乳房外下皱襞切口皮下腺体切除后假体植入术

目的：改善乳房残缺造成的不良外形和心理障碍，对因原位癌等疾病需作乳房皮下切除的患者探索一种既便于腺体完整切除和胸大肌后植入乳房假体，瘢痕又比较隐蔽，术后并发症较少的手术方法。方法：取乳房外下皱襞切口切除乳房腺体，经胸大肌外下缘进入胸大肌后间隙分离假体腔，植八注入式盐水乳房假体。结果：本方法切除接近腋窝的腺体尾部较下皱襞切口方便，比经胸大肌进入胸大肌后间隙的方法损伤少。用此方法切除腺体并隆乳50余侧，随访33侧隆乳术后2-7年的乳房，无一例发现腺体残留而发生乳腺疾病，假体植入后无一例发生血肿、乳房硬化等并发症，仅有一侧乳房假体轻度活动性移位：结论：乳房皮下腺体切除后同时重建乳房，能保持患者乳房良好的外形和曲线美，避免乳房残缺造成的心理障碍；本组患者大多为中年女性，重建后的乳房不宜过于丰满挺立，以免日后产生新的心理问题；外下皱襞切口较常用的下皱襞切口更能完整切除腺体，方便胸大肌后植入乳房假体，且并发症少。     

乳房下皱襞切口治疗青春期乳腺纤维腺瘤

目的：探讨乳房下皱襞切口治疗青春期乳腺纤维腺瘤。方法：均采用全麻,乳房下皱襞弧形切口,沿胸大肌筋膜表面潜行分离乳腺后方间隙组织,自乳腺后方确认瘤体位置,紧贴瘤体钝锐性放射状分离,完整切除肿瘤。腺体不予缝合,可吸收线皮内缝合切口。结果：本组12例术后病理为乳腺青春期纤维腺瘤,均痊愈出院,切口美观、手术切口瘢痕不明显。结论：乳房下皱襞切口设计简单,部位隐蔽,显露充分,易剥离,一个切口可摘除多个瘤体,达到了治疗和美容双重效果。     

双平面隆乳术86例分析

目的 探讨双平面(即部分胸大肌后间隙和部分乳腺后间隙)置人隆乳术的可行性及可靠性.方法 自2004年5月至2008年4月,共行双平面隆乳术86例,其中乳晕切口62例,乳房下皱襞切口24例.结果 对53例患者术后随访3个月至2年,除2例双侧乳房轻度不对称、1例包膜挛缩外,其余各例乳房外形良好,未见假体扭曲、血肿、感染等并发症发生,假体边缘不明显.结论 双平面隆乳术,改变了假体表面软组织覆盖及其生理力学关系,整合了乳腺下平面及胸大肌下平面的优势,是扬长避短的术式.     

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。     

改良Lejour法乳房缩小术42例总结

目的:对乳房缩小术的传统Lejour法进行改良,并评价其临床效果。方法:2008年5月~2014年2月,笔者对来院的乳房肥大症患者采用Lejour法改良术式,在原设计基础上增加新乳晕周径,并减少直线切口的长度,切开后剥离乳腺组织,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,将乳腺组织缝合悬吊于第2肋,重塑新乳房外观,下皱襞多余皮肤可适当辅助切口切除。结果:术后随访6~25个月,平均11.2个月,2例术后出现脂肪液化切口愈合延迟,均经换药,切口4周内完全愈合。术后乳房挺拔自然,切口瘢痕不明显,满意度高。结论:对传统Lejour法进行改良后手术乳房外观满意,乳晕及下极处瘢痕不明显,无下皱襞皮肤堆积,远期效果好,可作为乳房缩小术的可行术式之一。     

乳腺良性肿瘤隐匿性美容切口142例疗效分析

目的:观察乳腺良性肿瘤采用美容切口手术治疗的临床效果。方法:142例乳腺良性肿瘤患者分为两组,治疗组82例分别应用乳晕切口、乳房下皱襞切口、腋窝切口隐匿性切口切除良性肿瘤。对照组60例采用传统放射状切口手术治疗。对比分析两组患者手术时间、乳房对称情况、患者满意度进行比较。结果:治疗组术后切口均甲级愈合,平均手术时间29.57±7.23min。54例患者术后乳房较为对称,48例患者较为满意。对照组切口甲级愈合。平均手术时间26.01±8.56min。41例患者术后乳房较为对称,36例患者较为满意。结论:隐匿性美容切口切除乳腺良性肿瘤,对乳房外观破坏小,在乳腺良性肿瘤切除手术中有较好应用价值。     

