Davison Steven P, Mesbahi Ali N, Ducic Ivica, Sarcia Marc, Dayan Joseph, Spear Scott L
Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
Plast Reconstr Surg. 2007 Nov;120(6):1466-1476. doi: 10.1097/01.prs.0000282033.58509.76.
The inferior pedicle technique remains one of the most commonly used techniques in breast reduction surgery, despite lengthy operating times, poor nipple sensation, and bottoming-out over time. The superomedial pedicle in reduction mammaplasty has previously been described using limited incision patterns. This study evaluated the safety and reliability of the superomedial pedicle with various skin reduction patterns and compared the surgical time with the inferior pedicle technique.
A total of 279 superomedial breast reductions were reviewed over a 6-year period, representing the transition period from inferior pedicle to superomedial pedicle techniques of three attending surgeons. Among these reductions, 215 had complete records and were included in the data analysis. The remaining 64 records were evaluated for viability of the nipple-areola complex. Assessments included skin pattern markings, average size of reduction, average body mass index, and complications. Risk factors and patient comorbidities were also recorded.
There were no cases of nipple loss in the series. The overall complication rate was 18 percent; patients' average body mass index was 29. The revision rate for contour or scar improvement was 4 percent. A statistically significant reduction in operating time of 41 minutes (p = 0.0001) was seen in comparison with the inferior pedicle reduction.
The superomedial dermoglandular pedicle is a safe and reliable technique for reduction mammaplasty. Its versatility allows for reproducible results in a broad range of patients with various skin excision patterns. Use of the superomedial pedicle provides consistent results with respect to breast contour, nipple viability, and lasting superomedial fullness, and saves operating time compared with the inferior pedicle technique.
尽管下蒂技术存在手术时间长、乳头感觉差以及随着时间推移出现乳房下极皮肤松弛等问题，但它仍是乳房缩小手术中最常用的技术之一。以往对乳房缩小整形术中的上内侧蒂技术的描述仅限于有限的切口模式。本研究评估了采用不同皮肤切除模式的上内侧蒂技术的安全性和可靠性，并将手术时间与下蒂技术进行比较。
回顾了6年间共279例上内侧乳房缩小手术，这些手术代表了三位主治医生从下蒂技术向上内侧蒂技术的过渡阶段。在这些手术中，215例有完整记录并纳入数据分析。其余64例记录评估乳头乳晕复合体的存活情况。评估内容包括皮肤模式标记、平均缩小尺寸、平均体重指数和并发症。还记录了危险因素和患者合并症。
该系列中无乳头丢失病例。总体并发症发生率为18%；患者平均体重指数为29。轮廓或瘢痕改善的修复率为4%。与下蒂缩小术相比，手术时间在统计学上显著缩短了41分钟（p = 0.0001）。
上内侧真皮腺体蒂是一种安全可靠的乳房缩小整形技术。其多功能性使得在各种皮肤切除模式的广泛患者中能够获得可重复的结果。使用上内侧蒂在乳房轮廓、乳头存活以及持久的上内侧丰满度方面能提供一致的效果，并且与下蒂技术相比节省手术时间。
