双环法中央蒂真皮帽乳房缩小成形术的临床实践

Clinical practice of reduction mammaplasty using the central breast pedicle by a Double-Ring method

目的总结双环法中央蒂真皮帽乳房缩小成形术在巨乳治疗中的临床应用经验。方法对32例64侧乳房肥大伴或不伴乳房松垂者,采用以乳头为中心的中央蒂真皮帽双环法乳房缩小成形术,保留第4肋间神经径路的乳腺组织的完整性,切除多余的腺体组织,环形荷包缩拢外环口缝合。结果切除腺体组织量150～920 g/侧。3例术后9～12 d拆线时切口部分裂开;1例乳头表面部分坏死,经换药后痊愈。余均无伤口感染、血肿等并发症。随访0.5～5年,5例切口处瘢痕增生;4例乳晕形态不佳再次修复后满意;1例乳房肥大复发伴松垂。其余患者双侧乳房大小和乳头乳晕对称,形态自然,乳房上极较饱满,瘢痕隐蔽,乳头乳晕感觉正常,效果满意。结论双环法中央蒂真皮帽乳房缩小成形及悬吊术设计操作简单、灵活,瘢痕隐蔽,手术后可确保乳头乳晕的血供、感觉与哺乳功能。

Objective To summarize the clinical experience of the breast reduction with the Double- Ring central pedicle dermal cap method in treatment of macromastia. Methods To 32 patients with maeromas- tia and/or mastoptosis,we used the Double-Ring central pedicle dermal cap breast reduction method with the nipple in the center, retained the mammary gland containing the IV intercostals nerve, excised the redundant mammary gland in the periphery eonnately, and the incision of the outer ring was sutured by purse-string suture to reduce the outer incision to the size of the inner one with the non-absorbable suture. Results The weight of unilateral resected tissue was 150 g to 920 g. Three patients＇ incisions split partially when dermal sutures out 9 -12 days after operation. One patient＇s nipple surface showed up necrosis and was cured through~ changing dressings. Complications such as infection and haematoma did not occur on the other patients. All patients were followed up for 0.5 -5 years. Five patients＂ incision appeared obvious scar,4 patients felt satisfied after the repair of the areolae appearance. One patient recurred, and the other patients were satisfied with the results inclu- ding symmetrical size of breasts, symmetrical nipples and areolae, the natural appearance, the normal touch sen- sation, the full upper quadrant of breasts and the concealed scars. Conclusion It is an ideal method with simplicity, flexibility and results of concealed scar. After the operation, the normal touch sensation and blood supply of nipples and areolae can be preserved, so does laetational function.