应用皮肤皱缩缝合技术行垂直切口乳房缩小整形术

目的　减少乳房缩小整形术所导致的切口瘢痕。方法　在做乳房缩小整形术时 ,在乳房下皱襞处不做切口 ,仅保留乳晕周围和乳晕下垂直切口 ,对乳房进行悬吊和塑形 ,而对乳晕下多余的皮肤和较长的皮肤切口 ,应用皮肤皱缩缝合技术进行缝合 ,利用组织的弹性 ,使其在手术后自动逐渐展平。结果　共为 13例患者实施了垂直切口的乳房缩小整形术 ,术后切口皆一期愈合 ,无血肿、感染、皮肤或乳头坏死等并发症发生 ,除 3例巨乳合并乳房严重松垂者半年后需再次对下皱襞处多余皮肤进行小的修整外 ,其余患者术后乳房和垂直切口形态满意。结论　垂直切口乳房缩小整形术设计、操作简单 ,容易掌握 ,效果恒定 ,在保证乳房缩小整形良好的乳房形态的同时 ,避免了在乳房下皱襞处的切口 ,是一种较好的乳房缩小整形术式。     

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。     

A new technique of reduction mammaplasty: dermis suspension and elimination of medial scars.

In the last decades new techniques of reduction mammaplasty significantly improved the results obtained and led to a reduced incidence of complications. However, some important problems like the loss of a natural submammary fold and alteration in the shape of the breast with time still remained mostly unsolved and the medial scars in the inverted T techniques are aesthetically unsatisfying. A new strategy for reduction mammaplasty has been developed based on a combination of advantages of other techniques. The principle of using de-epithelialized infra-areolar skin for dermis suspension prevents sagging of the remaining breast tissue behind the inframammary fold to create a long-lasting, natural shape of the reduced breast with an accentuated submammary fold. The central pedicle is favoured because of good modelling even in big reductions. Better vascular and nerve supply of the nipple-areola complex and the continuity of the lactiferous ducts are further advantages of the central pedicle. Secondary operations after reduction mammaplasty or augmentation usually dictate the use of a superior pedicle together with the dermis suspension technique. B-shaped skin incisions prevent medial submammary scars and can be used up to a 10 cm transposition distance of the nipple without disadvantage. The operative technique is described in detail. Examples are given for the primary procedure and the technique as a secondary correction. The principle of dermis suspension in combination with the prevention of a medial scar is applicable to reduction mammaplasty as well as mastopexy.     

New view in the mammary asymmetry treatments

AIM: Breast asymmetry is a huge chapter of breast abnormalities. Surgical therapy is the exclusive one. The breast of women can vary in shape, volume and position, thus creating esthetic, social and psychological problems. METHODS: We classified breast asymmetry into 6 categories and then we treated them with different surgical techniques: reduction mammaplasty according to Planas; augmentation mammaplasty with prosthesis; grafts or both; ultimately mamma-prosthesis (association of mastopexy and prosthesis). We obtained satisfactory esthetic results often with one surgery procedure. Rarely we performed 2 or more procedures of symmetry. We treated 77 patients suffering from breast asymmetry. We excluded in this study the giant-mammary asymmetry (anomaly determined by severe and asymmetric mammary hypertrophy). RESULTS: We found a low number of complications at short and long term. These results are likely due to the ability of the surgeon in the appropriated preoperative evaluation of the patients and of their expectancy and correct surgical techniques. CONCLUSIONS: We tried to obtain 3 results: shape and position of the sick breast as same as possible to the contralateral breast and less evident scars located in hidden regions.     

乳房重度下垂的直线切口法乳房成形术

目的 介绍应用直线切口法乳房成形术(Lejour法)治疗重度乳房下垂方法及效果.方法 按Lejour法设计手术切口.该类患者新乳头位置较正常人群可适当下移1～2 cm,新乳房下皱襞上移5～10 cm,通过适当下移新乳头位置及上移新乳房下皱襞达到缩短垂直切口距离.剥离乳腺组织,将下垂乳腺组织从乳腺深层固定于胸大肌第2、3肋水平.皮肤无张力缝合.结果 36例中乳房肥大者30例、体积基本正常者6例,经术后3个月至2年随访,无明显并发症,新乳房外形挺拔自然,患者满意.结论 本术式简便易行,远期效果好,可作为重度乳房下垂的术式之一.     

