Stevens W Grant, Gear Andrew J L, Stoker David A, Hirsch Elliot M, Cohen Robert, Spring Michelle, Vath Steve D, Schantz Steve A, Heck Robert T
Marina Plastic Surgery Associates and the Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Aesthet Surg J. 2008 Mar-Apr;28(2):171-9. doi: 10.1016/j.asj.2008.01.001.
In the last 15 years, reduction mammaplasty has been increasingly performed on an outpatient basis. Despite this evolution, few outcome studies have been published regarding outpatient breast reduction surgery.
The authors documented clinical outcomes of reduction mammaplasty performed in an outpatient setting over an 11-year period and compared these results with published normative values in the plastic surgery literature.
A retrospective review was undertaken of 884 reduction mammaplasties in 444 patients at a single outpatient surgical center performed by the senior author (W.G.S.) from 1995 through 2006. In all cases, a laser-assisted, inferior pedicle, Wise pattern, reduction mammaplasty was performed. In addition to demographic and surgical data, complication frequency and type were recorded. Complication data were further stratified into minor and major categories. Potential minor complications included seroma, hematoma, soft tissue infection, dog-ears requiring revision, and small incisional breakdowns or delayed healing of less than 2 cm. Potential major complications included large incisional breakdowns or delayed healing of greater than 2 cm, nipple/areolar necrosis, need for blood transfusion, deep vein thrombosis, pulmonary embolus, myocardial infarction, and death.
The mean patient age was 38 years (range, 16 to 73 years). Mean body-mass index was 27 (range 17 to 47). The reported preoperative brassiere cup sizes ranged from a 34 C to a 38 K, with a DD being the most common size. The mean preoperative sternal notch-to-nipple distance was 29 cm (range 22 to 54 cm). Forty patients smoked (9%). Mean clinical follow-up was 13 months. Mean total resection weight of breast tissue was 1228 g (range 100 to 5295 g). Mean operative time for reduction mammaplasty was 115 minutes (range 50 to 195 minutes). Nineteen percent of patients underwent multiple procedures, including abdominoplasty, lipoplasty, and facial procedures, with a mean operative time of 132 minutes (range 75 to 345 minutes). The overall complication rate was 14%, with 70 minor complications occurring in 62 patients. Specific minor complications included one seroma, four hematomas, eight soft tissue infections, two of which required a short course of intravenous antibiotics, one patient with dog-ears requiring surgical revision, and 56 small incisional wound breakdowns (< 2 cm). The small incisional breakdowns, which represented the largest group of complications, were further subdivided into 44 minor T-zone wounds, 3 nipple-areolar complex wounds, and 9 wounds of the vertical and horizontal incisions. Three major complications (0.67%) were recorded. Two patients had development of partial nipple/areolar necrosis. A third patient required anticoagulation for a pulmonary embolus diagnosed 10 days after surgery. Statistical analysis of the complication data revealed one significant relationship. Patients with a body mass index above the mean had a 21% complication rate as compared with a 12% rate for those below the mean. Of note, there was no increase in complication rate in the context of multiple procedures.
This retrospective series is the largest to date involving outpatient reduction mammaplasty. Complication data derived from this series are comparable to previously published studies and thus support the safety and efficacy of outpatient reduction mammaplasty performed in an accredited facility.
在过去15年中，缩乳术越来越多地在门诊进行。尽管有这种发展，但关于门诊乳房缩小手术的结果研究很少发表。
作者记录了在11年期间门诊进行的缩乳术的临床结果，并将这些结果与整形外科学文献中公布的标准值进行比较。
对1995年至2006年由资深作者（W.G.S.）在单一门诊手术中心为444例患者进行的884例缩乳术进行回顾性研究。在所有病例中，均采用激光辅助下蒂、Wise模式缩乳术。除了人口统计学和手术数据外，还记录了并发症的频率和类型。并发症数据进一步分为轻微和严重两类。潜在的轻微并发症包括血清肿、血肿、软组织感染、需要修复的“狗耳”、小于2 cm的小切口裂开或延迟愈合。潜在的严重并发症包括大于2 cm的大切口裂开或延迟愈合、乳头/乳晕坏死、输血需求、深静脉血栓形成、肺栓塞、心肌梗死和死亡。
患者平均年龄为38岁（范围16至73岁）。平均体重指数为27（范围17至47）。报告的术前胸罩罩杯尺寸范围为34 C至38 K，最常见的尺寸为DD。术前胸骨切迹至乳头的平均距离为29 cm（范围22至54 cm）。40例患者吸烟（9%）。平均临床随访时间为13个月。乳房组织的平均总切除重量为1228 g（范围100至5295 g）。缩乳术的平均手术时间为115分钟（范围50至195分钟）。19%的患者接受了多种手术，包括腹壁成形术、脂肪抽吸术和面部手术，平均手术时间为132分钟（范围75至345分钟）。总体并发症发生率为14%，62例患者出现70例轻微并发症。具体的轻微并发症包括1例血清肿、4例血肿、8例软组织感染，其中2例需要短期静脉使用抗生素，1例患者有“狗耳”需要手术修复，56例小切口伤口裂开（<2 cm）。小切口裂开是最大的并发症组，进一步细分为44例轻微T区伤口、3例乳头乳晕复合体伤口和9例垂直和水平切口伤口。记录了3例严重并发症（0.67%）。2例患者出现部分乳头/乳晕坏死。第3例患者术后10天诊断为肺栓塞，需要抗凝治疗。对并发症数据的统计分析显示了一种显著的关系。体重指数高于平均水平的患者并发症发生率为21%，而低于平均水平的患者为12%。值得注意的是，在进行多种手术的情况下并发症发生率没有增加。
这个回顾性系列是迄今为止涉及门诊缩乳术的最大系列。该系列得出的并发症数据与之前发表的研究相当，因此支持在经认可的机构进行门诊缩乳术的安全性和有效性。
