应用下部蒂经乳腺上部皮瓣隧道行乳房肥大缩小术17例

1994年1月至2 0 0 3年1月我科采用下部蒂经乳腺上部皮瓣隧道行乳房肥大缩小术17例,效果较好。1　临床资料本组共17例,其中有15例为双侧,共32侧,均为女性患者。按乳房下垂及乳房肥大程度划分[1 ] :轻度1例,中度4例,重度12例。2　手术方法2 1　手术设计　新建乳头中点(N点)可参照乳房下皱襞水平线在锁骨中点与乳头的连线上投影标记点以及新乳头位于第4肋间,位于乳头上方9～10cm等因素来确定。以此点为中心1 5～2cm为半径画圆,此圆即为新乳头乳晕区。乳房下皱襞线与胸骨旁线,腋前线交点为A点、B点。在锁骨中点与乳头连线上,距新乳头N点下方6…     

双环中心蒂法乳房缩小术

目的 探讨双环中心蒂乳房缩小术矫治乳房肥大下垂的方法 和疗效.方法 采用环绕乳晕内、外的2个环形切口,形成以乳头为中心的中央真皮帽,楔形或双S形切除多余腺体组织,保留第4肋间神经走行的乳腺组织的完整性,塑形后用真皮帽固定塑形.自2009年4月至2012年5月,采取上述方法 治疗乳房肥大伴不同程度下垂患者12例(24侧).结果 本组患者12例,术后切口均Ⅰ期愈合,经随访3～24个月,乳房外形良好,瘢痕轻微,乳头-乳晕感觉良好.结论 双环中心蒂乳房缩小术设计、操作简单,术后可确保乳头-乳晕的血供和感觉,是矫治乳房肥大下垂的有效方法.     

改良乳房下真皮乳腺单蒂瓣巨乳缩小术

OBJECTIVE AND METHODS: A modification technique for reduction mammaplasty with an inferior dermal-glandular pedicle was designed. RESULTS: The paper reports the operation results of 132 breasts in 67 patients, who received reduction mammaplasty in "Chirurgic Esthetique Europeenne," Strasbourg, France, from Jan, 1994 to Nov, 1995. CONCLUSION: Clinical applications showed aesthetic and safe results with reliable nipple areola survival and preservation of nipple sensitivity.     

乳房缩小术56例报告

以乳头乳晕带蒂移植行乳房缩小成形术治疗乳房肥大症近十年来在国内已经开展,然而,在国外文献上早有报导,而且术式繁多,各有其优点和适应症。乳房肥大继而下垂,不仅上下加长,而且左右也加宽,乳房缩小成形术既要缩小体积,也要塑造优美的外形,健美的乳房近似圆锥体,术中既要缩小长度也要缩小宽度,因此术后多形成“?”状的切口疤痕,如果没有下方正中的垂直切口,则很难缩小乳房的宽度,结果形成上下短,而左右宽的乳房,如同本文所附的术后照片所示。除非将下方弧形切口向两侧上方延长,使两侧缩小宽度,这就等于是正中的垂直切口两侧方的换位而己,作者就此未加说明,希读者在引用时加以注意。     

改良双环法中心蒂乳房缩小成形术

目的 探讨双环法中心蒂乳房缩小成形术术后效果不佳的原因,以便改进手术方法,降低术后并发症的发生率,提高远期美学效果.方法 通过对1999年3月至2009年12月应用双环法中心蒂术式行肥大乳房缩小成形术的临床资料进行回顾性分析,总结应用该技术的临床经验,针对各类术后效果不佳的原因采取相应预防措施,并对改良术式术后效果进行评价.结果 对采用改良术式的76例随访3个月至3年,结果表明,患者对术后乳房形态满意,乳头-乳晕感觉良好,术后环乳晕瘢痕不明显,远期美学效果稳定,并发症发生率低,不需2次修整.结论 改良双环法中心蒂乳房缩小成形术是适合中国妇女的较优选术式;精细的术前设计和重视手术细节的把握是降低并发症、提高手术效果的有效措施.     

