乳下皱襞韧带的检验

目的　检验乳下皱襞韧带存在的真实性。方法　对９ 例１８ 侧经防腐处理的女性乳房进行了解剖及切面筋膜染色后的观察。结果　否定了先前由 Ｂａｙａｔｉ 和 Ｓｔｒａａｌｅｎ 等提出的有独立的乳下皱襞韧带的存在。结论　证明乳下皱襞的存在是基于乳房下部增厚并密集的 Ｃｏｏｐｅｒ 韧带所致。     

乳房下皱襞超微结构的研究及临床意义

国内外很多学者对乳房下皱襞进行了大量的基础及临床方面的研究，其研究结果概括起来可大致分为两种观点：一种观点认为乳房下皱襞处存在乳房下皱襞韧带，此韧带结构是形成乳房下皱襞的原因；另一种观点认为并不存在此韧带结构，而只是一些纤维带，这些纤维带不是真正的韧带，它们属于乳腺筋膜的一部分。我们通过对新鲜女性尸体乳房行大体解剖。     

美容、整形外科相关解剖学进展

美容、整形外科相关解剖学进展于佰凤高景恒３乳房下皱襞韧带乳房下皱襞韧带起于胸骨及第五肋骨内侧骨膜和第五、六肋间的外侧筋膜（胸大肌外缘水平），远端止于乳房下皱襞皮肤的真皮层。该韧带与内侧腹直肌筋膜，前距肌筋膜的外斜肌筋膜相延续。该韧带起到悬吊和固定乳房...     

乳房下皱襞的研究进展及其在假体隆乳术中的应用

<正>乳房下皱襞微乳乳房下缘,是由Sir Astley Cooper在1845年最早提出的,经国内外专家的大量研究,发现了解乳房下皱襞的结构和形成原因对乳房整形手术的成功有着极其重要的作用,现将有关乳房下皱襞的研究和其在乳房整形手术中的应用综述如下。1乳房下皱襞的组织结构和形成1.1乳房下皱襞的组织结构:乳房下皱襞位于乳房下缘,在内侧第5、6根肋骨的间隙,乳房下皱襞到乳晕的平均距离在小乳房上一般为5.5~     

乳房下皱襞的组织学和解剖学研究及其临床应用

目的 通过对乳房下皱襞相关组织结构的大体解剖和组织学研究,进一步明确乳房下皱襞的组织学和解剖结构.方法 采用新鲜成年女性尸体行解剖研究,并分别于乳房上缘、乳晕上缘、乳房下皱襞及乳房下皱襞下方4 cm处取材,制作HE染色及改良Gomori′s trichrome 染色切片,并进行图像分析.结果 共研究乳房20只,在乳房下皱襞组可见皮肤真皮层内红色的纤维组织排列平行于乳房下皱襞的长轴,胶原纤维的断面较少,各组的胶原纤维相对含量无明显差异.结论 乳房下皱襞区域无下皱襞韧带结构,真皮内胶原纤维的密度和其他三组相比,无明显差别.     

乳房下皱襞的组织学和解剖学研究及其临床应用

目的通过对乳房下皱襞相关组织结构的大体解剖和组织学研究,进一步明确乳房下皱襞的组织学和解剖结构.方法采用新鲜成年女性尸体行解剖研究,并分别于乳房上缘、乳晕上缘、乳房下皱襞及乳房下皱襞下方4 cm处取材,制作HE染色及改良Gomori′s trichrome 染色切片,并进行图像分析.结果共研究乳房20只,在乳房下皱襞组可见皮肤真皮层内红色的纤维组织排列平行于乳房下皱襞的长轴,胶原纤维的断面较少,各组的胶原纤维相对含量无明显差异.结论乳房下皱襞区域无下皱襞韧带结构,真皮内胶原纤维的密度和其他三组相比,无明显差别.     

乳房下皱襞韧带与隆乳术

９９４年Ｂａｙａｔｉ等［１］通过１３例尸解，并于临床进一步证实了乳房下皱襞处皮肤与肋骨骨膜及肋间肌筋膜间存在一束状纤维组织结构，并命名为乳房下皱襞韧带。１９９５年３月～１９９６年１２月间我们在行隆乳术时对这一结构进行了大体观察，并保留其完整性不被破坏...     

