Reduction mammoplasty by the central pedicle,avoiding a vertical scar

Reduction of the macromamma that causes posture malformations, neck and back pain, and psychological problems is very important. I performed the technique on 13 patients whose ages ranged between 17 and 60 years during 1990 and 1993. I observed no complications in the controls. To obtain a better result in reduction mammoplasty, I use a technique that can be performed on patients of any age, without causing any problems in vascularization, sensitivity, and lactation, and that avoids the vertical scar.     

Reduction mammoplasty with the short submammary scar (S-S-S) technique

Since its introduction, reduction mammoplasty has undergone a process of evolution and improvement that affects its three surgical goals: (1) safe transposition of the nipple-areola complex, (2) sufficient reduction of volume, and (3) aesthetically acceptable results. Unfortunately, most reduction mammoplasty techniques still result in a long transverse scar on the chest wall which often presents a problem, particularly a hypertrophic condition. In 1957 Arie proposed a vertical scar technique for mastopexy; recently Lassus, Marchac, Peixoto, d'Angieri Basile, and others reported their original methods that try to reduce the length of the transverse scar. We modified these previously proposed techniques and present our experiences with a reduction mammoplasty called the short submammary scar (S-S-S) technique.     

乳腺中心蒂乳房肥大缩小术

目的 探寻一种保证乳房肥大缩小手术后乳头乳晕的良好血运和感觉及哺乳功能、并减少手术并发症的术式。方法 选择乳头乳晕深部中心区的乳腺组织做乳头乳晕蒂，蒂中包含支配乳头乳晕的乳腺中央支血管、感觉神经，术中一直可观察到刺激乳头后的勃起反应，并使中心区保留的乳腺组织与乳头间有输乳管相连，以保留该部的哺乳功能。术中切除多余的乳腺及相应脂肪组织，缩小后的乳房容易塑形。结果 自1996年开展此项手术以来，共已完成17例，无1例发生乳头乳晕的并发症，感觉正常，并有1例曾经历哺乳。结论 乳腺中心蒂乳房肥大缩小术，不但可以保证乳头乳晕的血运，而且可避免对感觉神经的损伤，保留部分哺乳功能，并获得良好形态。     

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。     

内上腺体蒂乳房缩小成形术

目的 探讨一种能够保持乳房功能和形成良好外观的乳房缩小成形术。方法 根据乳房肥大的程度设计不同类型的皮肤切口，采用内上腺体蒂技术，切除外上方和下方过多的乳腺组织，将保留的乳腺组织重新塑形，切除多余的皮肤后缝合切口。结果 本组36例72侧乳房术后形态良好，无并发症，乳头乳晕感觉良好，效果满意。结论 内上腺体蒂技术是一种安全、有效的手术方法，能获得持久的塑形效果，通过选择不同类型的皮肤切口可以适用于各种程度乳房肥大的矫治。     

外上侧真皮腺体蒂皮瓣缩乳术

目的　介绍一种适用于中、重度乳房肥大的矫正术。方法　采用包括乳头乳晕复合体的乳房外上真皮腺体蒂皮瓣 ,切除上、内、下方多余的乳腺组织 ;将真皮腺体皮瓣旋转、调整、固定、重新塑形 ,切除多余的皮肤后缝合切口。结果　本组 4例 8侧乳房 ,术后双乳对称 ,乳头乳晕感觉良好 ,随访病例中 1例婚育者有哺乳功能。结论　乳房外上真皮腺体蒂皮瓣缩乳术是一种能够保持乳房外观及功能的合理术式 ,适用于中、重度乳房肥大。     

双环中心蒂法乳房缩小术

目的 探讨双环中心蒂乳房缩小术矫治乳房肥大下垂的方法 和疗效.方法 采用环绕乳晕内、外的2个环形切口,形成以乳头为中心的中央真皮帽,楔形或双S形切除多余腺体组织,保留第4肋间神经走行的乳腺组织的完整性,塑形后用真皮帽固定塑形.自2009年4月至2012年5月,采取上述方法 治疗乳房肥大伴不同程度下垂患者12例(24侧).结果 本组患者12例,术后切口均Ⅰ期愈合,经随访3～24个月,乳房外形良好,瘢痕轻微,乳头-乳晕感觉良好.结论 双环中心蒂乳房缩小术设计、操作简单,术后可确保乳头-乳晕的血供和感觉,是矫治乳房肥大下垂的有效方法.     