Reduction Mammaplasty in Teenagers

Background Asymmetrical breasts are an aesthetic problem for teenagers that should be dealt with by a plastic surgeon before it causes significant psychosocial problems. Incision placement is crucial, and attempts must be made to ensure that the scar is well hidden. Methods Eleven teenage girls with asymmetrical breasts underwent unilateral reduction mammaplasty of the larger breast, and four of them also underwent augmentation of the smaller-than-normal contralateral breast with a gel-filled implant. A submammary incision was made for reduction mammaplasty, and the natural elasticity of the young skin was put to good use. Results There were no postoperative complications, and all the patients were highly satisfied with the final results. The scars are invisible, concealed in the submammary crease. Conclusions Reduction mammaplasty is feasible for teenagers. The author recommends the procedure for correction of breast asymmetry to avoid emotional and social problems in the adolescent girl.     

不对称乳房美容整形治疗的探讨

目的探讨各种不同类型的不对称乳房的手术治疗方法。方法对48例不同类型的不对称乳房者，分别采用不同的乳房成形术进行矫治，其中包括两侧不同容积的乳房假体隆乳术(19例)，单侧隆乳术(11例)，切除两侧不同体积的乳房组织乳房缩小成形术(9例)，单侧乳房部分切除术(2例)，单侧乳房脂肪抽吸术(1例)，一侧巨乳房缩小成形术，一侧乳房悬吊术(3例)，一侧乳房悬吊，一侧隆乳术(2例)，单侧乳房悬吊(1例)。结果1例因乳房新皱襞下皮肤、皮下组织过多，进行了再次整复术。1例乳房悬吊术后半年，继发轻度下垂。1例因原乳腺组织切除过多且伴有乳房局部较大瘢痕，乳房前外侧稍有凹陷，形态不够满意。其余各例都取得了满意或基本满意的效果。结论对不对称乳房应针对不同的类型采用不同的术式治疗，不对称乳房的检查和测量应力求准确．以便达到尽可能的对称。     

Wineglass Pattern for Vertical Mammaplasty

The ideal reduction mammaplasty technique should create a pleasing breast shape with minimal scarring. The long and conspicuous scar associated with the classic inverted ``T' pattern mammaplasty techniques are not acceptable for many patients. Periareolar mammaplasty techniques cause less scarring, but they have major disadvantages such as scar widening, areolar distortion, and insufficient breast projection. We used a new pattern for vertical mammaplasty to overcome the insufficient breast projection caused by the round block technique and applied it to 51 patients during the last 3 years. This method results in a single vertical scar and a periareolar scar, allows sufficient volume reduction, and provides good breast shape and projection; the results are durable. This procedure is safe, causes few complications, and is easy to learn and perform.     

Adjustment of the contralateral breast following breast reconstruction

Surgery on the contralateral breast was performed in 64 of 100 patients for adjustment of size and shape or for diagnostic purposes. The patients found it more desirable to adjust size than shape asymmetry on the contralateral breast. There was only one early complication and six late ones. The former was a postoperative hematoma after a reduction mammaplasty. The latter were three cases of capsular contractures after augmentation mammaplasties. In these cases the implant was placed in a submuscular position. In three cases, patients asked for a secondary reduction mammaplasty because of poor symmetry. There were some difficulties in comparing pre- and postoperative mammography after augmentation mammaplasty. In the other adjustment procedures, there were only minor difficulties in a few cases comparing pre- and postoperative mammography. Patients with a high risk of bilateral breast cancer needing size and/or shape symmetry correction should be considered for mastectomy and immediate reconstruction.     

Reduction mammaplasty by central pedicle flap with short submammary scar

Reduction mammaplasty was performed in 30 patients by combining the central pedicle flap method with the short submammary scar (3-S) technique to avoid the common drawbacks of currently popular dermoglandular procedures. Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyme instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. Only the periphery of the breast parenchyme was resected circumferentially, with the exception of the inferolateral portion, so as not to injure the sensory nerve. The remaining breast parenchyme was preserved in an inverted cone shape. The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively, and lactation is possible because of preservation of the lactiferous ducts. The length of postoperative scars was reduced by using the short submammary scar technique. We believe this combined method is ideal in patients requiring resections ranging from 200 to 600 g per breast with good skin elasticity and moderate degree of ptosis.Presented at the Sixth Asian Pacific Congress of the International Confederation for Plastic and Reconstructive Surgery, in Seoul, Korea, October 1993.     

Vertical Mammaplasty for Gigantomastia

A 48-year-old female patient presented with gigantomastia. The sternal notch-nipple distance was 55 cm for the right breast and 50 cm for the left. Vertical mammaplasty based on the superior pedicle was performed. The resected tissue weighed 3400 g for the right breast and 2800 g for the left breast. The outcome was excellent with respect to symmetry, shape, size, residual scars, and sensitivity of the nipple-areola complex. Longer pedicles or larger resections were not found in the literature on vertical mammaplasty applications. In our opinion, by using the vertical mammaplasty technique in gigantomastia it is possible to achieve a well-projecting shape and preserve NAC sensitivity.     