隆乳术后的形态与乳房下皱襞韧带关系的探讨

自 1 995年 Bayati等人报告了乳房下皱襞韧带的存在以来[1] ,该韧带与隆乳术的关系引起众多临床工作者的关注。1 997年至 2 0 0 0年间 ,我们用经腋窝下切口 ,在胸大肌后间隙 ,行部分离断乳房下皱襞韧带的方法为 68例 1 36侧乳房做隆乳手术 ,术后效果满意 ,现报告如下。1　临床资料本组 68例 ,1 36侧乳房 ,年龄 2 0岁～ 5 0岁 ,未婚 1 0例 ,已婚生育 5 8例。其中乳房过小或平坦 ,属乳房发育不良的 45例 ;哺乳后乳房腺体萎缩 2 3例 ,其中伴乳房下垂 1 0例。乳房假体硅凝胶 5 0例 ,水凝胶 1 8例 ,最小为 1 80 ml,2 4 0 ml以上 5例 ,本组均采用…     

乳房下皱襞韧带与隆乳术

1994年 Bayati 等通过13例尸解,并于临床进一步证实了乳房下皱襞处皮肤与肋骨骨膜及肋间肌筋膜间存在一束状纤维组织结构,并命名为乳房下皱襞韧带。1995年3月～1996年12月间我们在行隆乳术时对这一结构进行了大体观察,并保留其完整性不被破坏,共施行12例,取得了满意效果。1 手术方法从乳头至乳房下皱襞的距离作为所选定假体的半径,以乳头为中心画圆,标出胸肌后所需分离的范围。在局部浸润麻醉下,缘下半乳晕缘作切口,深达乳腺包膜,沿此平面向乳房下皱襞方向分离4～5cm,以放射状切口切开乳腺实质至胸大肌前,沿肌纤维方向钝性分开胸大肌,然后用食指钝性分离胸大肌后间隙。先分离乳房内、上、外侧,再分离乳房下方,在到达乳房下皱襞前较易分离,至乳房下皱襞时则较为坚韧而遇有阻力。以拉钩拉开暴露腔穴,发现阻力来自一较坚韧的纤维结缔组织结构,附着于第5肋肋骨骨膜和第5、6肋问肌筋膜上,与乳房下皱襞走行方向相同,呈弧形(图1),     

联合切口隆乳术

虽然近年来有自体脂肪注射隆乳、亲水聚丙烯水凝胶注射隆乳等方法在临床应用 ,但目前国内外实践证明 ,乳房假体隆乳术仍为较安全可靠的隆乳方法。乳房假体隆乳术通常选用腋窝横皱襞、乳晕缘、乳房下皱襞及脐窝切口 ,各有优缺点。我们总结各种切口的优点并设计腋窝横皱襞切口结合乳房下皱襞小切口或乳晕切口 (以下简称联合切口 ) ,并运用肿胀麻醉技术 ,在局麻下完成腋窝入路隆乳术。该方法充分结合腋窝与乳房下皱襞入路的优点 ,同时有效的预防了各自的缺陷。自 1 999年以来 ,我们先后用此方法完成 32例小乳病人的隆胸术 ,取得良好的手术效果…     

乳下皱襞韧带的检验

OBJECTIVE: An anatomical study was carried out to examine the existence of the inframammary crease ligament. METHODS: 18 breasts of preserved female cadavers were dissected and dyed for the fascia. RESULTS: The so-called inframammary crease ligament described by other authors does not exist. CONCLUSION: The reinforced Cooper's ligament supports the inframammary fold in position.     

Inframammary fold reconstruction with a deepithelialized skin flap

Sagging of the remaining breast behind the inframammary fold after breast reduction or breast augmentation may necessitate revisional surgery. The authors achieved inframammary fold reconstruction by reconstruction of the inframammary crease ligament through a deepithelialized skin flap that is anchored to the periosteum of the fifth or sixth rib. They present their simple and safe technique.     

An alternative technique for managing the lower breast skin during secondary breast reconstruction with a TRAM flap

During secondary breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap, the native breast skin between the mastectomy scar and inframammary crease is usually left intact, excised, or deepithelialized. The authors have developed transposition flaps utilizing this skin and subcutaneous tissue in selected patients. This technique is most useful in patients who present for secondary reconstruction whose remaining lower breast skin may have contracted or in patients who should have a vertically inset TRAM flap but do not have a wide enough flap relative to the length of the inframammary crease. Although the authors use this technique infrequently due to additional scars placed on the breast, it is a useful technique to add to the armamentarium of the reconstructive surgeon.     

经脐孔缘切口置人充注式生理盐水假体隆乳术

目的 探讨经脐孔缘切口行充注式生理盐水假体隆乳术的手术方法,为隆乳术提供新切口选择.方法 沿脐孔缘切口,采用特制专用器械分离皮下隧道至乳房下皱襞,然后穿进胸大肌后间隙,分离假体放置空间,先置人扩张器,充注生理盐水后,调整乳房形态以及扩张器位置.然后取出扩张器,更换为充注式生理盐水乳房假体而完成手术.结果 采用经脐孔缘切口行充注式生理盐水假体隆乳术者,均获得了良好的手术效果,无感染、血肿、假体渗水、Baker Ⅲ或Ⅳ级纤维囊挛缩等并发症发生.结论 采用生理盐水充注式乳房假体,经脐孔缘切口可以完成胸大肌下隆乳术,增加了隆乳手术切口的选择范围.     

