双环法及乳头乳晕内上蒂缩乳术治疗重度男子乳腺发育

目的 探讨双环法及乳头乳晕内上蒂缩乳术治疗重度男子乳腺发育症的效果.方法 双环法设计内外环切口,并去除两环间的内上方部分表皮,形成包含真皮、乳腺及皮下组织的乳头及乳晕蒂,切除两环间其余大部分皮肤、腺体及脂肪组织后,将乳头乳晕蒂部适度内旋并与肌膜固定,外环收拢后与内环对位缝合.结果 9例(18侧),除1例单侧乳头乳晕表层坏死外,其余均Ⅰ期愈合,双侧乳房对称、外形满意.结论 利用双环法及乳头乳晕内上蒂缩乳术,可有效治疗重度男子乳腺发育症,内上蒂可确保乳头乳晕血运,并避免后期乳房下垂.     

Oncoplastic surgery after mammary reduction and mastopexy for bilateral breast cancer lesions: Report of a case

We report a case of bilateral breast cancer lesions treated successfully by partial oncoplastic surgery. A 46-year-old Japanese woman presented with a small mass in the right breast. Mammography showed neither a mass nor calcification in the right breast; however, an irregular-shaped mass lesion was shown in the left breast. Ultrasonography and fine-needle aspiration biopsy revealed ductal carcinoma in situ in the inner-upper quadrant of the right breast and invasive ductal carcinoma in the outer-upper quadrant of the left breast. We considered that it would be difficult to obtain a good symmetrical outcome after partial mastectomy for the bilateral breast lesions because of the asymmetrical location of each lesion and her ptotic breasts. Thus, we performed bilateral partial resection, followed by an inferior pedicle reduction mammaplasty-type operation, with and without axillary lymphadenectomy, and achieved good cosmetic and oncologic results.     

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。     

Plastic surgery of the breast

The authors divide the techniques of reduction mammoplasty into two groups. The first one is done by the so-called classical method in which the two important pedicles—th medial (internal mammary artery) and the lateral (lateral thoracic artery)—are preserved. The second one is made through the free transplant of the areolar, chiefly in those cases of large hypertrophic breasts. Both methods give good results in experienced and skillful hands, as well as good satisfaction to the majority of our patients. On the other hand, complications may arise, as in every field of plastic surgery.     

Predicting breast reduction weight using the mass of breast ptosis

BACKGROUND:

The preoperative prediction of therapeutic breast reduction weights, to achieve both relief of breast weight symptoms and yet achieve excellent breast shape, remains a challenge.

OBJECTIVES:

To design a simple clinical method to preoperatively predict and quantify therapeutic breast reduction weights.

METHODS:

In 31 women who underwent therapeutic bilateral reduction mammaplasty, the mass of the hypertrophic breast hanging below the inframammary fold was preoperatively weighed and then compared with the mass of the reduction specimen. Thirty patients underwent breast reduction using a superomedial nipple-areolar pedicle. Postoperative breast weight-related symptoms and breast shape findings were then noted. Statistical analysis relied on mean, SD, sample size, Mann-Whitney test for medians, Levene’s test for variances and regression analysis.

RESULTS:

The average clinical follow-up was 160 days, with all patients achieving satisfactory breast size and shape from both the patient and surgeon’s perspectives. All patients reported improvement of back pain, shoulder pain and lower neck pain. Two breasts developed delayed healing of the lateral skin flap, necessitating debridement and reclosure, followed by uneventful ongoing healing. There was no significant difference in preoperative ptotic breast mass and resectional breast mass (all P>0.05).

CONCLUSIONS:

Simple preoperative weighing of the ptotic portion of the hypertrophic breast can serve as a goal for the reduction weight, while creating pleasing breast proportions and improving breast weight-related symptoms. Preoperative quantification of the ptotic breast mass may guide the reduction technique and assist insurance precertification efforts.     

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。     

Diagnosis of breast tumors after breast reduction

We conducted a retrospective study to evaluate the diagnosability of breast tumors after breast reductions as this is a frequent surgical procedure. The data should shed light on the hypothesis that routine screening methods concerning the diagnosis of breast tumors prove more difficult after breast operations. All women who had undergone breast reduction at our department between January 1989 and December 1994 were examined. During this period we counted 166 patients; the majority of them (n = 144) had undergone a bilateral breast reduction and the rest of them (n = 22) a unilateral breast reduction for various reasons. After the operation, all patients were checked in standardized intervals. Those who developed any kind of breast mass (n = 6) were recorded and examined by ultrasound and mammography, and occasionally by an additional fine-needle biopsy. In case any doubt about the dignity had remained, an excisional biopsy was carried out. In none of our patients was it possible to get a precise diagnosis of an ill-defined mass with ultrasound. With mammography, some of the existing masses, which were really scars, mimicked different kinds of tumors, and once a carcinoma was initially interpreted as scar tissue with oil cysts. The diagnosis of breast masses after breast reductions with routinely used screening methods has proved to be more difficult as breast reductions lead to architectural alterations of the remaining breast parenchyma. Such alterations can and should be documented shortly after the operation so that later occurring tumors are distinguished more easily. Therefore, a basic mammography 3 months after each breast reduction has to be claimed in order to facilitate further breast tumor diagnosis.     

