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.     

The short scar three-block L-wing technique

IntroductionNumerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular supply and sensitivity of the nipple areola complex (NAC), breast feeding, and an esthetically pleasing result.ObjectivesIn the present preliminary report, we introduce a new technique called the three-block L-wing reduction mammaplasty that addresses the aforementioned difficulties.Materials and MethodsThe three-block L-wing reduction mammaplasty with a thick hemispheric superiorly based NAC pedicle and a medial as well as lateral pillar was performed in a total of 60 patients.ResultsOur technique increases both, vascular safety and the sensory supply to the NAC, as it conceptually decreases the need for dissection of breast tissue and skin. The incidence of fat necrosis and wound healing disorders may be reduced with this technique. Because the ducts of the breast-gland underneath the NAC are not dissected, this technique also promises a higher probability of regular breast-feeding. Finally, our technique permits a cosmetically pleasing round-shaped mound of the breast.ConclusionThe three-block modification simplifies the procedure of the superior pedicle L-wing mammaplasty markedly. It may increase the esthetic as well as the functional outcome and decrease postoperative complications.     

Vertical Mammaplasty for Gigantomastia

A 48-year-old female patient presented with gigantomastia. The sternal notch-nipple distance was 55 cm for the right breast and 50 cm for the left. Vertical mammaplasty based on the superior pedicle was performed. The resected tissue weighed 3400 g for the right breast and 2800 g for the left breast. The outcome was excellent with respect to symmetry, shape, size, residual scars, and sensitivity of the nipple-areola complex. Longer pedicles or larger resections were not found in the literature on vertical mammaplasty applications. In our opinion, by using the vertical mammaplasty technique in gigantomastia it is possible to achieve a well-projecting shape and preserve NAC sensitivity.     

保留乳腺横膈内上蒂垂直切口瘢痕乳房缩小术

目的 探讨保留乳腺横膈内上蒂垂直切口瘢痕乳房缩小术的临床效果.方法 采用Lejour穹窿顶式手术设计,切除乳房下方多余的皮肤、腺体,将乳头和乳晕以内上方真皮、腺体组织蒂抬高到正常位置,术中保护乳腺中隔神经、血管蒂.采用不吸收缝线缝合乳房下极腺体,适度修薄乳房下部皮肤,以便于皮肤回缩,减轻瘢痕.结果 共行手术27例,53侧乳房,其中1例为单侧乳房缩小术,手术效果满意,乳房形态良好.术后6例8侧乳房切口部分裂开,均经换药后愈合,无1例发生乳头、乳晕坏死.结论 保留乳腺横膈的内上蒂垂直切口瘢痕巨乳缩小术效果良好,提高了乳头、乳晕移位的安全性.     

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.     

Secondary reduction mammaplasty: does initial pedicle design matter?

Reduction mammaplasty is one of the most common plastic surgical procedures performed in the United States. Occasionally patients will require a second reduction to address persistent or recurrent symptomatic macromastia. When the vascular pedicle of a primary breast reduction is unknown, there is uncertainty regarding how best to proceed with a secondary reduction. When the pedicle is known, we include at least the primary pedicle in our operative plan. When unknown, we performed a modified central mound (MCM) reduction technique. The MCM reduction respects the blood supply to the nipple-areolar complex (NAC) by preserving any remaining vascularity that is present within the central mound tissue while also maintaining superior and inferior vascular pedicles. We avoid using a free nipple graft.Thirty patients (60 breasts) underwent repeat breast reductions between 2009 and 2016. Patients were placed into two groups whether their primary vascular pedicle was known or unknown, and then further grouped based on the type of reduction they received. There was no significant difference in the complication rate between patients that underwent an MCM reduction versus those that underwent reduction with other techniques. Most patients maintained breast sensation and none required a free nipple graft.Patients can be offered repeat reduction mammaplasty with the possibility of nipple sensation preservation and a normal-appearing NAC regardless if the primary vascular pedicle is known. If the primary pedicle is unknown, the MCM technique is an excellent option.     

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.     

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.     

Importance of the suprasternal notch to nipple distance (SSN:N) for vascular complications of the nipple areola complex (NAC) in the superior pedicle vertical mammaplasty: A retrospective analysis

Background

The superior pedicle, frequently used with vertical mammaplasty, bears some risk for vascular complications of the nipple areola complex (NAC) particularly in large breasts. The suprasternal notch to nipple distance (SSN:N), geometrically associated with the longitudinal axis of the breast and length of the superior pedicle, might be an indicative parameter to assess these complications. Importance of the SSN:N for vascular complication of the NAC was focussed upon in this study.

Material and methods

Arterial and venous complications of 104 patients following the superior pedicle vertical mammaplasty were retrospectively evaluated both sided (n = 208 breasts), according to the preoperatively measured SSN:N. Binary logistic regression (p ≤ 0.05) was used for statistical evaluation.

