应用无垂直瘢痕的下蒂瓣巨乳缩小术体会

The Experience of Using a Method of Inferior Pedical Compound Flap and With no Vertical Scar for Reduction Mammaplasty

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。

Objective To discuss how to use the inferior pedical dermal-fat-mammarygland flap with no vertical scar for reduction mammoplasty .And that how to ensure that there is enough skin in the inferior part of the new breast and remain the innervation of the nipple-areolar complex and function of the new breast were emphasized in this article. Methods 8 cases with macromastia had been treated with this method. In order to ensure that there is enough skin in inferior part of the new breast, the skin in the inferior part of old breast was utilized （the incision in the inferior fold was designed in higher place）; In order to remain the sensitivity of the nipple-areolar complex and function of the new breast, the inferior pedical dermal-fat-gland composite flap that was connected with pectoralis was formed. Results All of 8 cases obtained satisfactory contour of breast with fewer scar（have no vertical scar） after operation. 5 of them, followed-up in the 6th month to 2nd year after operation, had normal sensitivity of nipple-areolar complex Conclusion Proper design of incision in breast inferior fold can come over the shortage of having no enough skin in inferior part of the new breast; Dermal-fat-gland complex flap connected with pectoralis can increase the chance to remain the sensitivity of nipple- areolar complex and the function of the post-operative breast.