Division of Plastic Surgery, University of Massachusetts Medical School, UMass Medical Center, 281 Lincoln Street, Worcester, MA 01605, USA.
Aesthet Surg J. 2010 May-Jun;30(3):390-4. doi: 10.1177/1090820X10374109.
The medial pedicle is commonly employed in vertical breast reduction. With this procedure, there is concern about pedicle compression, especially in large breast reductions when a relatively large medial pedicle is rotated into a smaller sized areolar opening.
The author describes a technical refinement to the vertical mammaplasty, whereby a splitting incision is made into the upper pole parenchyma that allows safe pedicle inset without any constriction by the pillar closure, while upper pole fullness is still maintained.
A total of 94 patients underwent mammaplasty with the author's technique, in which a superomedial pedicle was dissected as a full-thickness flap. The excision of breast tissue was beveled (especially laterally) to treat lateral fullness, while it was maintained perpendicular to the chest wall at the areola opening to preserve upper pole fullness. A straight incision was made into the upper pole, such that the pedicle was then easily rotated to the defect, obviating the need for upper pole debulking.
Resection per breast ranged from 350 to 2505 g (average, 780 g). In this series, medial pedicle vertical mammaplasty was a safe and effective operation for a wide variety of breast sizes and shapes, without any nipple-areola complex necrosis. Follow-up at an average of one year demonstrated a stable and aesthetically pleasing shape in all patients.
The median incision of the upper pole adds to the safety of vertical mammaplasty by preventing medial pedicle compression. Additionally, the aesthetic outcome is improved.
在垂直乳房缩小术中，通常采用内侧蒂。采用这种方法，人们担心蒂受压，尤其是在较大乳房缩小术中，相对较大的内侧蒂旋转进入较小的乳晕开口时。
作者描述了垂直乳房成形术的一种技术改进，即在上极实质中做一个分裂切口，允许安全地插入蒂，而不会被支柱闭合器收缩，同时仍保持上极饱满。
共有 94 例患者接受了作者技术的乳房成形术，其中，超内侧蒂被解剖为全厚皮瓣。切除乳房组织时呈斜面（特别是外侧）以治疗外侧饱满，而在乳晕开口处保持垂直于胸壁以保持上极饱满。在上极做一个直切口，这样蒂就可以很容易地旋转到缺损处，避免需要上极去脂。
每侧乳房切除的组织量为 350 至 2505 克（平均 780 克）。在这个系列中，内侧蒂垂直乳房成形术对于各种大小和形状的乳房都是一种安全有效的手术，没有任何乳头乳晕复合体坏死。平均随访一年，所有患者的外形均稳定且美观。
上极的中央切口通过防止内侧蒂受压，增加了垂直乳房成形术的安全性。此外，还改善了美学效果。
