Chen Constance M, White Cheryl, Warren Stephen M, Cole Jana, Isik F Frank
Department of Surgery, University of Washington Medical Center, Seattle 98195, USA.
Plast Reconstr Surg. 2004 Jan;113(1):162-72; discussion 173-4. doi: 10.1097/01.PRS.0000095943.74829.33.
The vertical reduction mammaplasty is an evolving technique. Its proponents report significantly decreased scarring, better breast shape, and more stable results compared with the standard inverted-T method, but the learning curve is long and cosmetic outcomes can be inconsistent. Many surgeons have experimented with the vertical closure before returning to methods more familiar to them. The authors present their modifications to the vertical reduction mammaplasty. Their changes simplify the preoperative markings and the intraoperative technique to shorten the learning curve while maintaining reliable aesthetic results. With the patient standing, only four preoperative marks are made: (1) the inframammary fold; (2) the breast axis; (3) the apex of the new nipple-areola complex; and (4) the medial and lateral limbs of the vertical incision. In the operating room, a medial or a superomedial pedicle is developed. Excess breast skin is resected with the inferior and lateral parenchyma as a C-shaped wedge. The lateral skin-adipose flap is redraped inferomedially and sutured to the chest wall. The inferior aspect of the breast is aggressively debulked and a gathering subcuticular stitch is started 2 cm below the nadir of the nipple-areola complex. Finally, a 38-mm to 42-mm nipple-areola complex marker is used to create a circular defect that is offset 0.5 cm medial to the vertical axis of the breast. In their series, 56 patients were treated and no major complications were noted. The median follow-up period was 17 months. The average reduction was 554.5 g per breast; however, the reduction was greater than 1000 g per breast in eight patients. The authors found that (1) chest wall anchoring improves lateral contour and minimizes axillary fullness; (2) aggressive debulking inferiorly avoids the persistent inferior bulge; and (3) starting the subcuticular gathering suture 2 cm below the nipple-areola complex followed by placement of a nipple-areola complex marker at the conclusion of the case prevents lateral deviation and corrects the nipple-areola complex teardrop deformity. These innovations accelerate the learning curve by simplifying the preoperative markings and lead to more consistent postoperative results and an improved cosmetic outcome. In conclusion, these modifications yield a simple, easily learned vertical reduction mammaplasty with aesthetically reliable results.
垂直双蒂乳房缩小术是一种不断发展的技术。其支持者报告称，与标准倒T形手术相比，该手术的疤痕明显减少，乳房形状更佳，效果更稳定，但学习曲线较长，美容效果可能不一致。许多外科医生在回归到他们更熟悉的方法之前，都曾尝试过垂直缝合。本文作者介绍了他们对垂直双蒂乳房缩小术的改良方法。他们的改进简化了术前标记和术中技术，以缩短学习曲线，同时保持可靠的美学效果。患者站立时，术前仅需标记四处：（1）乳房下皱襞；（2）乳房中轴线；（3）新乳头乳晕复合体的顶点；（4）垂直切口的内侧和外侧边缘。在手术室中，制作内侧或上内侧蒂。切除多余的乳房皮肤以及下方和外侧的乳腺组织，呈C形楔形。将外侧的皮肤脂肪瓣向内下方重新覆盖并缝合至胸壁。积极切除乳房下方的组织，并在乳头乳晕复合体最低点下方2厘米处开始皮下缝合聚拢。最后，使用直径38毫米至42毫米的乳头乳晕复合体标记器制造一个圆形缺损，该缺损位于乳房垂直轴内侧0.5厘米处。在他们的系列病例中，共治疗了56例患者，未出现重大并发症。中位随访期为17个月。每侧乳房平均切除量为554.5克；然而，有8例患者每侧乳房切除量超过1000克。作者发现：（1）胸壁固定可改善外侧轮廓并减少腋窝丰满度；（2）积极切除下方组织可避免持续的下方隆起；（3）在乳头乳晕复合体下方2厘米处开始皮下缝合聚拢，然后在手术结束时放置乳头乳晕复合体标记器，可防止外侧移位并纠正乳头乳晕复合体的泪滴形畸形。这些创新通过简化术前标记加速了学习曲线，带来更一致的术后效果和改善的美容效果。总之，这些改良方法产生了一种简单、易于学习的垂直双蒂乳房缩小术，美学效果可靠。
