Cheng Ming-Huei, Smartt James M, Rodriguez Eduardo D, Ulusal Betul Gozel
Taipei, Taiwan; and Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; and Johns Hopkins School of Medicine.
Plast Reconstr Surg. 2006 Dec;118(7):1517-1525. doi: 10.1097/01.prs.0000240815.10945.7f.
Large nipples, disproportionate to the small areola and breast size, are an ethnic characteristic frequently encountered among Asian female patients. Patients seek correction to improve cosmesis and alleviate psychological and physical discomfort. The authors present a new technique of nipple reduction and describe its potential advantages over other techniques.
Between March of 2003 and April of 2005, 34 nipple reductions were performed in 19 female patients (mean age, 40.5 +/- 5.6 years) using the modified top hat flap. The neonipple is designed to reduce the nipple diameter at the superior pole of the nipple while preserving the subdermal plexus. A crescent-shaped section of nipple skin below the proposed neonipple is excised, maintaining the integrity of the neonipple and the central nipple core. Two lateral wing flaps are elevated and trimmed to reduce both nipple height and diameter at the lateral walls of the nipple. The flaps of the neonipple are then sutured to the areola.
Postoperative recovery was rapid and uneventful and no complications were encountered. The mean diameter of the hypertrophic nipple was 16.3 +/- 2.6 mm (range, 16 to 30 mm). The mean diameter of the neonipple was 7.9 +/- 1.7 mm (range, 5 to 11 mm), with an average reduction of 8.4 +/- 1.6 mm (range, 5 to 20 mm). At 17.2 +/- 2.9 months of follow-up, the neonipple had a natural appearance, with less projection and an inconspicuous scar. There was no statistically significant difference on monofilament sensation testing (p = 0.5829) between reduction nipple and areola in 11 nipples of seven patients.
The modified top hat flap requires minimal preoperative planning, is easy to perform, and yields reproducible results. This technique decreases both the diameter and height of any size nipple and can be modified to meet patient preferences. Because the continuity of the neonipple with the subdermal arterial plexus is maintained and the majority of the parenchymal elements are preserved, nipple sensation and circulation remain largely unaffected.
乳头过大，与乳晕及乳房大小不相称，是亚洲女性患者中常见的种族特征。患者寻求矫正以改善美观并减轻心理和身体不适。作者介绍了一种乳头缩小的新技术，并描述了其相对于其他技术的潜在优势。
2003年3月至2005年4月期间，对19例女性患者（平均年龄40.5±5.6岁）采用改良顶帽皮瓣进行了34次乳头缩小术。新乳头的设计旨在减小乳头顶端的直径，同时保留皮下血管丛。在拟新乳头下方切除新月形的乳头皮肤部分，保持新乳头和乳头中央核心的完整性。掀起并修剪两个侧翼皮瓣，以减小乳头侧壁处的乳头高度和直径。然后将新乳头的皮瓣缝合至乳晕。
术后恢复迅速且顺利，未出现并发症。肥大乳头的平均直径为16.3±2.6mm（范围为16至30mm）。新乳头的平均直径为7.9±1.7mm（范围为5至11mm），平均缩小了8.4±1.6mm（范围为5至20mm）。在平均17.2±2.9个月的随访中，新乳头外观自然，突出度减小，瘢痕不明显。7例患者的11个乳头在单丝感觉测试中，缩小后的乳头与乳晕之间无统计学显著差异（p = 0.5829）。
改良顶帽皮瓣术前规划最少，操作简便，效果可重复。该技术可减小任何大小乳头的直径和高度，并可根据患者喜好进行改良。由于新乳头与皮下动脉丛的连续性得以保持，且大部分实质成分得以保留，乳头感觉和血液循环在很大程度上未受影响。