中国妇女乳房乳晕乳头比例的测定及相关因素分析

目的为塑造自然、匀称而具有美感的乳房提供参考和依据。方法对45例22~45岁、对自己乳房满意且无乳房手术史的女性志愿者,分别测量体重、身高、乳头直径、乳晕直径、胸乳线(乳头至胸骨切迹连线距离)、乳房内侧半径(乳头至乳房下皱襞内侧止点连线距离)、乳房外侧半径(乳头至乳房下皱襞外侧止点连线距离)、乳房下半径(乳头至乳房下皱襞最低点连线距离)。以乳房外侧半径长度作为乳房大小参考指标,由此计算和确定乳房、乳晕、乳头之间的比例,并对可能影响其变化的年龄、体重、身高等因素进行研究分析。结果该组样本显示中国妇女乳房与乳晕之比约为3.7∶1.0,乳晕乳头之比约为3.4∶1.0。体重、体重指数与乳房大小、乳晕乳头比例之间呈正相关,具有显著的统计学意义;而年龄、身高的影响在该样本中并未显现。结论乳房与乳晕、乳头间具有一定的合适比例,体重和肥胖可能是影响该比例关系的因素。乳房、乳晕、乳头比例的确定对东方妇女的乳房整形和再造具有美学价值,可被用于手术中对乳房大小的理想化设计和预测。     

Immediate breast reconstruction using the skin expander: a modification in technique

A modification in the technique of immediate postmastectomy reconstruction of the small to moderate-size breast using the skin expander is presented. The advantage of the technique is that it simplifies the replacement of the expander with the permanent prosthesis while establishing a symmetrical inframammary crease and a laterally supported breast mound. Representative cases are shown.     

隆乳术切口和假体置放层次及手术剥离范围探讨

目的：探讨隆乳术的切口选择、假体置放层次和腔穴剥离范围。方法：于1996例9月至2001年9月间行隆乳术537例，选择三种手术切口；乳房下皱襞切口、乳晕切口、腋窝切口；假体置放于乳腺后间隙或胸大肌后间隙；胸大肌后间隙的剥离范围以第6肋间隙为下界。术后随访半年-5年。结果：术后乳房位置、形态、手感均满意511例（占95.2%）。结论：乳房下皱襞切口适于站立时乳房下皱襞明显或者乳房轻度下垂者；对于乳晕直径≥4cm的受术者，可采用乳晕缘内上或者内下弧形切口；腋下切口最为隐蔽，适于所有的受术者。假体置放于胸大肌后间隙具有手感更真实、不易形成纤维囊性硬变、不影响哺乳等优势。在胸大肌后间隙进行剥离，顺应乳房下皱襞韧带的解剖结构，将下界定于第6肋间隙。     

Diagnostic and treatment challenges of inframammary crease breast carcinomas

BACKGROUND: To review one surgeon's experience with tumours of the inframammary crease. METHODS: Individually reviewed cases were identified from a prospective database. RESULTS: Of the 550 patients treated between January 2000 and January 2005, six patients were found to have carcinomas of the inframammary crease (IMC). The features identified from these cases included diagnostic confusion with sebaceous cysts delaying diagnosis and early involvement of the dermis and chest wall resulting in management issues related to local T staging. Lymphoscintigraphy showed drainage to bilateral, contralateral or ipsilateral axillae as well as the internal mammary chain. CONCLUSION: The anatomy and histology of the IMC are reviewed, as is the available published work on IMC breast tumours. By virtue of their location, IMC tumours invade the dermis and chest wall early. Despite this, they do not seem to behave as T4 cancers. Their lymphatic drainage is a cross between patterns observed for breast parenchymal and skin primaries, making sentinel node lymphoscintigraphy essential. The clinical cases presented highlight these peculiarities of IMC breast cancer.     

Anatomical study of the breast superficial fascial system: the inframammary fold unit

The subcutaneous fascial system of the breast was investigated. The aim was to demonstrate splitting of the superficial fascia and the existence of an inframammary ligament. The inframammary region was studied in six cadavers (12 breast dissections) and in 21 patients during breast surgery (12 surgical and nine histological investigations). The superficial fascial system is related to sex, age, breast size, weight and adiposity. In females, the inframammary fold depends on the situation of the superficial fascia which, without true splitting, becomes deeper due to an absence of fat in the deep subcutaneous space, and on more adherence to the deep fascia through thickened retinaculum; there is a connective band, the anterior breast capsule, erroneously called ”superficial layer of the superficial fascia,” and mistaken for ”inframammary ligament”, which detaches from the superficial fascia. In males, there is a zone of adherence only at the inframammary midline. The microstructure of the breast fascial system at the inframammary region is demonstrated histologically. Surgical implications are suggested. Received: 18 June 1999 / Accepted: 10 January 2000