伴有乳房良性肿物的乳房肥大下垂缩小术

目的 介绍伴有乳房良性肿物的乳房肥大下垂缩小术的方法和效果。方法 1990年12月至2001年11月，共收治乳房肥大下垂伴乳房良性肿物的患者15例29例，其中，伴有错构瘤1例，腺纤维瘤1例，小叶增生伴乳腺纤维瘤2例，轻度乳头状瘤2例，导管扩张伴分泌物潴留2例，小叶及腺管增生7例，行垂直下蒂真皮瓣缩乳术9例，垂直双蒂真皮瓣缩乳术6例。结果 15例29侧乳房，成功率89.6%，3侧乳头坏死，手术后因乳房肥大下垂带来的合并症明显好转。结论 乳房缩小整形手术是治疗乳房肥大下垂同时伴有乳房良性肿物的首选方法，可以达到治疗和美容的双重效果。     

Improving shape and symmetry in mastopexy with autologous or cadaveric dermal slings

Mastopexy and reduction mammaplasty reshape breast parenchyma and restore youthful contour in women with ptotic breasts. However, recurrent ptosis and breast base widening are common. We have been using internal autologous or cadaveric (AlloDerm) dermal slings to circumferentially support and shape the breasts for symmetry or rejuvenation. Ten patients underwent unilateral mastopexy (3), unilateral reduction-mastopexy (1), bilateral mastopexy (5), or bilateral reduction-mastopexy (1) with an internal dermal sling to correct breast reconstruction asymmetry (2), congenital asymmetry (2), or acquired ptosis (6). Three of 6 patients acquired breast ptosis after massive weight loss. Autologous dermis was used in 5 patients, and 5 patients were reconstructed with AlloDerm. Patients have maintained projection and breast base width after 6 months to 3 years. In conclusion, internal dermal slings improve shape, breast projection, and base width in select patients undergoing mastopexy. An algorithm based on quantity and quality of native skin is provided.     

A method of assessing female breast morphometry and its clinical application.

A series of reproducible measurements have been developed with reference to a single midline datum that describe the position of key landmarks on the female breast. Measurements were made on a 'normal' population of 60 subjects content with their breast shape in order to (1) produce 'normal' reference data for breast shape in a population of varying weight and height; and (2) to evaluate factors which may influence the measurements. The findings show that the vertical positions of the measurements migrate inferiorly with increasing age. With increasing weight, the landmarks (except the medial end of the inframammary crease) migrate inferolaterally. Areolar diameter decreases with increasing age and increases with increasing weight. Only one of the 12 bilateral breast measurement parameters shows a significant mean difference between the right and left breast. However, in a proportion of subjects, individual measurements show fluctuating asymmetry. Subsequently, measurements were made of the breasts of women attending with requests for either reduction (n = 25) or augmentation (n = 6) mammaplasty. Compared with the 'normal' population, the group requesting reduction mammaplasty differed significantly in the majority of measurements. The group of patients requesting breast augmentation showed fewer differences compared with the 'normal' population. The average BMI of women requesting augmentation mammaplasty was significantly less and that of women requesting reduction mammaplasty significantly greater than the normal population. In conclusion, a simple and reproducible method of morphometric measurement of the female breast is described. Application of this method suggests that patients requesting reduction or augmentation mammaplasty on the NHS represent a significant deviation from 'normal' morphometry and do not simply have a subjective distortion of their own body image.     

Vertical scar reduction mammaplasty as a standard procedure – experiences in the introduction and validation of a modified reduction technique

Based on experiences with a modified vertical scar reduction mammaplasty technique over a 5-year-period, this article discusses the results obtained and complications encountered with this technique. From 1991 to 1995, 628 reduction procedures were performed using a single vertical scar technique in 228 patients. The percentage of procedures with the new technique increased from 17.4% in 1991 to 89% in 1995. There was an increase in the mean reduction weight from 528 to 1313 g (mean 1028 g, 260–3300 g). Sixty-eight percent of patients (n=154) underwent follow-up examinations at 3 and 12 months postoperatively. The complication rate including perioperative and post-discharge problems was 40.2%. Complications occurring as a result of the procedure included an excessively long vertical scar (13%), skin redundancy in the submammary fold (15%) and wound dehiscences (10%). Minor corrective surgery was carried out in 38 patients. The modified vertical scar reduction mammaplasty technique may be considered a safe standard procedure for almost all breast sizes. Received: 23 June 1997 / Accepted: 2 February 1998     

Transverse resection: a new technique of reduction mammaplasty.