Results

Probability of vascular compromise of the NAC is influenced by the SSN:N within the context of the superior pedicle vertical mammaplasty. An SSN:N > 30 cm (n = 112 breasts) is subject to venous (p = 0.002) as well as arterial (p = 0.232) complications of the NAC, both of which may result in partial necrosis of the tissue (p = 0.029).

Conclusion

The SSN:N measurement can be helpful to identify patients at risk for vascular complications of the superiorly stalked NAC. Modifications of the superior pedicle or other pedicles potentially providing enhanced vascular impact might be considered with an SSN:N beyond 30 cm to reduce vasculature-related complications of the NAC.     

Viability and sensation of the nipple-areolar complex after reduction mammaplasty

Reduction mammaplasty with nipple-areolar transposition on a medial pedicle was designed as an alternative to amputation and free nipple graft for women with severe mammary hypertrophy. The purpose of this study was to review the viability and sensory outcome of the nipple-areolar complex (NAC) in 72 women (133 breasts) after medial pedicle and inferior pedicle reduction mammaplasty between 1996 and 2000. The medial pedicle was used for 41 women (79 breasts) with moderate to severe mammary hypertrophy. An inferior pedicle was used for 31 women (54 breasts) with mild to moderate mammary hypertrophy. Mean follow-up for all patients was 25 months. Total sensation of the NAC was obtained in 68 of 79 breasts (86%) after medial pedicle reduction mammaplasty and in 50 of 54 breasts (92%) after inferior pedicle reduction mammaplasty. Total viability of the NAC occurred in 74 of 79 breasts (94%) after medial pedicle reduction mammaplasty and in 53 of 54 breasts (98%) after inferior pedicle reduction mammaplasty. Quantitative sensory testing of the NAC using the pressure-specified sensory device demonstrated that static and moving sensory thresholds of the NAC are lowest in the inferior pedicle group followed by the control group and the medial pedicle group. It can be concluded from this study that the medial and inferior pedicle techniques are capable of supporting vascularity and innervation to the NAC. The medial pedicle technique for severe mammary hypertrophy is a good alternative to free nipple grafting. The amount of breast tissue removed does not correlate with sensory outcome for both inferior and medial pedicle techniques. The pressure-specified sensory device is an excellent means of assessing sensory outcome.     

携带Würinger水平中隔的内上方真皮腺体蒂乳房缩小成形术

目的 探索应用携带Würinger水平中隔的内上方真皮腺体蒂乳房缩小成形术治疗乳房肥大症的方法及疗效.方法 自2009年1月至今,对15例中、重度乳房肥大伴有下垂患者施行携带Würinger水平中隔的内上方真皮腺体蒂乳房缩小成形术.结果 15例单侧腺体组织切除量为（522.9±218.3）g,术后胸骨上凹至乳头距离为（21.7±1.74）cm,平均上提乳头8.5 cm（4～16 cm）.术后无血肿及乳头乳晕复合物坏死并发症发生.1例发生小段切口裂开（发生率6.7%）.13例获随访6～18个月,新乳头乳晕感觉良好,切口瘢痕细小,新乳房外形饱满挺拔.结论 携带Würinger水平中隔的内上方真皮腺体蒂乳房缩小成形术,具有新乳头乳晕血运和感觉良好、乳房形态满意及效果稳定的优点,可作为治疗中、重度乳房肥大伴下垂的可选术式之一.     

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。     

Breast sensation after superior pedicle versus inferior pedicle mammaplasty: anatomical and histological evaluation.

Despite contradictory information about the course and distribution of the nerves supplying the breast, surgical techniques using an inferior pedicle have been recommended over those using a superior pedicle for preserving the nipple-areolar sensation after surgery. This anatomical study was designed to quantify the nerve branches preserved in inferior and superior pedicles after reduction mammaplasty performed on cadavers. Reduction mammaplasty was done on four fresh cadavers (within 48h of death) using a superior pedicle on the right and an inferior pedicle on the left in a standard way. The pedicle was cut at its base and then fixed in formalin. The base was divided in biopsy specimens and embedded in paraffin. The nerves were quantified and located in each pedicle with haematoxylin-eosin stain and light-microscopic evaluation. Histological evaluation of the pedicles showed the presence of a variable number of nerves (between one and seven) within two superior pedicles and three inferior pedicles. The nerves were located in fibrous tissue and accompanied by vessels in most cases. The nerves were always found superficially and were most likely to be located in the central part of the pedicle. Our results showed that including the nerves within the pedicle is technically uncertain regardless of the mammaplasty technique used. The final recovery of sensation in the breast after mammaplasty seems to result from the regeneration of severed cutaneous nerve branches or the remaining cutaneous innervation rather than the preserved adjacent cutaneous branches.     

