改良垂直瘢痕法乳房成形术的应用效果

Clinical efficacy of modified vertical scar mastoplasty

目的探讨改良垂直瘢痕法乳房成形术(Hall-Findlay法)的临床效果。方法2009年5月至2018年5月,南方医科大学南方医院整形科共完成128例女性乳房成形术,年龄22~49岁,平均38.3岁。其中巨乳缩小56例,单纯乳房悬吊72例。按Hall-Findlay法设计手术切口,剥离乳腺组织保留上部或内侧蒂;按水平横隔解剖结构去除部分肥大的下部及基底乳腺组织。对乳房肥大明显患者术中联合抽吸脂肪,减少乳房腺体外侧及侧胸部皮下脂肪。结果128例患者切口均一期愈合,105例患者对术后瘢痕非常满意,13例满意,4例可接受。切除乳腺组织最大左侧700 g、右侧500 g。术后3个月随访,1例因切除腺体组织过多,致乳头乳晕出现缺血。5例患者乳房形态欠佳或对瘢痕较为介意,2次手术适当修整术后6个月,乳房外形良好,满意度95.3%。结论改良垂直瘢痕法乳房成形术较Lejour法保留了蒂的完整厚度,降低术后出现乳头乳晕感觉功能减退以及血运不佳概率,远期效果好,乳房外形挺拔,值得临床应用。

Objective To introduce a modified vertical scar method(Hall-Findlay method)and its improved technique.Methods From May 2009 to May 2018,128 cases of female mammoplasty were completed in the Department of Plastic Surgery,Nanfang Hospital of Southern Medical University,aged 22 to 49 years,with an average of 38.3 years.56 cases underwent breast reduction surgery and 72 cases underwent breast suspension surgery.The surgical incision was designed according to the Hall-Findlay method.Firstly,the inner skin of the design line was shaved to form a leather cap,the breast tissue was removed,the upper or inner pedicle was preserved,and the Würinger's horizontal septum structure was arranged to ensure the blood supply and innervation of the nipple-areolar complex.The partially enlarged basal mammary gland tissue was removed,and the remaining mammary tissue was fixed upward at the second rib level.The redundant skin of the breast was fully reduced and sutured.For patients with obvious breast hypertrophy,intraoperative combined aspiration of fat was used,mainly to reduce the subcutaneous fat of the lateral and lateral chest of the breast gland.Results A total of 128 cases of breast disease and simple breast sagging were treated with this method.Only 1 case showed nipple-areolar complex ischemia in the early postoperative period.After 3 months to 6 months follow-up,the breast shape was good and the satisfactory rate was over 95%.Conclusions This procedure is modified from the Lejour method of vertical scar mammoplasty.The full thickness of the pedicle is preserved compared with the Lejour method.The anatomical structure of the horizontal septum is preserved during the operation to reduce the postoperative nipple-areolar complex dysfunction and poor blood supply.The probability of occurrence and the long-term effect are good,the shape of the breast is straight,and it is worth promoting.