Iaso Hospital, Athens, Greece.
Aesthetic Plast Surg. 2011 Feb;35(1):55-60. doi: 10.1007/s00266-010-9556-0. Epub 2010 Aug 20.
The Pitanguy method of reduction mammaplasty has been shown to be an anatomically safe technique in the management of the ptotic breast. However, the technique, as first described, cannot be applied in gigantomastia or severe breast ptosis cases or cases of dense parenchyma of the breast. The senior surgeon suggested an intraoperative modification of the Pitanguy method of reduction mammaplasty to make it applicable for such cases.
A retrospective study of 122 patients with severe breast ptosis (70), gigantomastia (45), or dense breast parenchyma (7) who underwent a modification of the Pitanguy method was performed. The current procedure involves all the operating steps of the superior pedicle technique as described by Pitanguy, from the marking technique to the keel resection of the breast. If the nipple-areola complex is elevated inadequately, the surgeon can use the senior surgeon's modification to elevate the complex to the desired height. This modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nipple-areola complex. The medial flap is then advanced superiorly, rotated 90°, and sutured to point A, while the lateral flap is placed below the medial one. This maneuver maximizes elevation of the nipple-areola complex to the desired height.
The mean change in nipple position was 14 cm (range = 10-16 cm). The mean weight reduction of each breast was 900 g (range = 700-1300 g). The follow-up included 119 patients and the follow-up period ranged from 1 to 3 years (mean follow-up = 2 years). Three patients were operated on less than 3 months ago and were not involved in this study. All patients gained natural shaped breasts and they were pleased with the results. Serious complications, including flap necrosis, were avoided since caution was used to preserve the internal mammary perforators while performing this method.
This technique provides a versatile, well-vascularized pedicle that allows elevation of the nipple-areola complex at the desired height in cases of severe breast ptosis, gigantomastia, or dense breast parenchyma.
Pitanguy 乳房缩小术已被证明是一种安全的解剖学技术，可用于处理下垂的乳房。然而，正如最初描述的那样，该技术不能应用于巨乳症或严重乳房下垂或致密乳腺组织的病例。资深外科医生建议对 Pitanguy 乳房缩小术进行术中修改，使其适用于此类病例。
对 122 例严重乳房下垂（70 例）、巨乳症（45 例）或致密乳腺组织（7 例）行 Pitanguy 乳房缩小术改良的回顾性研究。目前的手术过程包括 Pitanguy 描述的上蒂技术的所有操作步骤，从标记技术到乳房的龙骨切除。如果乳头乳晕复合体提升不足，外科医生可以使用高级外科医生的改良技术将复合体提升至所需的高度。该改良术包括垂直于胸大肌筋膜和乳晕乳头复合体向乳房上极进行解剖。然后将内侧皮瓣向上推进，旋转 90°，并缝合至 A 点，而外侧皮瓣置于内侧皮瓣下方。这种操作最大限度地提高了乳头乳晕复合体的提升高度。
乳头位置的平均变化为 14cm（范围为 10-16cm）。每侧乳房的平均减重为 900g（范围为 700-1300g）。随访包括 119 例患者，随访时间为 1 至 3 年（平均随访时间为 2 年）。3 例患者在 3 个月内接受手术，未参与本研究。所有患者均获得了自然形状的乳房，对结果满意。由于在进行该方法时小心保留了肋间内乳穿支，避免了严重并发症，如皮瓣坏死。
该技术提供了一种多功能、血供良好的蒂，可在严重乳房下垂、巨乳症或致密乳腺组织的情况下将乳头乳晕复合体提升至所需的高度。
