Bozola A R
Division of Plastic Surgery, School of Medicine Sao Jose do Rio Preto, Brazil.
Plast Reconstr Surg. 1990 May;85(5):728-38. doi: 10.1097/00006534-199005000-00013.
I didactically compared the breast as a glandular cone with an envelope of skin and subcutaneous tissue. The aesthetic alterations of the breast are classified in four groups related to form, to volume, to grams, and to ptosis in centimeters. An imaginary plane that passes by the mammary sulcus (plane A) will determine the area of the breast that is ptotic. The projection of this plane in the anterior part of the breast is called point A. The distance between point A and the nipple will give in centimeters the amount of ptosis. I use this distance to draw geometrically in the breast the amount of excess of skin to be removed to correct the ptosis. In group I, the volume is normal and part of the mammary gland is under plane A. In this type of breast, the skin is resected, and since there is no excess of breast tissue, the breast that is under plane A is used as an inferior pedicle flap to give a better volume to the new breast. In group II, the base of the breast is large, the height is normal, and the volume is increased by the enlargement of the base. In this type of breast, the excess of breast under plane A and a wedge under the nipple are resected to reach the normal volume at the end of the surgery. In group III, the base is normal and the volume of the breast is increased by the height. For treatment, I resect the excess of breast under plane A as well as a segment at the base to reduce its height. In group IV, the volume of the breast is increased by the size of the base and the height of the cone, and I treat by resection of the excess of tissue under the ptotic area, a wedge under the areola, and a transversal segment in the base to reduce all the dimensions. In the final result of this technique in the majority of patients I will obtain a short scar. This technique was used in 1083 patients from January of 1979 to May of 1988.
我以教学的方式将乳房比作一个带有皮肤和皮下组织包膜的腺锥体。乳房的美学改变可分为与形态、体积、重量以及下垂程度（以厘米为单位）相关的四类。一条经过乳腺沟的假想平面（平面A）将确定乳房下垂的区域。该平面在乳房前部的投影称为A点。A点与乳头之间的距离（以厘米为单位）即为下垂的程度。我利用这个距离在乳房上几何地画出为矫正下垂需要切除的多余皮肤量。在第一组中，体积正常，部分乳腺在平面A以下。对于这种类型的乳房，切除皮肤，由于没有多余的乳腺组织，平面A以下的乳房被用作下蒂皮瓣，以使新乳房有更好的体积。在第二组中，乳房底部大，高度正常，体积因底部增大而增加。对于这种类型的乳房，切除平面A以下多余的乳腺以及乳头下方的一个楔形部分，以便在手术结束时达到正常体积。在第三组中，底部正常，乳房体积因高度增加。治疗时，我切除平面A以下多余的乳腺以及底部的一段，以减小其高度。在第四组中，乳房体积因底部大小和锥体高度而增加，我通过切除下垂区域下方多余的组织、乳晕下方的一个楔形部分以及底部的一个横向部分来减小所有尺寸。在大多数患者中，这项技术的最终结果是我将获得一条短疤痕。从1979年1月到1988年5月，这项技术应用于1083例患者。
