复合组织下蒂法乳房缩小整形术25例

目的：回顾性总结复合组织下蒂法乳房缩小整形术25例病例资料,探讨复合组织下蒂法乳房缩小整形术手术注意事项及其并发症防治。方法：从2003～2008年5年间,对25例女性乳房肥大患者分别进行手术治疗,方法采用复合组织下蒂法。通过对术中复合组织下蒂的修整及术后乳房外形、乳头乳晕复合体血运、术后瘢痕及乳房感觉等方面观察,分析复合组织下蒂法乳房缩小整形术的术中注意事项及术后并发症的防治策略。结果：25例患者均取得了较好的效果,无乳头乳晕复合体血运障碍发生。结论：复合组织下蒂法乳房缩小整形术是较好的乳房缩小术式,良好的术前设计及术中调整是确保手术成功的关键。     

复合组织下蒂法在乳房缩小成形术中的应用

目的:探讨复合组织下蒂法在肥大乳房缩小整形术中的应用。方法:回顾性分析我科2007年1月-2013年12月,应用复合组织下蒂法矫治乳房肥大症患者18例,34侧乳房。术后根据术前伴随症状与乳房外形评判术后效果。论述本术式的基本方法与探讨操作要点。通过对患者术后乳房外形、感觉、瘢痕、不适症状的缓解及术后并发症等方面的分析,总结复合组织下蒂法的特点及优缺点。结果:本组18例患者,1侧术后切口发生局部脂肪液化,1例术后乳房仍有轻度下垂2例术后2个月出现乳晕扩大,余均效果满意。术前各种不适得到明显改善。乳房疼痛改善率为83.3%。肩、颈、项、背痛改善为100%,睡眠明显改善100%。结论:复合组织下蒂法是治疗乳房肥大症较理想的治疗方法。     

乳房缩小成形术手术方法的选择与比较

目的：对乳房缩小成形术的临床资料进行回顾和分析，选出比较好的手术方法。方法：总结西京医院整形外科中心开展的65例乳房缩小成形术的临床经验，比较各种常见的乳房缩小成形术的优缺点。结果与结论：包括纵行双蒂、横行双蒂、单纯下蒂和复合下蒂等多种方法用于乳房缩小成型术，其中复合下蒂法由于操作简单，乳头乳晕血液循环有保障能保留乳腺的哺乳功能，且乳房塑形好，值得推荐。     

整形

20060824内窥镜下额颞部除皱术，20060825几种乳房再造术的临床应用体会，20060826假体容积的双重选择及假体上极胸上肌填充隆乳术，20060827复合组织下蒂法乳房缩小成形术，20060828皮下乳腺切除同时行假体植入乳房重建术。[编者按]     

垂直双蒂法乳房缩小术的临床探讨

目的：探讨垂直双蒂法乳房缩小术的方法、注意事项及优缺点。方法：用Mckissock垂直双蒂法进行乳房缩小术,乳头、乳晕垂直皮下蒂移植,重塑乳腺实体。结果：术后乳房外形较好,乳头、乳晕成活良好,伤口大部分愈合良好。结论：运用此方法进行中、重度肥大及下垂乳房的缩小,效果满意。     

垂直双蒂法乳房缩小整形术

用垂直双蒂法为15例患者作乳房缩小悬吊术，手术全部成功。作者认为巨乳症或乳房下垂者其形态表现为乳房肥大沉重下垂，但其内在组织均有病理上的改变，因此手术通过对乳房组织的切除，不仅对乳房的形态作了整形，收到了良好的美容效果，而且也对病变组织切除，消除了临床症状，具有良好的治疗作用。本术式血供可靠、操作简单、安全性高，初学者较易掌握。     

