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上蒂与下蒂乳房成形术后的乳房感觉:解剖学和组织学评估

Breast sensation after superior pedicle versus inferior pedicle mammaplasty: anatomical and histological evaluation.

作者信息

Hamdi M, Greuse M, Nemec E, Deprez C, De Mey A

机构信息

Department of Plastic Surgery, C. H. U. Brugmann Free University of Brussels, Belgium.

出版信息

Br J Plast Surg. 2001 Jan;54(1):43-6. doi: 10.1054/bjps.2000.3464.

Abstract

Despite contradictory information about the course and distribution of the nerves supplying the breast, surgical techniques using an inferior pedicle have been recommended over those using a superior pedicle for preserving the nipple-areolar sensation after surgery. This anatomical study was designed to quantify the nerve branches preserved in inferior and superior pedicles after reduction mammaplasty performed on cadavers. Reduction mammaplasty was done on four fresh cadavers (within 48h of death) using a superior pedicle on the right and an inferior pedicle on the left in a standard way. The pedicle was cut at its base and then fixed in formalin. The base was divided in biopsy specimens and embedded in paraffin. The nerves were quantified and located in each pedicle with haematoxylin-eosin stain and light-microscopic evaluation. Histological evaluation of the pedicles showed the presence of a variable number of nerves (between one and seven) within two superior pedicles and three inferior pedicles. The nerves were located in fibrous tissue and accompanied by vessels in most cases. The nerves were always found superficially and were most likely to be located in the central part of the pedicle. Our results showed that including the nerves within the pedicle is technically uncertain regardless of the mammaplasty technique used. The final recovery of sensation in the breast after mammaplasty seems to result from the regeneration of severed cutaneous nerve branches or the remaining cutaneous innervation rather than the preserved adjacent cutaneous branches.

摘要

尽管关于供应乳房的神经走行和分布存在相互矛盾的信息,但为了术后保留乳头乳晕感觉,推荐采用下蒂技术的手术方法优于上蒂技术。本解剖学研究旨在量化尸体行乳房缩小整形术后下蒂和上蒂中保留的神经分支。对4具新鲜尸体(死亡后48小时内)进行乳房缩小整形术,右侧采用上蒂,左侧采用下蒂,均采用标准方法。蒂在其基部切断,然后固定在福尔马林中。基部被切成活检标本并嵌入石蜡中。用苏木精-伊红染色和光学显微镜评估对每个蒂中的神经进行量化和定位。对蒂的组织学评估显示,两个上蒂和三个下蒂中存在数量不等的神经(1至7条)。神经位于纤维组织中,大多数情况下伴有血管。神经总是位于表面,最可能位于蒂的中央部分。我们的结果表明,无论采用何种乳房整形技术,将神经包含在蒂内技术上都不确定。乳房整形术后乳房感觉的最终恢复似乎是由于切断的皮神经分支再生或剩余的皮肤神经支配,而不是保留的相邻皮支。

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