Virtual 3-dimensional modeling as a valuable adjunct to aesthetic and reconstructive breast surgery

Three-dimensional (3D) imaging technology currently is used by various commercial industries as a method for analyzing objects and shapes. Recent work from our group and others offer data to support the use of 3D imaging as a valuable tool in aesthetic and reconstructive breast surgery. We have developed a system for creating 3D breast models that provides clinical data that can help guide surgical management. With 3D breast models, surgeons are able to visually assess the size, shape, contour, and symmetry of the breast, as well as obtain quantitative breast measurements and volumetric calculations. Three-dimensional imaging may be applied to various plastic surgery procedures including breast reconstruction with implant/tissue expanders, local flap reconstruction, free-flap reconstruction, breast augmentation, and breast reduction surgery. The novel application of 3D imaging in these settings represents a significant advance from traditional approaches to aesthetic and reconstructive breast surgery in which surgical procedures are based on 2-dimensional photographs and visual size estimates.     

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目的 探讨乳腺癌保乳综合治疗的原则及近期疗效。方法 82例各期乳腺癌病例施保乳手术（局部乳腺切除 腋淋巴结清扫术）、术中或术后瘤床插植近距放疗 化疗。手术后2-4周再接受全乳腺外照射剂量为50Gy。激素受体阳性的病人均接受三苯氧胺治疗,随访时间中位数为42个月。结果 82例全部存活,无一例出现局部复发。1例出现骨转移。双乳对称。外形美观,其中1例为双侧乳癌,两侧病理类型不同,均做保乳手术。结论 早期乳腺癌病人接受保乳综合治疗可以取得满意的临床效果。可成为早期乳腺癌的首选治疗方法。     

Acellular dermal matrices: Use in reconstructive and aesthetic breast surgery

Acellular dermal matrices (ADMs) were first described for use in breast surgery in 2001. Since this initial report, ADMs have become an increasingly common component of implant-based breast procedures. ADMs have shown promise for use in both aesthetic and reconstructive breast surgery; however, concerns about their use remain because of the significant costs associated with these products. The present article reviews the history of ADM use in breast surgery and the outcomes reported to date. Common techniques for placement of ADMs in aesthetic revisionary and breast reconstruction surgery are provided, and use in the setting of chest wall irradiation and capsular contracture is discussed. Finally, the authors comment on the cost implications of these products in the Canadian and American health care systems.     

双环真皮单蒂缩乳术治疗男性乳房发育症

目的：探讨双环真皮单蒂缩乳术治疗男性乳房发育症的疗效。方法：5年来采用双环形切口,乳头乳晕外上真皮单蒂法治疗男性乳房发育症,共10例,20侧乳房。结果：每侧乳房切除150～500g组织,除1例一侧乳房出现乳晕部分坏死外,余胸部形态美观,感觉恢复,效果满意,随访2～50个月,效果较为满意。结论：双环真皮单蒂缩乳术治疗男性乳房发育症,操作简便,安全,并发症少,术后胸部形态美观,值得推荐。     

Equatorial breast reduction: A new technique for the correction of moderate-to-large mammary hypertrophy

The author describes a personal technique for moderate-to-large breast hypertrophy, regardless of the degree of ptosis, based upon a personal experience of more than 200 breast reductions. It is a superior monopedicle nipple-areola flap procedure, which leaves an inverted-T scar. It was used in 35 cases over the last 3 years involving tissue reductions ranging from 500 to 1950 g per gland. All patients underwent follow-up evaluations 1, 3, 6, and 12 months after surgery. No complications were observed, and areolar sensation was preserved in all cases. Apart from its effectiveness in cases of massive hypertrophy and the absence of difficulties related to elevation of the nipple-areola complex, the equatorial technique offers the significant advantages of a simple preoperative marking phase and well-defined, reproducible parameters for reduction and reshaping. These characteristics reduce the need for subjective judgment and, therefore, the risk of error. The results obtained are highly satisfactory in terms of volume reduction, form, and symmetry.     

