外侧上蒂式旋转乳房缩小成形术

目的:对女性巨乳症患者,采用一种矫正新术式,以达到乳房外形更加谐调完美的效果。方法:从1989年至2004年对26例52只女性巨乳症者,应用外侧上蒂式旋转乳房缩小成形术治疗。结果:术后随访26例患者6月至2年,乳房肥大下垂得到理想矫正,乳头勃起功能正常,未出现乳头乳晕感觉异常,切口瘢痕隐蔽不明显,整体外形美观。结论:通过该术式治疗实践,该法简单灵活、安全可靠、术后功能和形态满意。     

乳房缩小成形术几个热点问题浅析

整形外科是美丽与血运之间的持久战争。乳房缩小成形术的发展即是对此最好地阐释。 1乳房缩小成形术的发展历史 乳房缩小成形术始于1731年，早期以缩小乳房体积为主要目的，随着解剖学研究的不断深入，乳房缩小成形技术不断改良完善，至20世纪80年代逐渐成熟，     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上，设计了以乳腺基底部的腺体组织为蒂携带乳头，乳晕移位的乳房缩小整形术。通过１０例２０只乳房的临床应用，取得了满意效果。     

双环行切口乳房缩小整形术

我们在对各种经典的乳房缩小整形术进行研究的基础上，自行设计出双环形切口的乳房缩小整形术．并在手木方法上进行了一些改进，形成了本手术方法的五个特点。通过３７例７２只乳房的治疗实践，证明效果良好，尤其适用于中、重度乳房肥大的治疗。     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上,设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过10例20只乳房的临床应用,取得了满意效果。     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上，设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过１０例２０只乳房的临床应用，取得了满意效果。     

乳房缩小成形术进展

乳房肥大及下垂造成形态臃肿，行动不便，肩背酸痛，平卧时胸部有受压及窘迫感，天气炎热季节时，乳房下皱襞区易出现湿疹等皮肤病；同时，女性失去了匀称、苗条的曲线美轮廓，在身体和心理上造成双重负担，常使女性失去自信。为了从形态和功能上修复，从20世纪初开始，整形外科医生不断探索，开展了各种形式的乳房缩小成形手术，但是，传统     

改良Biesenberger乳房缩小整形术

乳房缩小整形术常用方法很多，效果均较为满意，但困扰着人们的是常留有较为明显的手术瘢痕。为了探求一种瘢痕隐蔽、塑形良好的手术方法，我们对古老的Ｂｉｅｓｅｎｂｅｒｇｅｒ乳房缩小整形术式加以改进：在保留乳房内侧双重血供的情况下，皮下广泛游离，直视下进行乳腺塑形，操作便捷；乳腺组织外上象限切除，切除了肿瘤好发部位，切除量达１／４￣１／３，切除量大；游离乳腺下瓣旋转上移塑形，双“Ｓ”形吻合，塑形灵活，乳腺组     

The advantages of a lower central breast segment in reduction mammaplasty

A method is described, which achieves reduction in the size of the breast and allows determination of breast shape, without the distortion of breast tissue and the production of unfavorable postoperative connective tissue tensions, inherent in most currently used techniques. Aesthetically pleasing breasts can be produced more consistently by a sculptural rather than an origami-like approach.     

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。     

The role of reduction mammaplasty in oncology

Background: A procedure to achieve symmetry is required in almost 50% of the cases of breast reconstruction and provides an opportunity to explore the second breast and eventually to remove any area which is suspect. The various techniques available for the symmetry procedure should be discussed according to the breast exploration required. This study analyzes the different types of reduction mammaplasty (RM) techniques, the histology and localization of contralateral tumors which allow the plastic surgeon to diagnose occult breast cancer more accurately.Method: From 1978 to 1993, 1814 patients with breast cancer underwent a mastectomy with breast reconstruction at the Gustave-Roussy Institute. A contralateral RM to achieve symmetry was performed in 440 patients.Results: Twenty (4.5%) clinically and radiologically occult breast cancers were found among the contralateral RM specimens. The relationship between the type of RM technique and incidence of occult breast cancer was not significant: 16 cases of occult breast carcinomas in 305 RM with supra-areolar pedicle and four cases from 135 RM with infra-areolar pedicle (Fisher exactp=0.21).Conclusion: Close collaboration between plastic surgeon and oncologist is required while performing a breast reconstruction in order to take advantage of the surgery of the second breast to explore the gland and to remove occult carcinomas in approximately 5% of cases. The choice of RM procedure depends usually on the shape of the breast and often the personal preference of the surgeon but this should also be planned according to the glandular area to be explored. There results underline the absolute necessity of histological examination of all the specimens removed in all kinds of breast reduction also when it is performed for purely aesthetic reasons.     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术。方法用双环形切口，保留乳头乳晕深动脉和乳房下限的组织，对肥大的乳房进行缩小和重新塑形。结果23例惠者的乳头乳晕均无坏死，感觉良好，乳房形态自然。结论本手术设计简单，操作容易，术后瘢痕隐蔽，效果稳定，是修复各种肥大或下垂乳房的较好方法。     

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。     

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.     

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.     

双环中央蒂乳房缩小成形术的加网或外侧附加切口技术并发症的特点和适应证

目的 比较双环中央蒂乳房缩小成形术中加网和外侧附加切口的并发症，分析其产生的原因，以避免或减少并发症的发生。方法 回顾2003年8月至2006年5月收治的58例乳房缩小成形术，比较两种方法发生的并发症，包括：感染、血肿、脂肪液化、乳头乳晕血运障碍、皮肤坏死、切口愈合不良、切口瘢痕明显、网片折叠、双侧乳房不对称、缩小程度不足等。结果 加网组19例，发生并发症者6例，其中4例早期并发症患者平均切除腺体重276g；无网也无外侧附加切口3例，无并发症。附加切口组36例，发生并发症者7例（19．4％），其中5例早期并发症患者平均切除腺体重1008g。结论 加网组的并发症主要与网片有关，而附加切口组的并发症与乳房过大、切除腺体多、影响保留的腺体血供有关，改进网片材质和编织工艺、调整网片张力、避免用于表面皮肤过薄的患者，可以减少加网组的并发症。巨大乳房不宜选用双环中央蒂乳房缩小成形术的附加切口法或双环法。