下蒂瓣法乳房缩小整形术的效果

Clinical efficacy of inferior pedicle flap method in reduction mammaplasty

目的探讨下蒂瓣法乳房缩小整形术治疗中重度乳房肥大症的方法及效果。方法2010年1月至2019年12月,南京医科大学附属妇产医院整形外科对19例女性患者(年龄18~54岁,平均36.2岁)38侧肥大乳房,以Robbins的垂直下蒂瓣术式为基础,结合乳房血供、神经等解剖学进展,进行乳晕设计、下蒂瓣位置等改进。结果19例38侧肥大乳房缩小整形手术均顺利完成,切口均一期愈合;无乳头乳晕血运障碍,乳头乳晕感觉正常,乳房外形效果满意。术中切除乳房组织量每侧385~1525 g,平均570 g。术后随访6个月至8年,术后的倒T形瘢痕,均未出现增生性瘢痕,除2例肤色较深术后瘢痕色素沉着比较明显外,其余17例效果均满意。1例患者术后双侧乳头乳晕位置偏高,其余18例患者对乳头乳晕位置及形态表示满意。结论该术式可切除乳房组织量较大,乳头乳晕复合体血供稳定,是治疗中重度乳房肥大症切实可行的方法。

Objective To introduce the method and clinical effect of inferior pedicle flap used in reduction mammoplasty.Methods From January 2010 to December 2019,19 patients with moderate to severe macromastia who underwent reduction mammoplasty with inferior pedicle flap were enrolled in this study.The method of inferior pedicle flap was based on Robbins vertical inferior pedicle flap.New position of nipple areola and inferior pedicle flap were designed in terms of the breast anatomy.Results A total of 19 patients(38 breasts)were included in this study.The average tissue reduction of one side breast was 570 g(385 g to 1525 g).After operation,all patients were satisfied with natural appearance and nipple erection effect.There were no operation-related complications including nipple-areola necrosis.After 6 months to 8 years following-up,No inverted T hypertrophic scar occurred.Hyperpigmentation occurred on two patients with dark-skinned.The position of bilateral nipples and areola was higher in 1 patient after operation.The other 18 patients were satisfied with the position and shape of nipples and areola.Conclusions It is a good choice for patients with moderate to severe macromastia to receive reduction mammoplasty with inferior pedicle flap.Through the method,large amount of breast tissue reduction and stable blood supply of nipple and areola complex could be obtained.