经乳晕上切口矫正轻度下垂乳房的隆乳术

目的一次性完成隆乳并矫正乳房轻度下垂.方法经乳晕上切口切除半月形皮肤,不切开乳腺置入乳房假体,将乳腺组织上移悬吊固定于胸大肌深筋膜.结果 23例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好,乳晕切口瘢痕不明显,乳头感觉及勃起正常.结论该方法隆乳同时矫正下垂乳房效果可靠稳定,创伤小,止血彻底,瘢痕不明显.     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的 一次性完成隆乳并矫正乳房轻度下垂。方法 经乳晕上切口切除半月形皮肤，不切开乳腺置入乳房假体，将乳腺组织上移悬吊固定于胸大肌深筋膜。结果 23例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好，乳晕切口瘢痕不明显，乳头感觉及勃起正常，结论 该方法隆乳同时矫正下垂乳房效果可靠稳定，创伤小，止血彻底，瘢痕不明显。     

硅胶假体隆乳术矫正乳腺萎缩伴轻度下垂

目的:一次性完成隆乳并同时矫正乳房轻度下垂。方法:经腋窝切口将乳房假体置入胸大肌后间隙。结果:28例乳腺萎缩伴乳房轻度下垂患者术后乳房及乳头形态位置良好,乳头感觉及勃起正常。结论:经腋窝切口隆乳术能同时矫正下垂乳房,创伤小,瘢痕隐蔽,效果稳定可靠。     

乳晕切口手术治疗乳房轻度下垂并乳腺良性肿物

目的:探讨通过乳晕切口既矫正乳房轻度下垂,又摘除乳腺良性肿物的手术方式。方法:对正常体积的轻度乳房下垂,选择乳晕旁月牙形或双环形切口,采用真皮帽技术,矫正乳房下垂。其间,对患有乳腺良性肿物者,在相应部位皮下,沿大乳腺管走向潜行剥离至肿物的上方,再切除肿物。结果:对56例患者随访6~18个月,乳房挺拔、丰满,感觉良好,切口瘢痕不明显。结论:经乳晕切口手术治疗轻度乳房下垂并乳腺良性肿物,乳房下垂得以矫正,乳腺良性肿物完全切除,形态和位置改善,乳头感觉和勃起正常,不明显的切口瘢痕在新的乳晕边缘隐蔽良好。     

兼顾矫正乳房中度下垂的隆乳术

目的：探讨应用乳晕周围双环切口隆乳同时悬吊乳房,矫正小乳症伴中度乳房下垂的方法。方法：采用乳晕周围双环形切口,在乳腺的上半象限纵行切开,按胸大肌纤维走向钝性分离至胸大肌后形成间隙,置入乳房假体。用4号丝线将切开的乳腺组织与胸大肌分离口两侧贯穿预缝置4针,打结闭合胸大肌分离口的同时将乳腺固定于胸大肌上,上部乳腺组织筋膜同时缝合固定在肋软骨膜上,以达到隆乳术同时矫正乳房下垂。结果：用本法矫正小乳症伴中度乳房下垂者26例,效果良好。结论：本手术方法简单易行,无须附加乳晕周围以外切口,瘢痕不明显,是矫正小乳症伴中度下垂的一种较好方法。     

应用乳腺旋转瓣固定矫正轻中度乳房下垂

目的:介绍采用乳房外下象限乳腺旋转瓣固定矫正轻中度乳房下垂的方法和经验。方法:经乳晕周缘"双环形"切口,去除内外环之间的表皮。在皮下脂肪组织与腺体之间广泛分离。在乳房下方正中垂直剖开乳腺,并向外侧分离,形成乳房外下象限乳腺瓣,并向内上方旋转固定,缩小乳房基底,重塑乳房外形,并上提下垂的乳头乳晕复合体。伴有明显乳腺萎缩者,同期或Ⅱ期行胸大肌下假体隆乳术。结果:2011年2月~2013年12月采用该方法共治疗轻中度乳房下垂19例,无血肿、感染、乳头乳晕坏死等并发症发生,术后随访1~2年,无乳房下垂复发,乳房下垂明显矫正,双乳对称,外形良好。切口瘢痕呈环线状,乳头乳晕感觉功能正常。结论:乳腺旋转瓣固定法结合了"双环法"和"垂直法"两种技术的优势,对轻中度乳房下垂的治疗,提供了一种新的思路和方法。     

改良的适应松垂小乳征的隆乳术

本文报告适应松垂小乳征的隆乳术具有隆乳和垂乳悬吊的双重美容效果。在不需增加附加切口条件下，利用乳晕切口之忧点，将切口位置改在乳晕内上方，既不影响隆乳手术操作，又便于同步进行垂乳悬吊，也可在切口上方切除一块半月形松弛皮肤。术中将乳晕边缘深层乳腺上提与胸大肌筋膜缝合固定，可起到矫正乳房下垂的目的。本术式弥补了以往松垂小乳征在隆乳术后可能出现的双层乳房、乳头下垂、乳房过低等并发症。     

