Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery, Emory University.
Plast Reconstr Surg. 2010 Apr;125(4):1051-1056. doi: 10.1097/PRS.0b013e3181d0ab08.
Breast reconstruction following skin-sparing mastectomy in women with macromastia is challenging. Complication rates are often higher, and cosmetic results are less favorable. The study compared partial and total breast reconstruction in women with macromastia.
Data were collected retrospectively on all women with macromastia and breast cancer who underwent unilateral breast reconstruction. A contralateral reduction of more than 300 g was required to be included. Comparisons were made between patients who underwent an oncoplastic reduction (group A) and those who underwent a skin-sparing mastectomy and reconstruction (group B).
There were 51 patients in group A and 30 patients in group B. The average contralateral reduction specimen weighed 757 g in group A and 668 g in group B. The length of stay was significantly lower in group A (0.87 versus 3.5 days). Complication rates were all lower in group A (overall, 22 versus 50 percent; breast, 22 versus 43 percent; and donor site, 0 versus 23 percent). The total number of procedures for group A was 2.4 compared with 5.8 for group B. No patients in group A required more that two trips to the operating room, compared with 53 percent of the patients in group B. Patient satisfaction with shape and symmetry was slightly higher in group A.
Partial breast reconstruction using reduction techniques is often easier and more predictable when compared with total breast reconstruction following skin-sparing mastectomy in women with macromastia. It results in less patient morbidity, reduced length of stay, fewer operative procedures, and favorable cosmesis.
巨乳症患者行保留皮肤的乳房切除术（skin-sparingmastectomy）后进行乳房重建具有挑战性。并发症发生率通常较高，美容效果较差。本研究比较了巨乳症患者行部分乳房重建和全乳房重建的情况。
回顾性收集所有接受单侧乳房重建且患有乳腺癌的巨乳症女性的数据。需要对侧乳房缩小超过 300 克才能纳入。比较了行保乳整形术（oncoplastic reduction，组 A）和行保留皮肤的乳房切除术及重建术（skin-sparingmastectomy and reconstruction，组 B）的患者。
组 A 有 51 例患者，组 B 有 30 例患者。组 A 平均对侧切除标本重量为 757 克，组 B 为 668 克。组 A 的住院时间明显更短（0.87 天对 3.5 天）。组 A 的并发症发生率均较低（总发生率 22%对 50%；乳房 22%对 43%；供区 0 对 23%）。组 A 的总手术次数为 2.4 次，组 B 为 5.8 次。组 A 中无患者需要到手术室超过两次，而组 B 中有 53%的患者需要到手术室超过两次。组 A 的患者对形状和对称性的满意度略高。
与巨乳症患者行保留皮肤的乳房切除术全乳重建相比，采用乳房缩小技术行部分乳房重建通常更容易、更可预测。它可降低患者的发病率，缩短住院时间，减少手术次数，并获得良好的美容效果。
