垂直切口乳房缩小术

目的　探讨应用垂直切口巨乳缩小术以减少术后瘢痕的方法与体会。方法　采用Lejour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蒂转移提高到正常位置 ,进行乳房塑形 ,术后仅留有垂直瘢痕。结果　采用垂直切口巨乳缩小术治疗 2 4例 ,手术效果满意。 1例术后 6个月切口下端局部修整残留的“猫耳朵”。 1例单侧乳头乳晕完全坏死。结论　垂直切口巨乳缩小术疗效良好 ,术后瘢痕细小 ,乳房形态良好。     

Reduction mammaplasty with a sliding nipple technique

Ninety-four consecutive patients (19 who underwent mastopexy, and 75 who underwent reduction mammaplasty) were reviewed. They had all been operated on using a sliding manoeuvre for transfer of the nipple-areola complex on its underlying parenchyma, which has been in use for reduction mammaplasty in our unit since 1978. This makes it possible to slide the nipple-areola complex on the glandular tissue by making incisions in the de-epithelialised dermal zone on both sides of the areola, and leaving a dermal bridge above. The technique increases the mobility of the nipple-areola complex without jeopardising the blood supply, and is a combination of horizontal and superior pedicle techniques. The patients had been followed up for three to six months, except for five who had been followed up for five to six years. Minor early complications occurred in two patients. The sliding nipple technique is applicable to most types of mammary ptosis and hypertrophy, except those with a sclerotic and stiff parenchyma.     

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.     

Vertical reduction mammaplasty for gigantomastia with massive fibroadenomatosis: a case report

Vertical reduction mammaplasty is one of the most debated < short-scar > breast reduction technique. Advantages and drawbacks of the technique are discussed; most of the authors do not accept it as the technique of choice for high glandular resection weights. In our case report we achieve it for a resection weight up to two kilograms with an areolar transposition distance of more than ten centimetres. We show that it is reasonable to realize it dealing with gigantomastia. The massive fibroadenomatosis is observed following immunosuppressive treatment for kidney transplantation. Cyclosporine intake, even sporadic, is at the origin of the growth of these multiple, bilateral and large fibroadenomas. Drug-induced cytokines stimulate their development.     

Experience with the Ribeiro reduction mammaplasty technique

The advantages and disadvantages of the Ribeiro reduction mammaplasty are cited. It is a very good technique when used with the described modifications in properly selected patients.     

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.     

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.     

"Vertical, triangular mammaplasty technique". Description, indications, six year retrospective study

The authors present a new mammaplasty technique with a vertical scar: the vertical triangular technique (VTT). A retrospective study was carried out on 82 patients, for six years, with a minimal hindsight of one year, an average glandular resection of 190 g and average liposuction of 60 mL. The technical principles are based on mammary liposuction of the basis, the inferior pole and the axillary extension, the glandular cavity of the inferior pole of the breast, the conical shape of the breast and the lower scar cutaneous bursa. The pitfalls and traps to avoid are described: the liposuction must be large enough except concerning segment IV, the cutaneous pinch must be hyper-corrected, the lower subcutaneous mastectomy must be complete, while a perfect suture of the glandular pillars conditions the shape of the future mammary cone. Short-term complications (7.5%) are the slackening of the bursa and seroma. Medium-term complications (< 10%) are the residual distortion of the bursa, an insufficiently tightened pinch, and a glandular resection defect. Analysis of the results of the VTT makes it possible to determine the long-term stability of the shape of the breasts, and to notice that the scar gain does not affect the morphological quality.     