中央腺体蒂法巨乳缩小成形术

目的 探讨中央腺体蒂法巨乳缩小成形术治疗乳房下垂及乳房肥大的疗效.方法 采用乳晕周围的双环形切口,去除两环之间表皮,形成真皮帽,在皮下沿腺体表面向四周分离达乳房基底部,去除多余腺体,形成能确保乳头乳晕血运的中央腺体带,固定真皮帽进行乳房塑形.结果 采用该法治疗轻、中、重度乳房肥大及下垂者共42例,术后形态美观持久,瘢痕轻,无乳头乳晕坏死.33例患者获6～24个月随访,效果满意.结论 中央腺体蒂法巨乳缩小成形术适合于轻、中、重度乳房肥大,为瘢痕轻微的巨乳缩小成形术式.     

Mckissock法与无垂直瘢痕下蒂瓣法行重度乳房肥大矫正的综合比较

目的：探讨应用Mckissock法及无垂直瘢痕的下蒂瓣法进行乳房缩小整形术的适应证、手术效果及优缺点进行对比分析。方法：2010年6月至2011年7月,我们采用Mckissock法与无垂直瘢痕的下蒂瓣法行乳房缩小整形术15例,术后患者就症状改善,外形改善,瘢痕,乳头敏感性及总体满意度进行问卷调查。结果：①15例患者术后乳房形态及乳头乳晕均较对称且外观良好;②无垂直瘢痕的下蒂瓣法较Mckissock法术后并发症发生率少,瘢痕隐蔽;③两种方法术后发生乳头乳晕血运障碍及感觉障碍无明显差异;④Mckissock法较无垂直瘢痕的下蒂瓣法切除乳腺的量稍多,术后乳房立体感良好;⑤无垂直瘢痕的下蒂瓣法较Mckissock法总体满意度高。结论：无垂直瘢痕的下蒂法及Mckissock法均适用于治疗中、重度乳房肥大症尤其对于重度乳房肥大症两种方法对乳房形态的重塑较好,总体来讲无垂直瘢痕的下蒂法术后瘢痕小且隐蔽而Mckissock法切除乳腺组织量多,两种方法各有利弊具体临床应用需要个体化分析。     

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.     

颈浅动脉薄皮瓣修复颌颈部瘢痕

为解决颌颈部瘢痕的功能和外观问题，１９９０年以来应用窄蒂颈浅动脉薄皮瓣修复１３例。皮瓣最大面积２２ｃｍ×１０ｃｍ，蒂宽３～５ｃｍ。断蒂时间７～１０天。１例皮瓣远端１／３坏死，２例远端早期出现水泡，３～５天后渐转红润，其余均成活良好。随访半年至２年，外形良好。该皮瓣与颌颈部色泽相近，蒂窄，穿支较恒定，供瓣面积大，供区隐蔽，皮瓣修薄后减少对蒂部血供依赖性，断蒂早，缩短疗程。笔者认为该皮瓣是颌颈部缺损修复较理想的方法     

下蒂瓣法乳房缩小整形术的效果

目的:探讨下蒂瓣法乳房缩小整形术治疗中重度乳房肥大症的方法及效果。方法:2010年1月至2019年12月,南京医科大学附属妇产医院整形外科对19例女性患者(年龄18~54岁,平均36.2岁)38侧肥大乳房,以Robbins的垂直下蒂瓣术式为基础,结合乳房血供、神经等解剖学进展,进行乳晕设计、下蒂瓣位置等改进。结果:19...     