倒T形上蒂法在巨乳缩小术中的应用体会

目的探讨倒T形切口上蒂法在巨乳缩小术中的作用效果。方法自2018年1月至2019年2月对收治的5例(均为双侧)巨乳症患者,采用倒T形切口上蒂法联合真皮悬吊,下极腺体切除重置行巨乳缩小术,其中,Ⅱ度1例,Ⅲ度4例。双侧乳房组织切除量为954～2033 g,平均1550 g。结果 5例患者随访3～18个月。切口均一期愈合,无脂肪液化、血肿或血清肿等并发症发生。术后1例出现乳头乳晕感觉减退,3个月后逐渐恢复正常。双侧乳房外形及乳头乳晕复合体高度、对称度均较好,均无明显瘢痕增生,患者均对术后效果满意。结论采用倒T形切口上蒂法行巨乳缩小术,可有效避免乳房下垂,获得较满意的临床疗效。     

巨乳症的手术整复治疗

解除巨乳给女性带来的腰酸背痛、皮肤糜烂、胸部形体畸形、生活的不便等诸多痛苦，恢复其胸部的正常美感曲线。以个体乳房情况选择垂直双蒂、上蒂、下蒂加设计双侧皮瓣的方法进行整复。结果：双侧被切除乳房的组织量为８００￣２０００ｇ，乳房缩小为丰满而挺立的青春期形状，而外观仅留少量的瘢痕。根据乳房切除的组织量多少，以采用不同的手术方法，切除多时拟用双蒂或上蒂法，切除少时应用下蒂法，均能得到满意的效果。     

保留Wǘringer水平横隔的中心蒂法乳房缩小成形术

目的 探讨应用保留Wǘringer水平横隔的中心蒂法乳房缩小成形术治疗女性乳房肥大的方法及疗效.方法 2009年3月至2011年9月,对21例轻、中度女性乳房肥大患者行中心蒂法乳房缩小成形术时,采用去除Wǘringer水平横隔头侧方向、保留横隔尾侧方向乳腺组织的方式.结果 21例患者单侧腺体组织切除量为(327.8±148.6)g,锁乳距由术前的24.0～28.0 cm(25.5 cm)缩小为术后的18.0 ～22.0 cm(20.0 cm),胸骨上凹至乳头的距离由术前的23.5～28.5cm( 26.0 cm)缩小为术后的19.5 ～22.5 cm(21.0 cm).上提乳头4.0～ 10.0 cm,平均6.5 cm.术后无一例血肿,无乳头、乳晕坏死的现象发生.1例患者切口小范围裂开,经换药后自愈.17例获术后3个月至2年的随访,乳头、乳晕感觉良好,乳房外形满意.结论 保留Wǘringer水平横隔的中心蒂法乳房缩小成形术,具有更好的解剖学基础,可以更加有效地保证乳头、乳晕复合体的血运和感觉,减少血肿或血清肿的发生率,术后远期效果更为稳定,适用于部分轻、中度乳房肥大的患者.     

下蒂法乳房缩小整形术设计的术中调整

目的为了克服以往乳房缩小手术设计方法不够灵活的缺点而进行本课题的研究。方法术前对新乳头位置和乳房多余皮肤切除范围按下蒂法初步定位，术中在近似直立的体位下对初步形成的乳房再进一步的调整定位，最后确定新乳头乳晕的位置，然后采用下蒂法完成乳房缩小术。结果自1995年8月起，共行34例，经术后3～18个月随访，无明显并发症，新乳房形态自然，乳头乳晕感觉正常。结论本法设计简单、灵活，手术安全、效果可靠。     

Short scar reduction mammaplasty in the bariatric patient

Reduction mammaplasty may be necessary even after massive weight loss. Patients typically present with unfavorable breast features such as significant loss of upper pole volume, inelastic skin, and severe ptosis. The most common approach in the United States has been the Wise-pattern inferior pedicle technique, emphasizing skin excision. This report presents the short scar vertical reduction mammaplasty approach for the bariatric patient population. It aims to demonstrate improved outcomes with less scar burden. The study included 15 women (n = 29 breast reductions) with mean age of 41.8 years. All the patients had undergone gastric bypass surgery, with mean weight loss of 109 pounds and mean body mass index of 33.3 kg/m(2). A modified superomedial pedicle vertical mammaplasty technique was used. New nipple position was placed lower than the inframammary fold in accordance with vertical lack of upper pole fullness. Suction-assisted lipectomy was used to contour the inferior pole of the breast before glandular resection. A full-thickness superomedial pedicle and median incision of the upper pole maximized pedicle safety. The mean breast resection was 605 g on the right side (range, 352-945) and 592 g on the left side (range, 360-908). Patient satisfaction was high, with pleasing and stable breast shape at long-term, and a mean patient-related aesthetic ranking of 4.3 of 5.0. No major complications were noted. It is shown that superomedial pedicle vertical reduction mammaplasty can be an alternative approach in bariatric patients, achieving long-term pleasing and stable results with significantly decreased scar burden.     