Free nipple reduction mammaplasty with a horizontal scar in high-risk patients

Women with extremely large and ptotic breasts have many complaints and difficulties during daily life. Conventional reduction mammaplasty techniques are not convenient because the presence of excess tissue beneath and over a long pedicle may cause nipple-areola complex necrosis. These patients mostly have systemic health problems so they benefit from a shorter operative procedure. The amputation method is an option providing rapid surgical operation time and little blood loss but it may lead to a flat, unaesthetic breast with poor projection. In this paper we present an alternative amputation with the use of a backfolded dermoglandular flap and free nipple graft. The inferior pole is amputated. The deepithelialized breast tissue is left on the superior pedicle extending below the 7-cm vertical limb mark. This deepithelialized tissue is tucked to give more central mound projection. The aesthetic outcomes, such as well-rounded breasts with good projection and a hidden scar at the submammary sulcus, have led us to perform this technique, which was first described by the Mansteins in 1997.     

Lejour法乳房肥大缩小术的临床体会

目的:探讨LEJOUR方法乳房肥大缩小手术的临床效果。方法:按照LEJOUR方法的设计,切除乳房多余腺体后将其固定于第二肋间胸肌筋膜上,并将剩下的腺体重新塑形;将乳房下极的皮瓣修薄。结果:共24例乳房肥大病人,手术后除1例出现单侧乳头感觉缺失外没有其他并发症,乳房外形满意。结论:LEJOUR方法是一种比较好的乳房肥大缩小手术方法。     

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     

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.     

Breastfeeding After Reduction Mammaplasty Using Different Techniques

Background This study reviewed mammary glandular function and breastfeeding after reduction mammaplasty performed via four different surgical techniques. Patients who underwent this procedure were asked to answer questions concerning the birth of a child, natural breastfeeding, and the reasons why natural breastfeeding was not performed or was interrupted. Methods Between 1992 and 2001, 368 reduction mammaplasties were performed in the Department of Plastic Surgery at the “La Sapienza” University of Rome. After reduction mammaplasty, 105 patients had a child and were enrolled in the study. Breastfeeding data were compared with data from hospital records at the time of surgery in terms of patient age, reduction mammaplasty technique, sensitivity of the nipple–areola complex after the operation, and proportion of the gland removed. Results Maternal breastfeeding was considered to have occurred if it lasted more than 3 weeks and was not accompanied by any nutritional supplements. Babies were breastfed by 60.7% of the patients who underwent a superior pedicle reduction mammaplasty, by 43.5% of those who underwent an inferior pedicle reduction mammaplasty, by 48% of those who underwent a medial pedicle reduction mammaplasty, and by 55.1% of those who underwent a lateral pedicle reduction mammaplasty. Conclusions The findings demonstrate that conservative reduction mammaplasty techniques supported by medical and paramedical staff permit subsequent breastfeeding. In particular, the best outcomes resulted from superior pedicle reduction mammaplasty. Skilled execution of the surgical technique is mandatory to guarantee adequate vascularization and sensitivity of the nipple–areola complex and to spare as many of the glandular ducts and lobules as possible.     

The use of a combined technique in reduction mammaplasty (inferior pyramidal and superior glandular techniques)

The management of mammary hypertrophy is a developing process. The common surgical options for reduction mammaplasty include amputation with free nipple graft as well as the bipedicled, inferior pedicle and vertical pedicle techniques. All techniques are used widely. Disadvantages of these procedures include nipple areola necrosis, insensitivity, hypopigmentation, and poor breast projection. Even with the standard modifications of the original techniques, the resultant breast and nipple may be wide and flat. The purpose of this study was to assess whether combined inferior pyramidal pedicle and superior glandular pedicle reduction mammaplasty can optimize nipple and breast projection. Attention will focus on the viability and sensation of the nipple areola complex. Nine patients with mammary hypertrophy were studied. The change in nipple position ranged from 7 to 13 cm. The amount of tissue removed from each breast ranged from 500 to 1150 g. Nipple/areola sensation was retained in all cases with the exception of one breast. Nipple/areola necrosis or hypopigmentation were not observed. Optimal central breast projection was maintained in all patients, and postoperative evaluation was carried out at 12 and 22 months. The patient satisfaction was very high.     

内上方真皮腺体蒂乳房成形术在多种乳房畸形中的应用

目的探讨内上方真皮腺体蒂乳房成形术对乳房肥大及乳房假体、聚丙烯酰胺水凝胶取出后的乳房畸形进行修复的疗效。方法对36例乳房肥大及乳房假体、聚丙烯酰胺水凝胶取出后乳房畸形的患者,行携带或不携带Wfiringer乳房水平中隔内上方真皮腺体蒂乳房成形术修复。结果36例患者,术后胸骨上凹至乳头距离为（20．10±1．94）cm,平均上提乳头7．5cm（4～13cm）,并且均未出现血肿及乳头、乳晕复合体坏死等并发症。2例发生小段切口裂开（发生率为5．56％）,其余均为I期愈合。28例获随访6～18个月,乳头、乳晕感觉良好,切口瘢痕不明显,乳房外形满意。结论应用内上方真皮腺体蒂术式可使乳房得到良好的塑形,同时又能充分保留乳头、乳晕复合体的血运及感觉功能,疗效满意。