内镜辅助腋窝入路Ⅰ型双平面假体隆乳术后乳房感觉异常53例分析

Sensitivity of the nipple-areola complex and breast pain following type Ⅰ dual-plane breast augmentation via endoscopic assisted axillary approach: a long-term retrospective study of 53 patients

目的探讨内镜辅助下腋窝入路Ⅰ型双平面假体隆乳术后远期乳房感觉异常发生情况,并分析其发病原因。方法收集2014年7月至2016年12月上海交通大学医学院附属第九人民医院整复外科由同一术者实施的内镜辅助下腋窝入路Ⅰ型双平面假体隆乳术患者临床资料,并让患者于2018年7~10月来院复查,通过整复外科医师对患者进行问询和乳房触诊,以及患者填写问卷,随访乳头乳晕复合体(NAC)、乳房下皱襞(IMF)及乳房其他区域是否存在感觉减退、感觉消失、感觉过敏、乳房疼痛等并发症,并对结果进行分析。结果最终纳入53例女性小乳症隆乳患者,年龄26~41岁,术后随访21~52个月。医师触诊及问诊结果:53例患者中10例出现乳房感觉异常或疼痛,其中6例(11.3%)出现NAC感觉减退,1例(1.9%)出现NAC感觉过敏,2例(3.8%)IMF感觉减退,1例(1.9%)出现术后乳房长期疼痛,无NAC感觉消失、IMF感觉消失、IMF感觉过敏病例。共51例患者完成乳房感觉问卷调查,其中33例(64.7%)存在乳房疼痛,12例(23.5%)存在乳头感觉减退,5例(9.8%)存在一过性乳头感觉减退。结论内镜辅助下腋窝入路Ⅰ型双平面乳房假体隆乳术后远期乳房感觉异常发生率较低,可能主要是由术中离断支配NAC的周围神经所导致。

Objective To evaluate the morbidity and causes of long-term abnormal sensation of breasts after typyⅠdual-plane breast implant augmentation via endoscopic assisted axillary approach.Methods A retrospective analysis was conducted on 53 patients who underwent endoscopic assisted transaxillary typeⅠdual plane breast implant augmentation by a same surgeon from July 2014 to December 2016.All patients were followed up for more than 18 months.Hyperesthesia,hypoesthesia and numbness of nipple-areola complex and imframammary fold and breast pain were accessed.Results According to the palpation and consultation of the surgeon,a total of 10 patients presented with post-operative long-term abnormal sensation of breasts,of which 6(11.3%of the total number)patients presented with hypoesthesia of nipple-areola complex,1 patient(1.9%of the total number)presented with hyperesthesia of nipple-areola complex,and 2 patients(3.8%of the total number)presented with hypoesthesia of inframammary fold region.One patient(1.9%of the total number)had long-term postoperative breast pain.According to the questionnaire designed to assess breast sensation,a total of 33 patients(64.7%)presented with long-term postoperative breast pain,a total of 12 patients(23.5%)presented with post-operative long-term hyperesthesia of nipple-areola complex,another 5 patients(9.8%)presented with transient hyperesthesia of nipple-areola complex.Conclusions It is clear that the incidence of post-operative long-term abnormal breast sensation following endoscopic assisted transaxillary typeⅠdual-plane breast implant augmentation is comparatively low and controllable.And the main reason for this complication is the peripheral nerve innervation of the nipple areolar complex.