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。     

改良无垂直瘢痕下蒂瓣法乳房缩小成形术45例疗效分析

目的 探讨改良无垂直瘢痕下蒂瓣法治疗巨乳症的效果.方法 回顾性分析郑州大学第一附属医院整形外科2015-01—2019-12行无垂直瘢痕下蒂瓣法乳房缩小成形术的45例巨乳症患者的临床及随访资料.结果 术后随访3～39个月.末次随访,45例患者术后乳房形态综合评分为87.22(3.26)分,高于术前的54.82(5.35...     

垂直窄下蒂瓣乳房缩小整形术

采用Ariyan介绍的垂直窄下蒂瓣法，进行乳房缩小整形术8例，效果满意。本法避免了传统的双蒂法及上蒂法手术由于上蒂折叠造成的局部臃肿，乳头乳晕区静脉淤滞等缺点。     

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...     

环乳晕切口下蒂瓣法矫治巨大乳房

目的:探讨环乳晕切口下蒂瓣矫正特别巨大乳房的临床效果。方法:采取环乳晕切口,以部分去表皮的下蒂瓣为基础,切除乳头乳晕上方、外侧大部分腺体皮肤及内侧部分腺体皮肤组织,上提下蒂瓣,固定重塑乳房腺体形态,再将下蒂两侧的皮肤均匀拉拢,覆盖下蒂瓣,切除多余皮肤,使之形成不超过乳房下皱襞的斜形短切口,乳晕及周围的皮肤真皮层辐射状环缩缝合,缝合皮肤。结果:10例20只乳房,单侧乳房组织平均切除量为1 050g,最大2 200g。随访6~12个月,无乳头坏死、感觉良好,外形饱满。患者对乳房形态、对称性、乳晕大小形状、乳头乳晕感觉及切口瘢痕的满意率分别为100%。结论:环乳晕切口下蒂瓣的巨大乳房缩小整形术,组织切除量大,瘢痕短,并发症少,是一种较好的巨大乳房缩小术式。     

应用改进的下蒂瓣乳房缩小术

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，１９８７年以来应用改进的下蒂瓣法对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，新服民头位置定在连线上第四肋骨间隙处，服民晖直径３－５ｃｍ，下蒂瓣宽度较原设计方法增加，１２－１４ｃｍ，手术时去除新乳晕区表皮，形成下蒂瓣，切队过多皮肤，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，缝合乳房下皱臂     

垂直双蒂乳房缩小术中乳晕大小的计算方法

垂直双蒂乳房缩小整形术（Mckiswsock法）由Mckissock在1972年首先报告，我们通过十余年应用Mekissock法手术的临床实践，认为新乳晕的大小、形状直接决定着塑形后乳房的大小和形状。我们1993年起设计了较精确的计算新乳晕大小的方法，并运用此方法行垂直双蒂法乳房缩小术26例，取得了满意的效果。     

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。     

改进的Mckissock法治疗乳房巨大良性肿瘤

目的:探讨应用改进的Mcki ssock法治疗乳房巨大良性肿瘤的临床效果。方法:在传统Mcki ssock法的基础上加以改进,设计较宽大的垂直双蒂瓣,将传统术式中应切除的内、外侧皮瓣仅削除表皮,保留真皮脂肪组织,形成蒂于乳房下皱襞的真皮脂肪瓣并与垂直双蒂瓣一并充填肿瘤切除后腔隙,经塑形获得了较为满意的乳房形态。结果:11例乳房巨大良性肿瘤术后外观满意,无乳头乳晕坏死及其它并发症发生,随访6个月～5年未见瘤体复发。结论:改进的Mcki ssock法行乳房巨大良性肿瘤切除成形手术方法简便,术后乳房外观良好,并发症少,尤其适合于对侧乳房中、小体积者。     

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。     

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。     

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.     