In patients who undergo breast reconstruction after unilateral mastectomy for breast cancer, the contralateral natural breast is often disproportionately large in comparison with the reconstructed breast. Such patients may express a desire to have reduction of the larger breast in order to achieve symmetry. A novel technique is described for breast reduction in such cases, which, despite the presence of visible scars, found acceptance among patients. The primary goal of reduction mammaplasty in these cases is symmetry, keeping in mind the shape, volume and degree of ptosis of the reconstructed breast, and not achieving youthful-looking breasts.     

Vertical Reduction Mammaplasty

The patients seeking our help for breast reduction are very often young and probably planning to have children later in their lives. Therefore it is most important to offer them a method of reduction mammaplasty that leaves as little scars and as much physiological function as possible. The vertical reduction mammaplasty as we perform it is a method that leaves normal sensibility in almost all cases, the possibility of lactation, little scarring and a pleasant form. The method can be used in all cases, ranging from mastopexy to reduction weights of over 2 kg of each breast. The vertical technique developed by Claude Lassus [1,2] and Madeleine Lejour [3,4,5,6] is a contemporary method of reduction that leaves few scars and conserves a maximum of physiological function. The method needs surgical skill and therefore it is not suitable for beginners in breast surgery. It is difficult to teach because it uses no patterns such as those of Strömbeck [7] or McKissock [8] but it gives the breasts a new form based on the anatomical circumstances and wishes of the patients. Due to some unfavorable results in the early beginning often caused by too long a caudal part of the breast or a dog-ear at the end of the vertical scar, we have added some modifications to the method. Weve heard of the same problems from several colleagues who no longer perform this method in major reduction plasties. We have been using this technique in all cases of breast reductions or mastopexies for the past 8 years.     

Vertical Mammaplasty Marking Using the Key Hole Pattern

Many modifications of the vertical mammaplasty procedure used to shorten the learning curve have been described. The authors advocate marking the breasts for the vertical mammaplasty operation according to the key hole pattern. They have used inverted T techniques on the upper breast and Lejour’s vertical mammaplasty on the lower breast. A total of 14 patients who had breast hypertrophy and ptosis underwent operations with this marking modification. The amount of removed breast ranged from 285 to 875 g per breast. Hematoma, skin necrosis, skin dehiscence, loss of nipple–areola sensitivity, and distortion were not observed in these cases.     

Refinements of Vertical Scar Mammaplasty: Circumvertical Skin Excision Design With Limited Inferior Pole Subdermal Undermining and Liposculpture of the Inframammary Crease

Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skepticism, vertical reduction mammaplasty is becoming increasingly popular in recent years because it best incorporates the two concepts of minimal scarring and a satisfactory breast shape. At the moment, vertical scar techniques seem to be more popular in Europe than in the United States. A recent survey, however, has demonstrated that even in the United States, it has surpassed the rate of inverted T-scar breast reductions. The technique, however, is not without major drawbacks, such as long vertical scars extending below the inframammary crease and excessive skin gathering and “dog-ear” at the lower end of the scar that may require long periods for resolution, causing extreme distress to patients and surgeons alike. Efforts are being made to minimize these complications and make the procedure more user-friendly either by modifying it or by replacing it with an alternative that retains the same advantages. Although conceptually opposed to the standard vertical design, the circumvertical modification probably is the most important maneuver for shortening vertical scars. Residual dog-ears often are excised, resulting in a short transverse scar (inverted T- or L-scar). The authors describe limited subdermal undermining of the skin at the inferior edge of the vertical incisions with liposculpture of the inframammary crease, avoiding scar extension altogether. Simplified circumvertical drawing that uses the familiar Wise pattern also is described.     

Mammaplasty in adolescent girls

The aim of this work is to analyze the experience in our pediatric center on the surgical management of mammary malformation in teenagers. We have reviewed or mammaplasty cases until 1999 (n = 24). We have divided them in two groups: augmentation (A) and reduction (R) mammaplasty. The analyzed parameters were: ethiology, associated pathology, surgical approach, aesthetic results and complications. Group A (n = 14; 17 implants). The surgical indication was moderate-severe mammary hypoplasia with psychological repercussion. Associated pathology: thoracic malformation (n = 13) and psychiatric pathology (n = 2). The surgical approach was submammary in 6 cases, videoassisted transaxillary in 4 and iterative on thoracic scar in 3. All the implants were located at the subglandular space. No major complications were found and the cosmetic results were good, with only one reoperation because of asymmetry. Group R (n = 10). Surgery was indicated because of bilateral puberal mammary hipertrophy in all cases. Associated pathology: obesity (n = 3), psychiatric and behaviour disorders (n = 3), scoliosis (n = 2), and one case of isosexual precocious puberty. In all cases but one the Str?mbeck mammaplasty was performed. We used the Lejour technique in this single case. The cosmetic results were good, except for 2 cases of hypertrophic scar. The only complication was a wound infection that healed well.