双环形切口乳房缩小整形术

目的:探讨乳房缩小整形术中手术方法及术后效果影响因素。方法:应用改良双环法进行乳房缩小整形术85例,术中切除腺体组织150～1200g,将外上侧腺体组织楔形切除后,将乳头-乳晕-腺体组织瓣置于正常解剖位置,以乳头为中心向内侧适度旋转,并适当固定塑形使乳房的上极保持丰满;并对手术后效果进行初步评价。结果:80例患者接受随访,手术后74例患者双侧乳房形态及乳头乳晕对称,乳房上极较丰满,乳头乳晕感觉良好,患者满意,总满意率为92.5%。结论:改良双环法乳房缩小整形术手术后乳房形态良好,患者满意度高,简易调查表显示患者手术后关心的问题首先是乳房形态及乳头乳晕感觉。     

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。     

Early experience with Lejour vertical scar reduction mammaplasty technique

The study contains 163 patients who underwent a reduction mammaplasty at the Karolinska Hospital during 1991–1992. Seventy patients were operated on using the Lejour short scar technique (superovertical pedicle) and 93 using the Strömbeck method (medial pedicle). The aim of this study was to compare the results of these two different methods with regard to scar formation, position and sensation in the nipple areola complex, postoperative complications, healing conditions, shape and volume symmetry of the breasts and patient satisfaction. An objective method [20] was used for assessment of postoperative breast asymmetry. Advantages and disadvantages of both methods are presented. The incidence of early complications was low in both groups, compared with the data presented in the literature, but Strömbeck's method was found to be superior in some respects because of fewer early postoperative complications, shorter healing period and better breast symmetry postoperatively.     

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。     

A new technique for reduction mammaplasty

A new surgical technique for reduction mammaplasty is described. Incisions are chosen according to Strömbeck's procedure and deepithelialization of the major part of the skin in the resection area is carried out. The upper part of the breast with the total skin for the planned breast is separated from the lower part with the dermis flap and the nipple and the desired resections are carried out from the lower part. A dermis cone or tube is then created with the mammilla at its apex and the skin is closed around the dermis cone.     

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.     

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     

上方宽蒂垂直瘢痕乳房缩小术在重度乳房增生下垂中的应用

目的 探讨乳房上方宽蒂垂直瘢痕的重度乳房增生缩小术较传统的倒"T"形巨乳缩小术的优势.方法 采用Lejour"穹窿顶"式的手术设计,切除乳房下方的皮肤、腺体组织,将乳头、乳晕上方的真皮及腺体组织的宽蒂抬高至正常位置后进行乳房塑形.自2006年3月至2009年11月,对37例重度乳房增生患者行巨乳缩小术.结果 术后14例患者的14侧乳房切口部分裂开,其中3侧乳房经清创缝合后愈合,其余的乳房经换药后愈合;随访37例患者2周至26个月,未发生乳头、乳晕坏死,乳房形态良好,患者满意率较高.结论 乳房上方宽蒂垂直瘢痕的巨乳缩小术具有降低乳头、乳晕坏死的危险,切口瘢痕细小,重缩的乳房外形良好等优点,是一种治疗重度乳房增生的良好、有效的手术方法.     

Transverse resection: a new technique of reduction mammaplasty.

In patients who undergo breast reconstruction after unilateral mastectomy for breast cancer, the contralateral natural breast is often disproportionately large in comparison with the reconstructed breast. Such patients may express a desire to have reduction of the larger breast in order to achieve symmetry. A novel technique is described for breast reduction in such cases, which, despite the presence of visible scars, found acceptance among patients. The primary goal of reduction mammaplasty in these cases is symmetry, keeping in mind the shape, volume and degree of ptosis of the reconstructed breast, and not achieving youthful-looking breasts.     

Periareolar mammaplasty: double-skin technique with application of mesh support

The increasing demand for reduced scars has led to the development of numerous minimal incision procedures, which constitute the most recent and exciting advances in breast surgery. Numerous different periareolar techniques are described in an attempt to eliminate scars on the breast surface by restricting them to the interface between the areola and the skin. These conclusions show a clear evolution of the technique as well as an improvement in the obtained aesthetic results. The author has developed new techniques for periareolar mammaplasty based on repositioning the breast parenchyma and maintaining this new architecture with a stronger and more durable supporting system. The development of new materials, technical refinements in the technique, and increased experience will undoubtedly lead to even better results in the future.