Chiu D T, Siegel H W
Division of Plastic and Reconstructive Surgery, Columbia Presbyterian University Medical Center, New York, NY, USA.
Ann Plast Surg. 1999 May;42(5):465-9.
The most common surgical approach to gynecomastia is through Webster's intra-areolar incision. The authors have modified the excisional phase of the operation to facilitate the delivery of a large mass of breast tissue through a relatively small incision. The essential features of this procedure are (1) delineation of the perimeter of the breast on the pectoral fascia; (2) elevation of the anterior chest wall skin and subcutaneous tissues over the entire breast mass; (3) serial application of Kocher clamps at the perimeter of the breast and, with gentle traction, sequential lysis of the peripheral and posterior attachments of the breast mass; and (4) delivery of the the mass simultaneously through the periareolar incision, as the dissection proceeds, until the entire specimen is exteriorized. The specimen then consists of the entire breast mass encircled by a pinwheel-like arrangement of Kocher clamps. Thirty-one patients (61 gynecomastic breasts) were operated using this method. En bloc tissue specimens weighing as much as 285 g were removed without the need for dividing the specimen or extending the single incision. The authors recommend this technique, which is straightforward and efficacious with minimal blood loss and good postoperative cosmesis.
男性乳房肥大最常见的手术方法是通过韦伯斯特乳晕内切口。作者对手术的切除阶段进行了改良，以便通过相对较小的切口取出大量乳腺组织。该手术的基本步骤包括：（1）在胸筋膜上划定乳房的边界；（2）将整个乳房肿块上方的前胸壁皮肤和皮下组织掀起；（3）在乳房边界处依次应用 Kocher 钳，并轻轻牵拉，逐步松解乳房肿块的周边和后部附着组织；（4）随着解剖的进行，通过乳晕切口同时取出肿块，直至整个标本完全取出。此时标本为由 Kocher 钳呈风车状排列环绕的整个乳房肿块。31 例患者（61 个男性乳腺肥大乳房）采用该方法进行手术。整块组织标本重量达 285 g，无需分割标本或扩大单一切口即可取出。作者推荐这种技术，它操作简单、有效，失血极少，术后美容效果良好。