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.     

A prospective quantitative comparison of breast sensation after superior and inferior pedicle mammaplasty.

Reduction mammaplasty techniques using the inferior pedicle have been recommended to preserve the nipple and areolar sensation after surgery. The vertical scar mammaplasty with a superior pedicle has often been criticised because of the potential for damage to the sensory supply of the nipple-areola complex. The aim of this study was to assess the breast sensation in two prospective series of patients operated upon using superior pedicle and inferior pedicle mammaplasties. Between November 1996 and February 1997, 20 consecutive patients (39 breasts) underwent breast reduction using the inferior pedicle technique with inverted T scar (Robbin's technique). This series of patients was matched with another series of 18 patients (36 breasts) who had breast reduction using a vertical scar mammaplasty with superior pedicle (Lejour's technique) in another centre. Cutaneous pressure thresholds were recorded using Semmes-Weinstein monofilaments. The values were obtained on the quadrants of the skin of the breast, the areola and the nipple. The sensitivity test was performed preoperatively, then at 3 and 6 months postoperatively. Patients' characteristics (age, weight, breast ptosis, breast mass resected and risk factors) were statistically similar between the two groups. The preoperative values of pressure sensation on the different areas tested were statistically similar between the two groups. The sensitivity decreased on almost all the tested areas of the breast at 3 months postoperatively. No patient had an insensitive area on the breast at 6 months after surgery. Some areas of the breast showed a significant difference in pressure sensitivity after one technique compared to the other: better sensation on the skin of the superior and lateral quadrants after the superior pedicle technique at 3 months (P< 0.001), poorer areolar sensation on the inferior quadrant after the superior pedicle technique at 3 and 6 months (P< 0.05) and on the superior quadrant after the inferior pedicle technique at 3 months only (P< 0.05). However, the mean value of the areolar quadrants was statistically similar after both techniques. The nipple sensation was significantly decreased in both groups at 3 months but remained comparable between the two groups. Breast innervation was damaged by breast reduction using both the inferior and the superior pedicle techniques. The breast skin had better sensation after the superior pedicle technique while the areola had slightly better sensation after the inferior pedicle technique. At 6 months, the mean value of nipple-areola complex pressure sensation was comparable in the two series of patients.     

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。     

Dermafascial Fixation Suture: A Technique for a More Durable Projection with Short-Scar (Vertical) Reduction Mammaplasty

Background Short-scar reduction mammaplasty has several advantages over the traditional technique, mainly reduced scarring and superior long-term breast shape. Multiple modifications of the short scar reduction mammaplasty technique have been made in an effort to decrease the learning curve while improving the results. The authors present another modification of the short-scar technique for a more durable projection without reliance on a skin envelope. Methods The perimeters of the medial pedicle and the nipple–areola complex are marked, and the medial pedicle is deepithelialized. A 2 × 5-cm skin area at the inferior border of the pedicle is further deepithelialized, then pexied to the pectoralis fascia in a superomedial direction using a nonabsorbable monofilamanet suture with a horizontal mattress suturing technique. Results Taking the suture bites from the dermis rather than the breast parenchyma for the pexy aims to spare the pedicle’s circulation. This durable internal rearrangement of the breast parenchyma with dermafascial pexy further decreases the tension at the nipple–areola complex because the final breast shape no longer relies on the skin closure. Suture spitting at the nipple–areola complex also is prevented with elimination of the purse-string suture because there is no need for a further decrease in the tension with the purse-string suture after the dermafascial pexy. Conclusions The authors believe that the dermafascial pexy is a concept more than a technique. It incorporates the two strongest structures, the dermis and the fascia, to achieve more durable results not only with reduction mammaplasty, but also with any aesthetic breast surgery that uses the pedicles.     

