隆乳术切口和假体置放层次及手术剥离范围探讨

目的：探讨隆乳术的切口选择、假体置放层次和腔穴剥离范围。方法：于1996例9月至2001年9月间行隆乳术537例，选择三种手术切口；乳房下皱襞切口、乳晕切口、腋窝切口；假体置放于乳腺后间隙或胸大肌后间隙；胸大肌后间隙的剥离范围以第6肋间隙为下界。术后随访半年-5年。结果：术后乳房位置、形态、手感均满意511例（占95.2%）。结论：乳房下皱襞切口适于站立时乳房下皱襞明显或者乳房轻度下垂者；对于乳晕直径≥4cm的受术者，可采用乳晕缘内上或者内下弧形切口；腋下切口最为隐蔽，适于所有的受术者。假体置放于胸大肌后间隙具有手感更真实、不易形成纤维囊性硬变、不影响哺乳等优势。在胸大肌后间隙进行剥离，顺应乳房下皱襞韧带的解剖结构，将下界定于第6肋间隙。

THE INCISIONS, IMPLANTS POCKET, AND DISSECTION SCOPE OF THE AUGMENTATION MAMMAPLASTY

Objective:To discuss the three main factors of t he augmentation mammaplasty:the in cisions,implants pocket,and dissection scope.Methods:We report 537cases of augmentation mammaplasty from 1996to 2001.Three k inds of incisions were used:the In-framammary incision,the periareolar incision,and the axillary incision.The implants were placed submusc ularly or subglandularly.If placed submuscularly,the inferior border of the dissection should reach the sixth intercostal space.Posto perative follow -up from 6mouths to 5years were done.Results:In 511of 537cases(95.2%),the cosmetic results were satisfactory with a natural contour and a soft breast.While there were a few ca ses with complications such as ugly s car,double -layered breasts,capsu lar contracture,ect.Conclusion:The inframammary incision allows ea sy access to the submuscular or subglandular position.However,the incision will be noticed when the patient is nude.The periareolar incision is chosen to lo cate at the inner -upper edge or inner-lower edge of the areola of breast to avoid injuring the intercostal nerve innervating the nipple areola complex.The axillary incision results in scarless breast,but it is more difficult to visualize the pocket.Submuscular placement has a lower incidence of capsular contracture and rippling,results in natural contour and soft breast.The inferior border of the submuscular p ocket should reach the sixth intercostal space according to the anatomic structure of the inframammary crease ligament.