乳房神经血管解剖学研究及在乳房缩小成形术中的意义

The neuro-vascular anatomical study of breast and it's signification in reduction mammaplasty\

目的 探讨乳房的血供模式和神经支配走向 ,寻找适合各型乳房肥大的短小瘢痕乳房缩小成形术术式。方法 应用血管铸型、标本透明技术和大体解剖对 12具成年女性尸体的胸壁乳房血供模式和乳房的神经支配进行研究 ,并设计出改良的双环形切口乳房缩小成形术 ,用于 2 8例乳房肥大患者。结果 成年女性前胸壁软组织乳房或为两层血管构筑或为三层血管构筑 ,各层间均通过垂直穿支形成吻合并首先在胸肌筋膜表面形成致密的血管网 ,这些垂直穿支在乳房下部粗大 ,上部细小。乳头乳晕的神经支配以第 4肋间神经外侧皮支的深支为主 ,在下垂乳房于腺体内呈S形走行。 2 8例患者行乳房缩小成形术后外形满意 ,乳头乳晕完全成活 ,仅 1只乳房感觉减退或消失。结论 改良的双环形切口乳房缩小成形术是较为理想的术式 ,除具有原术式瘢痕不明显、乳房突出度好、效果持久等优点外 。

Objective To investigate the pattern of the blood supply and the nerve distribution of breast, in order to find a way for short scar reduction mammaplasty. Methods\ Twelve adult women cadavers were investigated for the vasculature of the anterior thorax and the nerve distribution of the breasts by using the blood vessel casting, specimen transparency technique and the autopsy. Based on the anatomical study, a modified double circle reduction mammaplasty technique was designed to treat 28 patients with hypertrophical breasts. Results\ There existed two or three layers vasculature in the anterior thorax. The extensive vertical vascular anastomoses were found among the three layers. The cutaneous perforators, penetrated out of the pectoralis major muscle, were formed a dense vessel network in the retromammary space. The vertical vessels thereafter emerged from the network, passed through gland and linked to the subcutaneous vessels. These vertical vessels were smaller and denser above the fourth intercostal space, but they were larger and sparser below the fourth intercostal space. The innervation of the nipple areola mainly came from the lateral deep branches of the 4th intercostal nerve. It appeared S shape running into the dropped breasts. The 28 patients were successfully treated with the modified technique, except one case with the loss of the nipple areola sense. Conclusion\ The modified double circle reduction mammaplasty could maximally fulfill the blood supply to the remained gland and the innervations to the nipple areola, by keeping the advantages of the traditional technique such as invisible scar, good projection and the long lasting results. It could also be a safe and reliable technique.