垂直切口内上蒂法在乳房肥大整形术中的临床应用

目的 探讨垂直切口内上蒂法在乳房肥大整形术中的临床应用。方法 自2020年3月至2023年3月,合肥市第二人民医院整形修复外科对45例乳房肥大患者采用垂直切口内上蒂法行乳房缩小上提矫正,个性化设计新乳头位置、新乳晕直径、内上真皮腺体蒂宽度等。内上蒂去表皮,切除“C”形区皮肤及皮下组织,保留2.0 cm安全皮肤罩厚度下个性化切除外侧及外上方皮肤罩深层组织,蒂部适当修整有利于旋转及塑形,修薄新旧下皱襞区,采用美容缝合技术,重新塑造乳房形态。结果 共45例患者（90侧乳房）乳房上提高度为3.0～15.5 cm,切除的腺体质量380～2300 g,术后5例出现脂肪液化及切口愈合不良,经换药后愈合,乳头、乳晕血运功能良好,术后随访3～12个月,躯体不适症状明显改善,乳头感觉良好。患者对术后乳房大小、形态、瘢痕情况均较满意。结论 采用垂直切口内上蒂法矫正肥大下垂的乳房,蒂部血供安全,行个性化操作,充分切除冗余组织,术后瘢痕隐蔽,乳房外形饱满对称,对部分轻度、所有中度及大部分重度乳房肥大伴下垂患者,可达到满意效果。     

奥美定注射隆乳术后注射物取出同期假体隆乳术效果观察

目的:探讨经乳房下缘切口入路行胸部注射物取出并同期进行胸大肌下假体隆胸术的临床效果。方法:对27例注射隆胸患者直视下行乳房下皱襞切口,取出注射物并根据手术局部情况同期于胸大肌后间隙置入硅胶假体,双侧留置引流管,分层缝合手术切口。结果:患者植入硅胶假体后近期效果均良好,无血肿和感染。1例因皮肤松弛,术后形态不佳行二次手术矫正。术后随访6个月～1年,所有患者均外观自然、手感柔软。结论:经乳房下皱襞切口入路取出隆胸注射材料后根据具体情况同期胸大肌后间隙置入硅凝胶假体进行隆胸手术即达到了取出胸部注射物且有维持了胸部高耸形态,是一种切实可行、效果良好的方法。     

乳房假体植入术后乳房下皱襞低的原因分析及处理

目的：分析乳房假体植入手术后下皱襞低的原因及处理方法。方法：回顾性分析2006年5月～2007年4月期间192例各种乳房假体植入手术患者，共有5例因术后出现单侧乳房下皱襞低，其中1例为乳癌术后再造，2例为单纯隆乳术，2例为乳房聚丙烯酰胺水凝胶取出术后再次隆乳术患者，均施行乳房下皱襞重建手术修整。结果：所有患者术后恢复顺利，两侧乳房基本对称，随访3～6月，矫正效果稳定。结论：整形外科医师应当重视乳房整形手术中下皱襞的保护和重建。     

延期乳房再造中应用单蒂TRAM皮瓣移植重建自然形态的乳房

目的:探讨乳癌根治术后延期乳房再造中应用单蒂腹部横形腹直肌肌皮瓣(transverse rectus abdominis musculocu taneous,TRAM)重塑自然形态乳房的方法。方法:2004年7月～2007年10月,笔者应用单蒂TRAM皮瓣对15例患者进行延期乳房再造。于较正常侧高1～2cm的位置设计患侧新乳房下皱襞,切除范围为新乳房下皱襞与乳癌根治术后切口瘢痕之间的皮肤,TRAM皮瓣修复瘢痕切除后创面。结果:所有患者术后随访4～26个月,平均随访15.2个月,效果优10例,良3例,一般2例。2例患者出现TRAM皮瓣II区皮下脂肪坏死,经引流后愈合,1例患者乳房下皱襞较健侧低,二期修复后手术效果为优。结论:本组病例应用的技术有利于再造乳房呈现自然形态,避免明显补丁样畸形。     

乳房下皱襞切口入路配合高负压引流系统治疗巨大纤维腺瘤

目的 探讨乳房下皱襞切口入路配合高负压引流系统治疗巨大乳腺纤维腺瘤的价值.方法 巨大纤维腺瘤患者16例,均采用乳房下皱襞切口入路切除肿瘤,乳房后间隙置高负压引流系统.肿瘤大小(5 cm×5 cm×4.5 cm) ～(15 cm×10cm×9 cm). 结果 本组16例均顺利完成手术,痊愈出院.术后病理均为乳腺青春期纤维腺瘤,术后随访3个月～1年,切口美观、手术切口瘢痕不明显,具有隐蔽性. 结论 乳房下皱襞切口设计简单,部位隐蔽,显露充分,美容效果好;配合高负压引流系统行乳房后间隙引流,避免了术后胸壁加压包扎,改善了术后患者的生活质量,值得推广.     

Vertical Mammaplasty as Secondary Surgery After Other Techniques

Vertical mammaplasty, a technique that avoids submammary scars, has proved to be a reliable method of breast reduction because it is adaptable to most cases and produces beautiful and durable results. What about secondary cases? In the last 14 cases referred for secondary mammaplasty, at 1–19 years after their initial surgery, patients' indications were poor shape (14), visible and improperly located scars (9), excess volume (8), asymmetry of the areolas (5) or the breasts (1), insufficient volume (2), and asymmetry with reconstructed breast (2). The original scars were inverted T (10), periareolar (2), oblique (1) or vertical (1). Their appearance was a concern for nine patients. All patients but one, who had long submammary scars surrounded by heavy stitch marks requiring correction, could benefit from a vertical mammaplasty. This avoided long months of scar redness and visibility along the submammary folds. Good symmetry and shape could be obtained in all cases by adjusting the markings to the needs. Liposuction was a great help to remove volume without endangering the blood supply of the areolas, possibly transforming reductions in simple mastopexies.     

