应用扇形组织瓣治疗乳房肥大

目的:探索一种新的可适合任何程度乳房肥大及乳房下垂的手术方法,术后乳头乳晕复合体感觉良好,外形丰满、自然。方法:在乳房中下部作一横向的弧形切口,切除中央皮肤两侧袪真皮的三角区,形成扇形皮瓣,上提乳头乳晕至新的正常位置,锥体塑形成新乳房。结果:从2001年1月￣2006年5月50例术后效果令人满意,无乳头乳晕血运障碍,3例乳房中线伤口表皮裂开,经2周换药治疗愈合,未影响手术效果。结论:扇形组织瓣可适用各种程度的乳房肥大及乳房下垂,术后乳头乳晕复合体感觉良好,新乳房外形丰满,是一种安全实用手术方式。     

Incorporating the surgical treatment of symptomatic macromastia into a Breast Cancer Unit: could this be a useful management policy?

Oncoplastic Breast Surgery (OBS) is becoming an integral part of breast cancer management, but training is difficult and not easily available. We propose a bold management policy: the introduction of the reduction mammaplasty into a Breast Cancer Unit (BCU) as treatment for symptomatic macromastia. This management policy could bring about clear advantages both to patients (larged-breasted patients and those with a breast cancer) and surgeons.     

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。     

改良双环法巨乳缩小术

目的：探讨双环法缩乳术的技术改进。用双环形切口，切除外上象限适量乳腺组织对肥大乳房进行缩小和重塑，恢复乳房正常形态。结果：23例46侧术后瘢痕不明显，乳头乳晕无坏死，感觉良好，效果满意。结论：本术式设计简单，满意度高，是治疗巨乳的好方法，有更好的应用前景。     

应用无垂直瘢痕的下蒂瓣巨乳缩小术体会

目的探讨如何更好地运用无垂直瘢痕的下蒂瓣巨乳缩小术,重点讨论了如何解决新乳房下部皮肤不足、保存术后乳头乳晕感觉及术后乳房潜在的泌乳功能。方法通过①提高乳房返折处皮肤切口(高于乳房下皱襞线1.5cm～2cm),利用部分原乳房下部皮肤来补足新乳房下部皮肤不足的情况。②所有患者的下蒂瓣均制作成真皮-脂肪-乳腺复合瓣,蒂宽不小于12cm,该复合瓣由浅入深逐渐增宽,并保持与胸大肌附着。结果所有8例患者的16只巨乳术后切口均一期愈合。5例于术后6个月到2年时获得随访,乳房外形满意,乳头乳晕感觉正常,乳房表面瘢痕少而隐蔽。结论(1)当设计乳晕下缘与原乳晕上缘间距过短(不足4cm)时,可通过提高乳房返折处皮肤切口(高于乳房下皱襞线1～2cm)保留部分原乳房下部皮肤来补足新乳房下部皮肤不足的情况。(2)与胸大肌附着的真皮-脂肪-乳腺复合瓣有助于保存术后乳头乳晕的感觉及潜在的泌乳功能。     

妊娠合并巨乳症1例报告

妊娠期合并巨乳症临床上罕见,多为双侧性,常为永久性病变,体积增大迅速,不能自行消退。常发生于第二次妊娠,下次妊娠时复发,本疾病由于乳房组织受正常激素刺激的异常反应所致,继发坏死、出血和感染者很多见,病死率颇高。巨乳症的确切病因尚不明确,一般认为可能与乳腺组织对内分泌的刺激过分敏感有关,而性激素却在正常范围。     

陆德铭辨治乳腺假血管瘤样间质增生验案1则

<正>陆德铭教授系上海市名老中医,对各种乳房疾病的诊治有丰富的经验,特别对于乳房疑难罕见疾病的辨证论治、遣方用药独具特色,疗效显著。笔者有幸随陆师接诊1例罕见的青春期少女巨乳症反复发作病例,病理明确诊断为双乳乳腺假血管瘤样间质增生病,终经双乳全切术治疗后行中医药辨证调理治疗,疗效确切。现将陆师辨证治疗的思路方法及随访过程报告如下。1病案实录郭某,女,15岁。初诊日期:2013年3月7日。     

Juvenile gigantomastia: Report of a case

Juvenile gigantomastia in a 12-year-old girl was treated by a bilateral reduction mammoplasty with free transplantation of the areolae and nipples and the removal of 3,980 g of breast tissue. Regrowth of the residual breast tissue has been suppressed by the administration of tamoxifen, an antiestrogen drug, since the surgery. This case was positive for estrogen receptors (ER) by the dextran-coated charcoal method, while tissue staining for ER and estradiol resulted in a darker staining of the epithelial contents, especially of fibroadenoma-like nodules, using an immunocytochemical assay. It is thus suggested that the etiology of this disease might be related to a local hypersensitivity to estrogen.     

Breast cancer in reduction mammaplasty specimens: case reports and guidelines

Increasing numbers of women of all ages are electing to have reduction mammaplasty for very large breasts. Breast cancer can be an incidental finding in reduction mammaplasty specimens. We report here the discovery of breast cancer in specimens from four patients who underwent elective breast reduction, three of whom had not had recent mammograms. All four patients underwent modified radical mastectomy. The role of mammography, surgical options, specimen evaluation, and practical guidelines are discussed.     

Incidental breast carcinoma in reduction mammoplasty

Aim: The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed.

Methods: We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented.

Results: A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2–73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%).

Conclusions: Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.