修复韧带和保留T4肋间神经的巨乳缩小术

目的 探讨一种能保留T4肋间神经和血管韧带的重塑锥体形乳房的巨乳缩小术.方法 对18例轻、中、重度巨乳者,乳腺组织切除选择在乳房中线上、下极部形成中央蒂,蒂部保留了内外侧深浅韧带、T4肋间神经外侧皮支深浅支.蒂部旋转移位固定,缩小乳房基底,增强韧带张力.二瓣法旋转皮瓣从内到外缩小乳房.保留T4肋间神经走行区真皮层以保护其浅支,旋转固定后起到纤维隔的作用.结果 术后乳头乳晕血供和感觉良好,乳房外形挺拔.随访3个月至2年,平均7个月.随访达1年者,瘢痕已不明显,外观无明显改变,患者满意.结论 修复韧带和保留T4肋间神经的巨乳缩小术设计简单,手术时间缩短,术后乳房外形挺拔稳定.     

修复韧带和保留T4肋间神经的巨乳缩小术

目的 探讨一种能保留T4肋间神经和血管韧带的重塑锥体形乳房的巨乳缩小术.方法 对18例轻、中、重度巨乳者,乳腺组织切除选择在乳房中线上、下极部形成中央蒂,蒂部保留了内外侧深浅韧带、T4肋间神经外侧皮支深浅支.蒂部旋转移位固定,缩小乳房基底,增强韧带张力.二瓣法旋转皮瓣从内到外缩小乳房.保留T4肋间神经走行区真皮层以保护其浅支,旋转固定后起到纤维隔的作用.结果 术后乳头乳晕血供和感觉良好,乳房外形挺拔.随访3个月至2年,平均7个月.随访达1年者,瘢痕已不明显,外观无明显改变,患者满意.结论 修复韧带和保留T4肋间神经的巨乳缩小术设计简单,手术时间缩短,术后乳房外形挺拔稳定.     

巨乳缩小成形术50例的疗效探讨

乳腺增生肥大症又称巨乳症,以往多半忽略治疗。我院从1985年5月至1990年11月,选用六种术式,仿William'n法4例,W形法3例,钱氏法1例,仿Passort法1例,三瓣法1例,改良式法40例。改良式法并发症2.5％,比国外报道的9.8～16％显著减少。经50例临床实践融合各式优点,改进发展了改良式法。通过增加扇形真皮蒂和应用嵌插法消灭死腔,并在扇形瓣基底增加表皮舌形瓣,结合乳房横径,调整其弧度以缩小横径。经过改进的改良式法能塑造出符合我国女性逼真的乳房形态,又可减少并发症。     

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.     

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。     

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。     

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。     

巨乳缩小术的护理体会

巨乳症是乳房发育超常,与整体大小比例明显失调,为乳房肥大,多见于中青年女性。病因多为青春期内分泌紊乱或哺乳后导管扩张。主要表现为腺体增生,间质增生,脂肪组织堆积,乳腺导管扩张,可以是以某种改变为主,亦可为终合改变。巨乳缩小成形术是以切除部分乳房皮肤、乳腺组织,使乳房形体缩小和乳房位置改善,并进行乳头、乳晕整形的技术。巨乳缩小成形术的方法很多,     

中央腺体蒂法巨乳缩小成形术

目的 探讨中央腺体蒂法巨乳缩小成形术治疗乳房下垂及乳房肥大的疗效.方法 采用乳晕周围的双环形切口,去除两环之间表皮,形成真皮帽,在皮下沿腺体表面向四周分离达乳房基底部,去除多余腺体,形成能确保乳头乳晕血运的中央腺体带,固定真皮帽进行乳房塑形.结果 采用该法治疗轻、中、重度乳房肥大及下垂者共42例,术后形态美观持久,瘢痕轻,无乳头乳晕坏死.33例患者获6～24个月随访,效果满意.结论 中央腺体蒂法巨乳缩小成形术适合于轻、中、重度乳房肥大,为瘢痕轻微的巨乳缩小成形术式.     

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间的表皮,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.     

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.     

Reduction mammaplasty with the modified round block technique in Chinese patients and its anatomy study

Background: Although reduction mammaplasty is one of the most common procedures in plastic surgery, it is associated with some serious complications, especially in cases of severe hypertrophy or advanced ptosis, including necrosis of the nipple and areola, absence of normal sensation of the nipple-areolar complex, and loss of lactational function for future nursing. A thorough understanding of the breast anatomy is vital for successful reduction mammaplasty. This article describes the blood supply and innervation of the breasts, and introduces a modified round block technique for reduction mammaplasty based on this anatomy.

Methods: Six adult female cadavers were used to assess the vasculature of the anterior thorax and the nerve distribution of the breasts according to vascular perfusion and autopsy. Based on this anatomical study, a modified round block technique was designed for reduction mammaplasty, which was performed in 40 Chinese patients with breast hypertrophy.