改良乳房下真皮乳腺单蒂瓣巨乳缩小术

目的为了进一步保证巨乳缩小术后乳头乳晕的血供和感觉，减少手术并发症。方法设计应用乳房下真皮单蒂瓣，并保留部分乳腺组织的垂直乳腺蒂，及切除的乳腺组织位于乳房下方两侧的巨乳缩小术，自１９９４年１月至１９９５年１１月，为６７例（１３２侧）巨乳患者在法国斯德拉斯堡欧洲美容整形诊所进行治疗。结果术后全部患者无乳头乳晕并发症，感觉正常。结论结合乳腺垂直蒂和乳房下真皮单蒂瓣的改良巨乳缩小术，不但可以确保乳头乳晕的血供，且可减少感觉损伤，降低手术并发症，及提供良好形态。     

改良乳房下真皮乳腺单蒂瓣巨乳缩小术

目的为了进一步保证巨乳缩小术后乳头乳晕的血供和感觉,减少手术并发症。方法设计应用乳房下真皮单蒂瓣,并保留部分乳腺组织的垂直乳腺蒂,及切除的乳腺组织位于乳房下方两侧的巨乳缩小术,自1994年1月至1995年11月,为67例(132侧)巨乳患者在法国斯德拉斯堡欧洲美容整形诊所进行治疗。结果术后全部患者无乳头乳晕并发症,感觉正常。结论结合乳腺垂直蒂和乳房下真皮单蒂瓣的改良巨乳缩小术,不但可以确保乳头乳晕的血供,且可减少感觉损伤,降低手术并发症,及提供良好形态。     

应用改进的下蒂瓣乳房缩小术

乳房缩小术可解除巨乳患者的各种烦恼，缓解症状恢复形体美，１９８７年以来应用改进的下蒂瓣法对２４例患者施行乳房缩小术，具体方法是画出锁骨中点与乳头的连线，新服民头位置定在连线上第四肋骨间隙处，服民晖直径３－５ｃｍ，下蒂瓣宽度较原设计方法增加，１２－１４ｃｍ，手术时去除新乳晕区表皮，形成下蒂瓣，切队过多皮肤，脂肪及乳腺组织，如疑有乳腺病变可将乳腺腺体全部切除，重新固定乳头乳晕于新乳晕区，缝合乳房下皱臂     

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。     

无垂直瘢痕的下蒂瓣法乳房缩小整形术

目的:介绍一种适用于中、重度乳房肥大的矫正术,探索乳房缩小手术的最佳术式。方法:回顾总结2001年以来对21例中、重度乳房肥大患者采用无垂直瘢痕的下蒂瓣法行乳房缩小整形术的情况,分析其效果。结果:21例患者术后双乳对称,下垂状况纠正,体积缩小,乳头乳晕感觉良好,术后瘢痕隐蔽。2例合并副乳,1例合并乳头内陷的患者同时手术切除矫正。2例乳晕表皮营养不良、部分坏死,经换药愈合。结论:无垂直瘢痕的下蒂瓣法乳房缩小整形术是治疗中、重度乳房肥大症的良好选择。     

Reduction mammoplasty by the central pedicle,avoiding a vertical scar

Reduction of the macromamma that causes posture malformations, neck and back pain, and psychological problems is very important. I performed the technique on 13 patients whose ages ranged between 17 and 60 years during 1990 and 1993. I observed no complications in the controls. To obtain a better result in reduction mammoplasty, I use a technique that can be performed on patients of any age, without causing any problems in vascularization, sensitivity, and lactation, and that avoids the vertical scar.     

Reduction mammoplasty by the total dermoglandular pedicle

The use of a total dermoglandular pedicle in 700 cases of reduction mammoplasty are described by this team of authors. They emphasize that their modification of the dermoglandular pedicle provides an extremely reliable blood supply to the areola and is quick and easy to perform. There is no anesthesia of the nipple postoperatively, and the shape of the breast is favorable both in the immediate postoperative period and over the longterm follow-up observation between the years 1979 and 1984.     