乳晕切口法解剖型假体隆乳术治疗轻度乳房下垂

目的探讨应用解剖型假体(又称泪滴型假体)隆乳术矫正轻度乳房下垂的可行性及临床效果。方法术前依据原乳房三维形态,测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据,以确定所需采用的假体类型、容量及下垂乳房下皱襞距离,选用乳晕切口对36例轻度乳房下垂者应用麦格410解剖型假体行隆乳术。结果全部隆乳者术后乳房挺拔,下垂基本得到矫正,受术者均表满意。结论应用解剖型假体的隆乳术是目前矫正有增大乳房容积愿望的轻度乳房下垂者的最佳选择之一。     

经乳晕切口双平面隆乳术

乳房轻度下垂可通过硅凝胶假体置入乳腺后间隙予以矫正,但对乳房下垂伴皮肤、皮下组织及乳腺组织匮乏或胸大肌发达者,前者假体的被覆组织较薄,可能触及假体;后者则假体与被覆组织(皮肤皮下组织及胸大肌)很难融为一体,无法有效矫正乳房下垂,易形成乳房上部隆起而下部依然下垂的"双泡"畸形.为有效矫正上述畸形,我们曾采用联合切口(腋窝横皱襞切口联合乳房下皱襞小切口)双平面隆乳[1],但因部分患者不愿接受双切口,为此我们改用经乳晕切口双平面隆乳.自2003年以来,我们先后完成10例手术,取得良好的手术效果.     

经乳晕切口双平面隆乳术

乳房轻度下垂可通过硅凝胶假体置入乳腺后间隙予以矫正,但对乳房下垂伴皮肤、皮下组织及乳腺组织匮乏或胸大肌发达者,前者假体的被覆组织较薄,可能触及假体;后者则假体与被覆组织(皮肤皮下组织及胸大肌)很难融为一体,无法有效矫正乳房下垂,易形成乳房上部隆起而下部依然下垂的"双泡"畸形.为有效矫正上述畸形,我们曾采用联合切口(腋窝横皱襞切口联合乳房下皱襞小切口)双平面隆乳[1],但因部分患者不愿接受双切口,为此我们改用经乳晕切口双平面隆乳.自2003年以来,我们先后完成10例手术,取得良好的手术效果.     

Submuscular Periareolar Approach to Augmentation Mammoplasty in Korean Women

Augmentation mammoplasty can be approached by various methods according to the type of implant and implantation site depending on the status of the patient or surgeon's preference. The advantage for submuscular placement is based on problems associated with subglandular placement, especially capsular contracture and sensory changes in the nipple, and interference with the interpretation of mammograms is avoided. There are fewer complications such as hematoma, infection, and extrusion of the implant with submuscular dissection and relatively avascular, minimal sensory changes in the nipple compared with subglandular approach. The submuscular periareolar approach to augmentation mammoplasty was first described in the 1970s. This approach provides easy access to both the subglandular and subpectoral planes. It also provides a central point of access for creation of the implant pocket, which allows for easier and more accurate dissection in all diameters. The resultant periareolar scar is usually minimal with less injury to breast parenchyme and eventual biopsy or mastectomy incision to be performed through or around the areola. During the period of March 1999 to January 2000, 19 cases of who received submuscular periareolar augmentation mammoplasty under general anesthesia resulted in favorable scars with accurate access to pocket margin, easier dissection, and less bleeding compared with submuscular transaxillary augmentation mammoplasty. In our experience with the submuscular periareolar approach to breast augmentation it was highly versatile, safe, and less painful; postoperative hematoma incidence was greatly reduced and breast tissue injury was minimized.     

双平面法隆乳术切口与入路的改进

目的:探讨双平面法隆乳术手术切口及入路的选择。方法:由2008年1月～2009年6月期间应用经乳晕中线垂直切口行双平面法双侧隆乳术28例,术中于乳腺上极垂直切开乳腺腺体,沿胸大肌肌纤维方向分离并部分离断胸大肌起点,将假体下半部分置于乳腺后间隙,上半部分置于胸大肌后间隙。结果:28例患者随访3～6个月,术后恢复良好,切口愈合好,瘢痕隐蔽。结论:应用乳晕中线切口,纵行剖开乳腺腺体上极并沿胸大肌方向分离并离断部分胸大肌进行双平面法硅凝胶假体植入隆乳术,术野清晰,解剖层次显露好。为一种较好的手术方法。     

一种乳房体积测量器及其在隆乳术中应用

目的:设计一种乳房体积测量器,对其在隆乳术中的应用进行评价和探讨。方法:设计并自制乳房体积测量器,对隆乳的患者进行测量和计算,选择合适容积的乳房假体行隆乳术。结果:本组52例,41例乳房对称者,隆乳术后效果好;11例乳房不对称者,其中,8例术后乳房对称,效果好,2例有细小差异,1例因假体型号(直径和凸度)选择不当,术后乳房体积接近但直径和高度存在差别。结论:本乳房体积测量器准确合理、方便快捷,在隆乳术中对乳房假体容积的选择具有指导意义。     

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...     

