Mizgala C L, MacKenzie K M
Section of Plastic Surgery, Ochsner Clinic LLC and Alton Ochsner Medical Foundation, Tulane University School of Medicine, New Orleans, LA 70121, USA.
Ann Plast Surg. 2000 Feb;44(2):125-33; discussion 133-4. doi: 10.1097/00000637-200044020-00001.
The outcome of 75 consecutive bilateral breast reduction procedures on 73 patients (65 inferior pedicle and 9 superior pedicle with inverted-T closure, and 1 ultrasonic-assisted lipoplasty) is evaluated. Fifty-six surveys at an average follow-up of 35 months, 36 standardized examinations at an average follow-up of 31 months, 52 paired preoperative/postoperative photographs, and 73 chart reviews comprise the data. Mean age at surgery was 32 years. Of the patients surveyed, there were 51 whites, 18 blacks, and 4 other races. The majority of survey respondents reported improvement in breast appearance (93%), self-esteem (85%), posture (84%), and activity level (77%). The percentage of patients free of back pain rose from 9% preoperatively to 59% postoperatively. Some decrease in nipple sensitivity was noted by survey in 34 nipple-areolar complexes (31%), and clinical examination detected decreased sensitivity in 16% of nipples. Thirty-one percent of patients reported improvement in their intimate relationship postoperatively and 65% reported no change. Ninety-five percent felt they had made the right decision in having breast reduction surgery. Physical examination revealed excellent maintenance of shape and impressive fading of surgical scars over the years in the majority of patients. The postoperative aesthetic result depends on several important preoperative factors, including skin tone, breast shape, and degree of ptosis. Adverse sequelae included infection (1.3%), nipple cyanosis (1.3%) but no nipple-areolar necrosis, and wound dehiscence (4.0%) but no skin flap necrosis. Late complications included underresection requiring reoperation (4.0%), fat necrosis (2.7%), hypertrophic scars (6.7%), and pseudoptosis (12.0%). Breast reduction surgery results in a good outcome for most patients, with high patient satisfaction. Patients are accepting of the large T-pattern scar that fades surprisingly well with time in exchange for symptomatic relief and substantial improvement in breast size and shape.
对73例患者连续进行75例双侧乳房缩小手术（65例采用下蒂法和9例采用上蒂法并倒T形缝合，1例采用超声辅助脂肪抽吸术）的结果进行了评估。数据包括平均随访35个月时的56份调查问卷、平均随访31个月时的36次标准化检查、52组术前/术后配对照片以及73份病历回顾。手术时的平均年龄为32岁。在接受调查的患者中，有51名白人、18名黑人以及4名其他种族。大多数受访者表示乳房外观（93%）、自尊（85%）、姿势（84%）和活动水平（77%）有所改善。无背痛患者的比例从术前的9%升至术后的59%。调查发现34个乳头乳晕复合体（31%）的乳头敏感性有所下降，临床检查发现16%的乳头敏感性降低。31%的患者表示术后亲密关系有所改善，65%表示没有变化。95%的患者认为进行乳房缩小手术的决定是正确的。体格检查显示，大多数患者多年来乳房形状保持良好，手术疤痕明显淡化。术后美学效果取决于几个重要的术前因素，包括肤色、乳房形状和下垂程度。不良后遗症包括感染（1.3%）、乳头发绀（1.3%）但无乳头乳晕坏死，以及伤口裂开（4.0%）但无皮瓣坏死。晚期并发症包括需要再次手术的切除不足（4.0%）、脂肪坏死（2.7%）、增生性瘢痕（6.7%）和假性下垂（12.0%）。乳房缩小手术对大多数患者来说效果良好，患者满意度高。患者接受大的T形疤痕，随着时间推移疤痕淡化效果惊人，以换取症状缓解以及乳房大小和形状的显著改善。