美乳切口治疗乳房肿瘤效果对比及术后瘢痕程度分析

目的观察乳晕边缘弧形切口、乳房下皱襞切口及腋前皱襞切口治疗乳房肿瘤效果,探讨美乳切口临床价值。 方法选择2013年1月至2015年2月本院收治的乳房肿瘤患者80例,采取配对分组法分为两组,每组40例,对照组采取传统放射状切口手术治疗,观察组采取美乳切口手术治疗,根据肿瘤位置、大小实施乳晕边缘弧形切口、乳房下皱襞切口、腋前皱襞切口,比较两组患者手术一般情况及术后瘢痕情况。 结果两组患者手术时间及出血量比较差异均无统计学意义[（35.4±11.3）min vs（36.9±12.1）min,（25.6±12.5）ml vs（27.8±14.5）ml,均P>0.05]。观察组瘢痕情况显著优于对照组,但差异无统计学意义（χ²=4.698,P=0.09）。观察组满意程度显著优于对照组,差异有统计学意义（χ²=6.598,P=0.01）。两组并发症比较差异无统计学意义（χ²=1.013,P=0.31）。 结论美乳切口治疗乳房肿瘤效果较佳,瘢痕程度较轻,且患者满意程度高,具有重要临床价值。     

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。     

Interobserver variation and cosmetic result of submuscular breast reconstruction

Four experienced plastic surgeons judged the results of 6 different variables in 99 breast reconstructed women. In the range good to poor the observers assessed symmetry of size, position of the submammary fold, symmetry of shape, nipple-areola reconstruction and scars. The grand mean for total cosmetic results was 2.16 (2 = good, 3 = acceptable). Our material shows a great variance between patients in the total cosmetic result. We considered that no variable here shown has unacceptable reliability in terms of interobserver within patients and interpatients within observers variance ratio. The strongest correlations to the total cosmetic result were shown by symmetry of shape, position of the submammary fold and symmetry of size. Thus, in order to improve the total cosmetic result it is important to focus attention on these three aspects.     

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.     

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.     

Breast ptosis. Definition and treatment.

A definition of ptosis of the breast is given which permits differentiation of several kinds of defects to be made: pseudoptosis, partial ptosis, and true ptosis. In case of true ptosis, three degrees are described according to the nipple relation to the submammary fold and skin brassiere. An association with hypoplasia is described. The corrective techniques chosen are different according to the various types of ptosis and their possible association with various types of hypoplasia. The subpectoralis augmentation is used to insert the prosthesis in all cases.     

The Pedicle Tram Flap: A Focus on Improved Aesthetic Outcome

Background The transverse rectus abdominis muscle (TRAM) flap technique is the most versatile and artistic procedure currently used for breast reconstruction. Several variations have been described in the past with regard to the aesthetic objectives of reconstruction and the technical steps to achieve these goals. This study aimed to analyze changes introduced by the authors to improve the aesthetic outcome of breast reconstruction using the pedicle TRAM flap in terms of three specific aesthetic goals: (1) better definition of the submammary fold, (2) improved reconstruction of the tail of the breast and anterior axillary wall after axillary clearance, and (3) improved projection of the lower pole of the reconstructed breast. Methods The design of the pedicle flap has been modified to accommodate four surgical scenarios: vertical orientations of the flap with either an ipsi or contralateral pedicle and horizontal orientation of the flap with either an ipsi or contralateral pedicle. In each of these variations, specific surgical steps were undertaken to produce extension of the flap into the axilla, better definition of the submammary fold, and folding of the flap in its lower part to increase lower pole projection. Postoperatively, standardized five-view images of the patients were taken and presented to blinded observers, who were requested to award a numeric score to the aesthetic outcome. The numeric scores then were analyzed statistically. An experimental group of 11 patients who underwent reconstruction using the modified/improved technique were compared with a control group of 17 patients who underwent reconstruction using the classic technique. The incidences of complications for the two groups were compared and analyzed as well. Results The two groups of patients were comparable in terms of their age distribution and incidences of donor site and recipient site complications. A statistically significant difference was noted between the aesthetic scores awarded to patients who underwent surgery using the improved technique and those awarded to those who underwent surgery using the classic technique (p = 0.0006). Conclusion A model is presented for statistical analysis of the aesthetic outcome for breast reconstruction using an improved TRAM flap design as compared with using a classic TRAM flap design. This model offers an evidence-based decision-making process and uses the principle of aesthetic breast surgery adapted to breast reconstruction. On the basis of this model, the authors conclude that the aesthetic outcome of breast reconstruction can be improved by attention to details such as better projection of the breast’s lower pole, improved sculpting of the submammary fold, and attention to filling contour deficits of the axilla after axillary clearance.