Combining muscle-splitting biplane with multilayer capsulorrhaphy for the correction of bottoming down following subglandular augmentation

Implant malplacement is the second most common reason for revision and bottoming down is the most common presentation of implant malplacement. Submuscular biplane relocation was combined with capsulotomies and multilayer capsulorrhaphy when bottoming down was seen following subglandular breast augmentation. Between 2005 and 2009, bottoming down following subglandular mammoplasty was seen in 41 breasts (19 bilateral and three unilateral). Of the 19 patients, 12 had downward transgression of inframammary crease (IMC) alone; this also included a patient with vertical scar mastopexy. Two patients had multiplane malplacements where bottoming down was associated with lateral displacement (telemastia) in one and medial displacement (symmastia) in the other. Two had simultaneous downward transgression of the IMC and nipple areolar complex (NAC) and three had bottoming down with capsular contracture independent of NAC descent. Follow-up of up to 3 1/2 years showed stable IMC and NAC relationship with acceptable results. Dog ear revision was required in one patient when IMC relocation was accompanied with vertical scar mastopexy and one patient needed revision for further relocation and improvement of symmastia. No wound breakdown or periprosthetic infection was seen in their series. Multilayer capsulorrhaphy with submuscular biplane repositioning of implants is a suitable option to correct bottoming down following subglandular augmentation.     

Mammoplasty with an L-shaped limited scar and retropectoral dermopexy

In mammoplasty the goal of the surgeon is giving the breast new form and volume and good, durable shape with minimal scarring. This article presents a simple technique of reduction mammoplasty that avoids incisions in the so-called hypertrophic areas of the chest, the medial and the lateral extremities of the submammary fold. The technique is based on nipple transposition on a superior semicircular flap in the new predetermined side, supra-areolar dermopexy. The skin of the inferior pole of the breast is internally de-epithelized to two curvilinear incisions that end near the projection of the anterior axillary line to form an inferior dermal flap for retropectoral dermopexy. The limited residual scar is L-shaped. Ptotic and hypertrophic breasts can be treated with this method.     

应用改进的下蒂瓣乳房缩小术（附24例报告）

乳房缩小术可解除巨乳患者的各种烦恼，缓解症状恢复形体美，１９９７年以来应用改进的下蒂瓣法为２４例患者施行乳房缩小术，具体方法是画出锁骨中点与乳头的连线，新乳头位置定在连线上第四肋骨间隙处，乳晕直径３～５ｃｍ，下蒂瓣宽度较原设计方法增加，为１２～１４ｃｍ，手术时去除新乳晕区表皮，形成下蒂瓣，切除过多皮肤、脂肪及乳腺组织，如疑有乳腺病变可将乳腺腺体全部切除，重新固定乳头乳晕于新乳晕区，缝合乳房下皱襞切口。２４例轧头乳晕均成活良好，外形满意。双乳头平均上移１６．５ｃｍ，切除组织平均１２８８ｇ。随访时间最长３年，最短６个月，乳房大小与原设计基本相符，巨乳所致胸椎前倾、颈背疼、乳痛症消失，乳头感觉及勃起功能良好。由此认为改进的下蒂瓣法，不仅设计灵活，操作简易，且与其他术式相比无垂直瘢痕，切口均在乳晕缘和下皱襞上等。值得推广。     

Reduction mammoplasty using a modified "B" shape method

This article presents a technique of reduction mammoplasty that is modified from the "B" operation for breast reduction devised by Dr Regnault. The overall excision line resembles the letter "B". The advantages of this technique are as followings: 1. It avoids incision in the so-called hypertrophic areas of the chest. 2. The patient has only a short curved scar (the medial horizontal branch of classic inverted-T incision is eliminated) that is not visible laterally. 3. Because there is no skin undermining, and the nipple is transposed on a upper semicircular dermal flap, so the blood supply of the nipple and areola is very good. 4. Ptotic and hypertrophic breasts can be treated with this method. 5. The resulting shape of the breast was satisfactory.     

硅凝胶乳房假体隆乳的临床应用体会

目的：探讨硅凝胶乳房假体置入隆乳术的临床疗效。方法：依据测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据确定选用的假体类型、容量;采用腋窝切口或乳晕切口,将假体置于胸大肌深面或浅面。结果：统计我科自2010年5月至2011年12月采用国产硅凝胶毛面假体隆乳术122例,其中置于胸大肌深面68例、置于浅面54例,术后随访3个月至1年,所有患者乳房外形逼真,手感真实柔软,出现轻度包膜挛缩1例,未见感染、血肿及假体扭曲等并发症。结论：硅凝胶乳房假体与身体组织相容性好,适当的手术方法及术后处理可明显降低包膜挛缩率。