中国修复重建外科杂志

中国修复重建外科杂志

改良倒 T 形下蒂法在重度巨乳缩小术中的应用体会

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目的 探讨改良倒 T 形下蒂法行重度巨乳缩小术的效果。 方法 2016 年 1 月—2017 年 5 月,对 15 例重度巨乳患者采用倒 T 形下蒂法结合真皮悬吊术行乳房缩小术。患者年龄 20~49 岁,平均 31.6 岁。体质量指数 24.9~32.5 kg/m2,平均 30.8 kg/m2。其中 11 例有生育史。乳房下垂程度:Ⅱ 度 6 例、Ⅲ 度 9 例。单侧乳房组织切除量为 480~1 050 g,平均 615 g。 结果 术后 3 例 T 形切口交界处皮瓣少许坏死,经换药后愈合;12 例切口均 Ⅰ 期愈合,未出现脂肪液化、血肿或血清肿。术后 2 例乳头乳晕感觉减退,之后逐渐恢复。患者均获随访,随访时间 6~18 个月,平均 13 个月。患者双侧乳房外形及乳头乳晕复合体高度、对称度均较好,均无瘢痕明显增生。术者评价:乳房外形满意 12 例、不满意 3 例;瘢痕明显 3 例、不明显 12 例;乳头感觉正常 12 例、减退 2 例;乳头对称 11 例、不对称 4 例。患者自评:症状缓解均满意、乳房外形满意 10 例、较满意 4 例、不满意 1 例;遗留瘢痕情况满意 9 例、较满意 4 例、不满意 2 例;总体评价满意 10 例、较满意 4 例、不满意 1 例,总体满意度为 93.3%(14/15)。 结论 对于重度巨乳患者,改良倒 T 形下蒂法可有效避免远期乳房下垂,获得较满意疗效。

Objective To explore the effectiveness of modified inferior pedicle technique with inverted T shape pattern for severe breast hypertrophy. Methods Between January 2016 and May 2017, 15 patients of severe breast hypertrophy have undergone breast reduction using inferior pedicle technique with inverted T shape incision combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m2, with an average of 30.8 kg/m2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 grams on average (range, 480-1 050 g). Results The skin flap necrosis at the " T” trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shape of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape, 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 12 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetrical nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast in 4 cases, and unsatisfactory breast in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate as 93.3% (14/15). Conclusion For severe breast hypertrophy, the modified inferior pedicle technique with inverted T shape pattern can obtain satisfactory long-term appearance and avoid the mastoptosis.

关键词: 重度巨乳; 乳房缩小术; 下蒂法; 真皮悬吊术

Key words: Severe breast hypertrophy; breast reduction; inferior pedicle technique; dermal suspension sling technique

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