早期乳腺癌保留乳房手术62例疗效评价

目的探讨早期乳腺癌保留乳房手术治疗疗效。方法回顾性分析1996～2004年经治的62例早期乳腺癌实施保乳手术治疗疗效。结果全部病人手术过程顺利,近期乳房外形保持良好。术后随访1～8年(平均2年),无局部复发、远处转移和死亡病例。无放疗后合并症。结论保乳手术治疗早期乳癌的近、远期疗效满意。术前严格掌握手术适应证,术后规范的综合治疗,是保乳手术获得良好疗效的保证。     

影响乳腺癌患者保乳手术边缘阳性因素的临床研究

目的探讨乳腺癌的临床病理学特征对保乳手术边缘阳性的影响。方法189例预行保乳手术术(BCT)的原发性乳腺癌患者,分析她们的临床特征(年龄,活检类型)和病理学特征(肿瘤大小,组织学类型,激素受体状态,HER2状态,和腋窝淋巴结状态)与阳性手术边缘的关系。结果189例患者中本组室心针肿脾物案例活检确诊79例,门诊或手术中切除活检确诊128例。61例手术边缘阳性(32.3%)。结论本研究的结果揭示:肿瘤直径大于2cm,腋窝淋巴结阳性PR阳性和年龄小于50岁是乳癌保乳手术边缘阳性的高危因素对1999年1月～2004年7月189例乳腺癌患者按受保乳手术进行回顾性分析,并总结手术切口边保阳性与临床特征病理案组但表现及激素受体状态的关系。     

Transaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery

BACKGROUND: Endoscopic surgery for inner-side breast cancer usually is performed by periareolar approach, but leaves deformation or malposition, and sensory disturbance. We devised an approach of retromammary route without subcutaneous removal, from an axillary skin incision, to treat distant cancers and also to preserve sensation to skin touch. METHODS: We have performed video-assisted breast surgery on 230 patients. The transaxillary retromammary-route approach was performed on 20 patients with early breast cancer. From a 2.5-cm axillary incision, we dissected the major pectoral muscle fascia to detach retromammary tissue. We cut the proximal side of the gland vertically, and dissected the skin flap over the tumor by the tunnel method. Then we cut each side of the gland vertically and removed it through the axillary port. RESULTS: All surgical margins were negative. The surgical time was 45 minutes longer than the conventional video-assisted breast surgery. The postoperative esthetic results were good. CONCLUSIONS: The transaxillary retromammary-route approach leaves no injury on whole breast, and can become a single standard method for breast-conserving surgery wherever a cancer is situated.     

Incidence of abnormal mammograms after reduction mammoplasty: implications for oncoplastic closure

Background

Reduction mammoplasty requires significant tissue dissection, which may impact the interpretation of future mammograms used in breast cancer surveillance. The aim of this study was to define the incidence of abnormal mammography after reduction mammoplasty and to assess the impact of substantial tissue remodeling on interpreting mammography.

Methods

We conducted a single-center retrospective case-control study examining results of postoperative mammography after reduction mammoplasty over a 5-year period.

Results

Between 2001 and 2005, 87 patients underwent breast reduction and had available postoperative mammography. A control group of 30 patients were identified who underwent consultation for breast reduction but did not have surgery. The median time to postoperative mammography was 52 weeks. The incidence of abnormal first postoperative mammogram (Breast Imaging-Reporting and Data System [BIRADS] 0, 3–6) was not significantly different between reduction mammoplasty patients and controls (n = 23, 26% vs 8, 27%, respectively, P = 1.00). Age, postoperative complications, tissue pathology, history of previous breast biopsy, and abnormal preoperative mammography did not significantly predict abnormal postoperative mammogram. Postoperative mammography led to additional imaging in 20 patients (23%) and breast biopsy in 1 patient (1.1%).

Conclusions

Despite the substantial tissue mobilization performed during reduction mammoplasty, postoperative screening mammography does not lead to significantly more imaging or diagnostic interventions when compared with nonoperative controls. This small case-control study suggests that oncoplastic closure techniques should not adversely impact subsequent mammography.     

The principles of the up-to-date breast reduction

In all cases of moderate- to high-grade hypertrophy of the breast, with or without ptosis, the author emphasizes that the reduction mammaplasty with L-shaped suture lines proves to be an effective method that avoids unacceptable scars extending to the midline of the thorax, especially in the young patient.     

Secrets of the full pedicle in breast reduction surgery]

Based on his experience of 1,500 bilateral reduction mammaplasties using the total dermoglandular pedicle technique, the author defines the particular features of this operation. He briefly summarises the various steps of the technique and reviews the essential points by analysing them, comparing them and giving useful tips.