巨乳缩小手术方式比较及相关并发症的处理

目的：探讨巨乳缩小手术的最佳术式及相关并发症的处理。方法：回顾1988年以来作者所在科室实施的56例巨乳缩小手术，总结其成功的经验，并对各种手术方式的优缺点进行了分析和比较，同时对各种并发症的处理提出了作者自己的意见。结果：本组56例受术者，包括8例发生并发症者，经治疗后，疗效均满意。结论：巨乳缩小手术要根据受术者具体的身体条件选择合适的手术方式；其主要并发症包括切口裂开、血肿形成、乳头乳晕坏死等，经对症处理可取得满意效果。     

Periareolar reduction mammaplasty utilizing the inferior dermal pedicle

The critical points which should not be overlooked when performing reduction mammaplasty are to minimize scar on the breast and to ensure a sufficient blood supply for the viability of the nipple–areolar complex. Periareolar reduction mammaplasty has been widely used because it left only one scar around the areola. However, with the typical periareolar reduction mammaplasty technique, it is difficult to remove a large amount of breast tissue and mobilize the remaining breast tissue. It may result in necrosis of the nipple–areolar complex in some cases. To overcome these limitations we combined the periareolar incision with the inferior dermal pedicle, which has a relatively good blood supply. This new technique was employed in 22 consecutive women (44 breasts) with hypertrophy and a varying degree of ptosis. Infiltration of a tumescent solution and liposuction were performed in all cases. After periareolar incision, dissection of the skin was performed, and the breast was elevated from the fascia of the pectoralis major muscle, leaving the inferior dermal pyramidal pedicle. An adequate amount of tissue was resected in the superior, medial, and lateral areas. After mastopexy, closure was done with a purse-string suture. The amount of tissue resected ranged from 180 to 1510 g per breast, and the mean was 466.1 g. The mean length of elevation of the nipple was 10.6 cm along the meridian of the breast. There were a few complications which needed revision operation: hematoma collection in one breast (2.3%), wound dehiscence in one breast (2.3%), and fat necrosis in one breast (2.3%). There was no necrosis of the nipple–areolar complex. With this new technique of periareolar reduction mammaplasty utilizing the inferior dermal pedicle, we were able to minimize the scar, preserve the nipple–areolar complex, and improve the motility of the breast tissue. But we also observed a flat or square appearance in the case of a large amount of resection in the patients with poor skin elasticity. This technique is safe and versatile and produces aesthetically acceptable results in selected patients.     

内上方蒂法与吸脂术在乳房缩小成形术中的联合应用

目的 探讨结合脂肪抽吸法的内上方真皮腺体蒂乳房缩小成形术对乳房肥大伴下垂进行修复的疗效.方法 对8例乳房肥大伴下垂的患者,行结合脂肪抽吸法的携带Würinger＇s乳房水平中隔内上方真皮腺体蒂乳房缩小成形术进行修复.结果 8例患者术后均未出现血肿及乳头乳晕复合体坏死等并发症.1例发生小段切口裂开.均获随访6～18个月,新乳头乳晕感觉良好,切口瘢痕不明显,新乳房外形满意.结论 联合应用脂肪抽吸法和内上方真皮腺体蒂术可使肥大伴下垂的乳房进一步得到良好的塑形,疗效满意.     

晕周三环形切口乳房缩小悬吊术应注意的美学问题

目的:探讨符合美学要求的晕周三环形切口进行乳房缩小悬吊术中应注意的问题及其可行性。方法:局麻下沿晕周三环形切口切除乳房松垂皮肤,悬吊乳腺腺体,以荷包收拢方式缩小封闭晕周切口。结果:用本方法治疗松垂巨乳畸形8例,效果良好。双侧切除乳腺组织重量约0.5～0.9kg。乳头上移5～11cm。经3个月至2年随访未见并发症发生,晕周瘢痕不明显。结论:该术式由于操作简便,效果确切,乳房外观满意,瘢痕不明显,不失为一种矫正轻、中度巨乳畸形的可取方法,值得推广。