Experience and refinements with the supero-medial dermal pedicle for nipple-areola transposition in reduction mammoplasty

The supero-medial dermal pedicle was reported only once in a small group of patients. Further experience and refinements have shown the technique, with a relative thick pedicle augmenting the medial quadrant, to offer good areolar support and permit extensive reduction of the lateral breast.This method was used on 78 patients with a follow-up of up to 2 1/2 years. It was found to be suitable, simple, and safe, and it preserves the sensory qualities of the areola. The increased sophistication and understanding, as presented here, may have borne fruit in the performance of this technique.This work was accomplished in Rotterdam while serving there as a fellow.     

Reduction mammaplasty by central pedicle flap with short submammary scar

Reduction mammaplasty was performed in 30 patients by combining the central pedicle flap method with the short submammary scar (3-S) technique to avoid the common drawbacks of currently popular dermoglandular procedures. Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyme instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. Only the periphery of the breast parenchyme was resected circumferentially, with the exception of the inferolateral portion, so as not to injure the sensory nerve. The remaining breast parenchyme was preserved in an inverted cone shape. The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively, and lactation is possible because of preservation of the lactiferous ducts. The length of postoperative scars was reduced by using the short submammary scar technique. We believe this combined method is ideal in patients requiring resections ranging from 200 to 600 g per breast with good skin elasticity and moderate degree of ptosis.Presented at the Sixth Asian Pacific Congress of the International Confederation for Plastic and Reconstructive Surgery, in Seoul, Korea, October 1993.     

Accordion-style pedicle suspension in inferocentral pedicled mammoplasty

Objective: In breast reduction surgery, while the primary objective may appear to be decreasing the breast volume, the ultimate goal is to achieve symmetrical, appealing, and sustainable breast cosmesis. To circumvent late-term ptosis following inferior pedicle mammoplasty, methods such as pedicle suspension to the ribs, support with dermal flaps and grafts, and the use of some alloplastic materials have been proposed. This paper presents a method of folding and fixing the inferocentral pedicle on itself and the underlying pectoral fascia.

Methods: Inferocentral pedicled, inverted T-scar reduction mammoplasties were performed on 50 patients from June 2009 to June 2014. The inferocentral pedicle, which was kept narrow and long, instead of the conventional inferior-based pyramidal design, was folded over its de-epithelialised surfaces in an accordion fashion and sutured. The confection was then sutured to the pectoral fascia by its lateral and superior borders for long-term preservation of breast moulding.

Results: In inferocentral breast reduction, the quest for a method that achieves appealing and lasting pyramidal breast shape continues.

Conclusions: This technique is regarded as a simple and effective method for achieving good short- and long-term results for patients being considered for moderate and advanced breast reduction.     

应用改进的下蒂瓣乳房缩小术（附24例报告）

乳房缩小术可解除巨乳患者的各种烦恼，缓解症状恢复形体美，１９９７年以来应用改进的下蒂瓣法为２４例患者施行乳房缩小术，具体方法是画出锁骨中点与乳头的连线，新乳头位置定在连线上第四肋骨间隙处，乳晕直径３～５ｃｍ，下蒂瓣宽度较原设计方法增加，为１２～１４ｃｍ，手术时去除新乳晕区表皮，形成下蒂瓣，切除过多皮肤、脂肪及乳腺组织，如疑有乳腺病变可将乳腺腺体全部切除，重新固定乳头乳晕于新乳晕区，缝合乳房下皱襞切口。２４例轧头乳晕均成活良好，外形满意。双乳头平均上移１６．５ｃｍ，切除组织平均１２８８ｇ。随访时间最长３年，最短６个月，乳房大小与原设计基本相符，巨乳所致胸椎前倾、颈背疼、乳痛症消失，乳头感觉及勃起功能良好。由此认为改进的下蒂瓣法，不仅设计灵活，操作简易，且与其他术式相比无垂直瘢痕，切口均在乳晕缘和下皱襞上等。值得推广。     

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.     

下蒂瓣法乳房缩小整形术的效果

目的:探讨下蒂瓣法乳房缩小整形术治疗中重度乳房肥大症的方法及效果。方法:2010年1月至2019年12月,南京医科大学附属妇产医院整形外科对19例女性患者(年龄18~54岁,平均36.2岁)38侧肥大乳房,以Robbins的垂直下蒂瓣术式为基础,结合乳房血供、神经等解剖学进展,进行乳晕设计、下蒂瓣位置等改进。结果:19...