Hamdi M, Greuse M, De Mey A, Webster M H
Department of Plastic Surgery, C. H. U. Brugmann, Free University of Brussels, Brussels, Belgium.
Br J Plast Surg. 2001 Jan;54(1):39-42. doi: 10.1054/bjps.2000.3456.
Reduction mammaplasty techniques using the inferior pedicle have been recommended to preserve the nipple and areolar sensation after surgery. The vertical scar mammaplasty with a superior pedicle has often been criticised because of the potential for damage to the sensory supply of the nipple-areola complex. The aim of this study was to assess the breast sensation in two prospective series of patients operated upon using superior pedicle and inferior pedicle mammaplasties. Between November 1996 and February 1997, 20 consecutive patients (39 breasts) underwent breast reduction using the inferior pedicle technique with inverted T scar (Robbin's technique). This series of patients was matched with another series of 18 patients (36 breasts) who had breast reduction using a vertical scar mammaplasty with superior pedicle (Lejour's technique) in another centre. Cutaneous pressure thresholds were recorded using Semmes-Weinstein monofilaments. The values were obtained on the quadrants of the skin of the breast, the areola and the nipple. The sensitivity test was performed preoperatively, then at 3 and 6 months postoperatively. Patients' characteristics (age, weight, breast ptosis, breast mass resected and risk factors) were statistically similar between the two groups. The preoperative values of pressure sensation on the different areas tested were statistically similar between the two groups. The sensitivity decreased on almost all the tested areas of the breast at 3 months postoperatively. No patient had an insensitive area on the breast at 6 months after surgery. Some areas of the breast showed a significant difference in pressure sensitivity after one technique compared to the other: better sensation on the skin of the superior and lateral quadrants after the superior pedicle technique at 3 months (P< 0.001), poorer areolar sensation on the inferior quadrant after the superior pedicle technique at 3 and 6 months (P< 0.05) and on the superior quadrant after the inferior pedicle technique at 3 months only (P< 0.05). However, the mean value of the areolar quadrants was statistically similar after both techniques. The nipple sensation was significantly decreased in both groups at 3 months but remained comparable between the two groups. Breast innervation was damaged by breast reduction using both the inferior and the superior pedicle techniques. The breast skin had better sensation after the superior pedicle technique while the areola had slightly better sensation after the inferior pedicle technique. At 6 months, the mean value of nipple-areola complex pressure sensation was comparable in the two series of patients.
采用下蒂法的缩乳术式被推荐用于术后保留乳头和乳晕感觉。带蒂上蒂垂直瘢痕乳房缩小术常遭诟病,因其可能损伤乳头-乳晕复合体的感觉神经支配。本研究旨在评估两组分别采用上蒂法和下蒂法乳房缩小术的前瞻性患者系列的乳房感觉。1996年11月至1997年2月,连续20例患者(39个乳房)采用下蒂法联合倒T形瘢痕(罗宾技术)行乳房缩小术。该组患者与另一中心18例采用上蒂垂直瘢痕乳房缩小术(勒茹技术)的患者(36个乳房)进行匹配。使用Semmes-Weinstein单丝记录皮肤压力阈值。在乳房皮肤、乳晕和乳头的象限获取数值。术前、术后3个月和6个月进行敏感性测试。两组患者的特征(年龄、体重、乳房下垂程度、切除的乳房肿块及危险因素)在统计学上相似。两组在不同测试区域的术前压力感觉值在统计学上相似。术后3个月,几乎所有测试的乳房区域敏感性均下降。术后6个月,无患者乳房出现感觉缺失区域。与另一种技术相比,一种技术术后乳房的某些区域在压力敏感性上存在显著差异:上蒂法术后3个月上外象限皮肤感觉更好(P<0.001),上蒂法术后3个月和6个月下象限乳晕感觉较差(P<0.05),仅下蒂法术后3个月上象限乳晕感觉较差(P<0.05)。然而,两种技术术后乳晕象限的平均值在统计学上相似。两组术后3个月乳头感觉均显著下降,但两组间仍具有可比性。下蒂法和上蒂法乳房缩小术均会损伤乳房神经支配。上蒂法术后乳房皮肤感觉更好,而下蒂法术后乳晕感觉稍好。术后6个月,两组患者乳头-乳晕复合体压力感觉的平均值具有可比性。