Modification of Vertical Scar in Vertical Mammaplasty Technique

Vertical mammaplasty is a simple and safe procedure that relies on an upper pedicle to the areola with lower central breast reduction and glandular shaping. We applied this technique to six patients adding a modification of the vertical scar which distributed skin tension both to the areola and vertical suture line. It prevented an unacceptable puckering vertical scar and enlargement of areola. This modification also provided satisfactory breast shape with a good vertical scar especially at the early postoperative period.     

No-vertical-scar inferior pedicle breast reduction using the dermal suspension sling

Background

The authors previously presented favorable outcomes with the use of the horizontal dermal suspension sling and plication of the inferior pedicle in reduction mammaplasty surgical cases. We propose a modification to this technique tailored to patients with moderate to severe ptosis. The modification avoids the vertical scar inherent to the inverted T pattern.

Methods

The surgical technique utilizes portions of the dermal suspension and plication technique previously described by the authors. Minor modifications were made to take advantage of the vertical excess of skin found in patients with moderate to severe macromastia and ptotic breasts. The modification leads to a superior skin flap that drapes the inferior pedicle and newly constructed breast mound, resulting in a single inframammary scar.

Results

Thirty-eight women have undergone breast reduction using the vertical scarless inferior pedicle with horizontal dermal suspension and plication surgical technique. Breast projection and shape were sustained during follow-up with positive aesthetic results; the median follow–up time was 7 months.

Conclusions

The modifications to our surgical technique allowed for an improved appearance in the postoperative breast scar and in the overall cosmetic outcome in patients who underwent large-volume breast reductions. Level of Evidence: IV, therapeutic study     

The Asplund-Davies vertical scar breast reduction technique preserves the sub-areolar skin thickness in the long term: a matched comparative study with the inverted T technique.

BACKGROUND AND AIM: The inverted T technique, a popular method of breast reduction, relies on stretching the skin over glandular breast tissue to create the breast shape. The Asplund-Davies vertical scar method of breast reduction by contrast uses glanduloplasty to create the desired breast shape, achieving tension-free skin closure. Indeed the skin at the end of the vertical scar technique is wrinkled. It is known from tissue expansion literature that when skin is placed under tension the dermis becomes thinner. In this pilot cross-sectional study we compared breast skin thickness between two matched groups of patients undergoing breast reduction either with the inverted T or the vertical scar techniques, to determine whether the method of breast reduction impacts on breast skin thickness in the long term. MATERIALS AND METHOD: With a high frequency ultrasound machine the breast skin thickness of 24 breasts, 12 in each group, was measured by an independent consultant radiologist. Patients were matched in terms of age, time since operation, Fitzpatrick skin type, preoperative cup size and the amount of tissue resected. RESULTS: The breast skin in the inverted T group was significantly thinner than the vertical scar group (P<0.001). The inverted T group also had thinner skin in comparison to its control point (P<0.05). The vertical scar group had comparable skin thickness compared to its control point (P>0.05). CONCLUSION: This pilot study suggests that tension-free closure of skin with the vertical scar technique maintains breast skin thickness. Maintenance of breast skin thickness in this group may in turn contribute to the long term preservation of breast shape and form.     

Circumareolar Mastectomy in Female-to-Male Transsexuals and Large Gynecomastias: A Personal Approach

Breast reduction or amputation in female-to-male surgery presents a specific surgical problem: obtaining a good breast shape of the masculine type. Over a 2-year period, 17 patients (12 female-to-male transsexuals and 5 extreme gynecomastias) were operated on using the circumareolar approach for subcutaneous mastectomy. The nipple-areola complex was left on a very wide deepithelialized dermal pedicle, and the final closure of the wound was performed using a round-block technique followed by numerous fine sutures to reduce wrinkling. This technique provides naturally flat masculine breasts, leaving sufficient dermal vascularization for the nipple-areola complex which is of the utmost importance. All the patients were very satisfied with the result because of the periareolar scar only. Two areolar necroses occurred due to perforation of the thin vascular dermal pedicle: one superficial which epithelialized spontaneously in a short period of time and one deeper which required skin grafting.