两种乳房肥大缩小术的临床应用

Clinical application and operating skills of two different reduction mammaplasty

目的探讨两种不同术式乳房肥大缩小术的临床应用及操作要点。方法根据57例患者的临床表现和术后瘢痕遗留大小,选择性地采取双环法或垂直双蒂法乳房缩小术。结果在57例手术患者中,术后6个月内得以随访者39例。患者术后双侧乳房形态自然挺拔,乳头乳晕对称且感觉正常,手术瘢痕隐蔽,无乳头乳晕坏死等严重并发症。2例患者术后早期出现乳晕局部缺血,经对症治疗后恢复血供;4例患者术后切口处瘢痕增生明显,其中2例患者经早期醋酸曲安奈德注射后,瘢痕明显减退,另外2例患者术后半年在局麻下行局部瘢痕切除后瘢痕明显变小变浅;其余患者均自觉满意。结论对轻、中度乳房肥大且要求术后瘢痕隐蔽的患者采用双环法乳房缩小术;对重度乳房肥大,并能接受术后乳房皱襞下瘢痕的患者采用垂直双蒂法乳房缩小术,术后治疗效果明显,患者满意度高,值得临床推广。

Objective To explore the clinical application and operating skills of two different reduction mammaplasty. Methods 57 patients were given either round block technique or vertical bipedicle technique of reduction mammaplasty according to their clinical manifestation and postoperative scar formation. Results Among all 57 patients,39 cases were followed up for 6 months. All patients had obtained excellent appearance of reconstructed breast, symmetrical nipple and areola with normal sensation, and hidden incision scar,and no serious complication occurred. 2 cases showed up with ischemic areola earlier after the operation and then recovered well by symptomatic treatment. There were 4 cases of obvious scar formation. Two of them were improved by local injection of triamcinolone acetonide acetate, while the other two were surgically removed and turned insignificant after six months. All patients obtained satisfied appearance. Conclusion Round block technique is more suitable for the patients with mild to moderate mammary hypertrophy who demands hidden scars,while vertical bipedicle technique is a better choice for the patients with severe mammary hypertrophy who is also acceptable for inferolateral fold scars. Choosing proper surgical methods of reduction mammaplasty according to patients＇ clinical classification can get good healing and beautiful appearance.