patients. Periareolar mammaplasty techniques cause less scarring, but they have major disadvantages such as scar widening, areolar distortion, and insufficient breast projection. We used a new pattern for vertical mammaplasty to overcome the insufficient breast projection caused by the round block technique and applied it to 51 patients during the last 3 years. This method results in a single vertical scar and a periareolar scar, allows sufficient volume reduction, and provides good breast shape and projection; the results are durable. This procedure is safe, causes few complications, and is easy to learn and perform.     

应用皮肤皱缩缝合技术行垂直切口乳房缩小整形术

目的　减少乳房缩小整形术所导致的切口瘢痕。方法　在做乳房缩小整形术时 ,在乳房下皱襞处不做切口 ,仅保留乳晕周围和乳晕下垂直切口 ,对乳房进行悬吊和塑形 ,而对乳晕下多余的皮肤和较长的皮肤切口 ,应用皮肤皱缩缝合技术进行缝合 ,利用组织的弹性 ,使其在手术后自动逐渐展平。结果　共为 13例患者实施了垂直切口的乳房缩小整形术 ,术后切口皆一期愈合 ,无血肿、感染、皮肤或乳头坏死等并发症发生 ,除 3例巨乳合并乳房严重松垂者半年后需再次对下皱襞处多余皮肤进行小的修整外 ,其余患者术后乳房和垂直切口形态满意。结论　垂直切口乳房缩小整形术设计、操作简单 ,容易掌握 ,效果恒定 ,在保证乳房缩小整形良好的乳房形态的同时 ,避免了在乳房下皱襞处的切口 ,是一种较好的乳房缩小整形术式。     

改良真皮帽双环法行乳房缩小整形术

目的：灵活应用真皮帽双环法行乳房缩小成形。方法：采用传统的双环法设计切口，外下象限辅助S形切口线，保留乳晕周围较大面积完整的真皮帽，切除乳房外下象限腺体组织，设计外上及内下两个腺体组织瓣交错连接固定成形，乳晕周围内外环真皮荷包缝合，修整乳晕周围及外象限多余皮肤，切口呈环形，辅助切口瘢痕较小。结果：术后三月随访，新乳房的大小和形态．乳头乳晕的位置和形态均满意，除具有良好的感觉及勃起功能外，还保留了泌乳功能。结论：用组织瓣旋转固定的改良真皮帽双环法行乳房缩小成形，手术操作简单，组织瓣及乳头乳晕供血丰富，组织损伤小，值得推广。     

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.     

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。     

A New Application for Increasing Breast Projection in Free-Nipple-Graft Reduction Mammaplasty

BACKGROUND: Free-nipple-graft reduction mammaplasty is the procedure of choice in patients with massive breast hypertrophy. Breasts that have undergone free-nipple-graft reduction mammaplasty usually cannot maintain projection. Many modifications of free-nipple-graft reduction mammaplasty have been described to treatment this problem. We describe our modification of the free-nipple-graft reduction mammaplasty. METHODS: The technique includes two key points: The first is the fold of the midportions of the breast. The second is suturing the midportion of the breast to the fascia of the pectoral muscle. The fold increases breast projection and the suturing helps to obtain long-lasting breast projection. RESULTS: A total of 16 patients underwent free-nipple-graft reduction with the modified technique between 2003 and 2008. Mean follow-up was 21 months (range = 3-60 months). An average of 2016 g of tissue per breast was excised (range = 1250-2700 g per breast). An average of 4031 g of tissue per patient was excised. All patients had long-lasting, pronounced breast mound projection. Satisfactory breast projection was maintained. No "bottoming out" was seen. The level of satisfaction felt by all patients was very high. CONCLUSION: Long-term projection can be maintained by suturing the half-trianges to each other and to the fascia of the pectoral muscle. One more useful alternative technique for increasing projection in free-nipple-graft reduction has been added with the technique presented.