胸腰段短阶段椎弓根螺钉置钉位置不佳原因临床分析

目的: 分析临床应用胸腰段短阶段椎弓根螺钉出现置钉位置不佳的原因, 以提高手术成功率及手术效果。方法: 1995年 3月~2003年 8月行短阶段椎弓根螺钉固定治疗胸腰椎脊柱疾患 592例, 其中置钉位置不佳 22例, 通过临床检查、初次手术情况、X线片检查, 再次手术情况对置钉位置不佳的原因及对策进行分析。结果: 22例置钉位置不佳原因主要包括: (1) 解剖不熟悉所致 12例: 包括正常椎弓根变异; 骨折及退变时椎弓根变化而致进钉点掌握不当; (2) 手术技术掌握不够所致 10例: 包括进钉的深度和角度不当。结论: 应用短阶段椎弓根螺钉系统治疗胸腰椎疾患手术医师应术前仔细阅X线片, 熟悉椎弓根的局部解剖及手术技术。     

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。     

采用双蒂瘢痕组织皮瓣治疗关节部位的瘢痕挛缩畸形

目的：介绍双蒂瘢痕组织皮瓣治疗关节部位的瘢痕挛缩。方法：2004年10月～2007年初,利用双蒂瘢痕组织皮瓣共治疗了5例关节部位瘢痕组织挛缩畸形的患者,1例为肘关节,2例为腋窝,2例为膝关节,手术均在伤后半年以上进行。术后随访3个月～1年,平均随访时间为6个月。结果：对所有患者,术后效果都是可以接受的。双蒂瘢痕皮瓣的优点是手术简单,皮瓣坏死可能性低,肢体固定时间短,瘢痕挛缩复发的可能性低。结论：这种双蒂瘢痕组织皮瓣可作为关节部位瘢痕挛缩治疗的选择方法之一。     

Pericardial reconstruction using a pedicle flap of the diaphragmatic central tendon

A 46-year-old woman was referred to our hospital for further evaluation of an abnormal shadow on a chest X-ray. Chest computed tomography and magnetic resonance imaging revealed a lobulated tumor arising from the left lower lobe. At operation, the tumor tissue was found to have invaded the lingula and pericardium, involving the left phrenic nerve. Resection of the left lower lobe, lingula and pericar-dium including the phrenic nerve was performed for extended pulmonary malignancy. A pedicle flap of the diaphragmatic central tendon was used as a pericardial patch for pericardial reconstruction with satisfactory results. The patient’s postoperative course was uneventful. The postoperative histological diagnosis was pulmonary adenocarcinoma with sarcomatous elements [pT3N2M0]. At present, 43 months after the operation, the patient is receiving chemotherapy after having undergone cyberknife radiotherapy for brain metastasis of the tumor. The use of a pedicle diaphragmatic flap was effective in repairing a pericardial defect after extensive resection of pulmonary malignancy.     

皮下蒂瘢痕复合皮瓣乳头再造术

目的 利用乳癌术后再造乳房局部增生瘢痕在Ⅱ期修整术时行乳头再造.方法 形成携带5.0cm×1.0cm增生瘢痕及两个翼状三角瓣的皮下蒂随意皮瓣,使蒂在乳房非整复区域内,转位移植形成乳头.采用磨削法去除表皮及真皮乳头层形成乳晕.结果 共7例患者行皮下蒂瘢痕瓣乳头再造.其中5例全部成活,形态和色泽接近自然乳头;2例瘢痕瓣远端尖部坏死,修整后成形满意.1年随访,再造乳头体积萎缩1/3～1/2,5例效果满意,2例补充局部皮瓣后效果良好.结论 利用再造乳房切口瘢痕,采用皮下蒂瘢痕复合皮瓣法再造乳头方法可行,再造乳头质地及色泽接近自然乳头.     

Reduction mammoplasty by the total dermoglandular pedicle

The use of a total dermoglandular pedicle in 700 cases of reduction mammoplasty are described by this team of authors. They emphasize that their modification of the dermoglandular pedicle provides an extremely reliable blood supply to the areola and is quick and easy to perform. There is no anesthesia of the nipple postoperatively, and the shape of the breast is favorable both in the immediate postoperative period and over the longterm follow-up observation between the years 1979 and 1984.     

受区炎性疤痕吻合血管游离皮瓣移植术中的血管处理

目的探讨受区炎性疤痕吻合血管游离皮瓣移植术中的血管的正确判断和处理方法,提高游离皮瓣手术的成功率。方法受区炎性疤痕,需行游离皮瓣修复7例,其中桥式交叉吻合1例,血管移植3例,扩大清创至正常区域吻合3例。结果所有皮瓣均完全存活,未出现血管危象,术后功能恢复良好。结论受区慢性感染所致的炎性疤痕内的血管不可行血管吻合,吻合处应位于正常组织内,以提高皮瓣存活率,减少术后血管危象发生。