Results: Würinger’s horizontal septum was observed in all six cadavers. In the superficial layer, the main sources of blood are the second and third intercostal perforating branches of the internal thoracic artery, which run along the medial ligaments, and the branches of the lateral thoracic artery, which run along the lateral ligaments. In the deep layer, the main sources of blood are the fourth and fifth intercostal artery perforators, which run along Würinger’s horizontal septum. Innervation of the nipple-areolar complex is achieved mainly by the lateral branches of the fourth intercostal nerve, which also run along Würinger’s horizontal septum toward the nipple-areolar complex. The 40 patients with breast hypertrophy underwent successful reduction mammaplasty using our modified round block technique, except for one case, which developed necrosis of the nipple-areolar complex.

Conclusions: Reduction mammaplasty using our modified round block technique can maximally preserve the blood supply to the remaining gland as well as the innervation to the nipple-areolar complex, while maintaining the advantages of the traditional technique, such as an invisible scar and good projection.     

Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions

IntroductionContralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics.Materials and methodsThe study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammaplasty between 1/2007 and 12/2011. The data was retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and postoperative follow-up.ResultsReduction mammaplasty specimens revealed abnormal findings in 68 (21.5%) patients. High-risk lesions (ADH, ALH, and LCIS) were revealed in 37 (11.7%), and cancer in six (1.9%) patients. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Abnormal histopathological findings were more frequent in patients with reduction mammaplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064).ConclusionThe incidences of malignant and high-risk lesions are doubled compared to patients without prior breast cancer. Patients with abnormal histopathology cannot be preoperatively identified based on demographics. If reduction mammaplasty is performed before oncological treatment, the incidence of abnormal findings is higher. In the light of our results, contralateral reduction mammaplasty with histopathological evaluation in breast cancer patients offers a sophisticated tool to catch those patients whose contralateral breast needs increased attention.     

Central pedicle reduction mammaplasty with a vertical scar: a technical modification

Background: This study introduces a central pedicle reduction mammaplasty with a vertical scar technique.

Objectives: This study is aimed to create a more conical breast shape and long-lasting better projection by modifying reduction mammaplasty by central pedicle flap.

Method: Preoperative markings were made including the meridian line of breast and the new location of the nipple-areola complex (NAC). The new location of the inframammary fold was marked ～2?～?4?cm above the original inframammary fold. An incision was made around the areola, the area between the resection margins and NAC was excised en bloc. The breast parenchyma was excised circumferentially, so that a cone shaped central mound was formed. An inferior and inferolateral glandular resection was performed to reduce the area of the breast base by elevating the position of the inframammary fold. After completion of dissection, the central pedicle surmounted by the NAC was transposed to its new location.

Result: Fifty-six patients were operated with our modified central pedicle technique. The mean amount of resection was 475?g (range?=?130–1080?g). The mean length of follow-up was 18?months (range?=?12–53?months). The mean postoperative satisfaction score was 4.23 (SD?=?0.81). The breast parenchymal ratio significantly increased from 1.2 preoperatively to 3.9 postoperatively.

Conclusion: The modified central pedicle reduction mammaplasty with a vertical scar technique is a versatile breast reduction technique for all shapes and tissue conditions, by providing an attractive conical shape of the breast with minimum scar burden and maximum preservation of breast function.     

巨大乳房纤维腺瘤切除后的乳房成形术

目的：寻求巨大乳房纤维腺瘤切除后合理重塑乳房外形的方法。方法：按缩乳术原则设计乳头、乳晕新位置，标记需切除的表皮区和全层皮肤区。切除部分表皮、皮肤及全部肿瘤，再按隆乳方法重塑因肿瘤的和乳腺切除而空虚的乳房外形。结果：经远期随访本组7例（1例除外）乳房大小，乳头及乳房的挺拔性、对称性，手感及乳头、乳晕的感觉和勃起程度均较满意。结论：该手术方法可以较好地一期解决因切除肿瘤而后遗的乳房缩小畸形。     

Familial Severe Gigantomastia and Reduction with the Free Nipple Graft Vertical Mammoplasty Technique: Report of Two Cases

Background. Gigantomastia, characterized by massive breast enlargement during adolescence or pregnancy, is thought to be caused by an abnormal and excessive end organ response to a normal hormonal milieu. The amputation technique with the free nipple–areola graft is the mainstay for severe macromastia, but it has been criticized because it results in a flattened, nonaesthetic breast with poor projection. This report presents two sisters with unusual, excessive breast enlargement. Methods. The measured distance from the sternal notch to the nipple was 50 cm for the first case and 55 cm for the second case. The free nipple graft transplantation based on the vertical mammoplasty technique was used, and an average of 4,200 g of breast tissue per breast was removed. To increase breast projection, superior dermoglandular flaps were used Results. The follow-up period was 24 months. The patients had long-lasting, pronounced breast mound projection, and the level of satisfaction for both cases was very high.Conclusion The ideal geometric structure of the breast is rather conical, and the authors believe that reshaping the breast tissue in a vertical plane using the vertical mammoplasty technique may be more effective in the long term and may provide better projection.