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。

Prosthesis implantation after gland resection through exo-inframammary fold incision

Objective: To amend the unpleasant figure and consequent psychological handicap caused by breast deformity. To explore a surgical option for CIS (carcinoma in situ) patients subject to endermic mastectomy that not only facilitates the complete removal of gland and the afterwards post-ectopectoralis implantation of prosthesis, but also assures inconspicuous scar and less complication. Methods: To cut the mammary gland off via inferolateral fold incision, enter the posterior mammary space via the inferolateral border of the ectopectoralis, separate the prosthesis cavity and then implant the injectable 0. 9% NS prosthesis. Results: This method makes it more convenient to remove the tail of the gland than that via the incision at the inferior fold and entails less damage than entering the post -ectopectoralis space via ectopectoralis. Adopting this method, we have completed 50 cases of gland excision with breast augmentation, 33 of which have been followed up for 2-7 years. None of the patients contracted mastosis due to rudimental gland. No complication, such as hematoma and breast sclerosis, was found. We only found one case with mild shift of breast prosthesis. Conclusions: Reconstructing breasts after subcutaneous mammary gland excision renders patients' breasts pleasant figure and prevents psychological handicap entailed by breast deformity. Since most studied patients are middle-aged female, the reconstructed breast should not be over-plump in case further mental problems arises in the future. Compared with traditional practice with inferior fold incision, the new method, with incision at the inferolateral fold, makes it more convenient to implant the prosthesis and assures a more complete removal of gland and less complication.