Nazareth Hospital, 2375 Woodward Street, Suite 102, Philadelphia, PA 19115, USA.
Aesthetic Plast Surg. 2012 Apr;36(2):349-54. doi: 10.1007/s00266-011-9796-7. Epub 2011 Aug 19.
Simultaneous augmentation mastopexy for moderately to severely ptotic breasts presents the challenge of determining how much excess skin should be removed after implant placement to create symmetry and provide for maximal skin tightening without compromising tissue vascularization.
Simultaneous augmentation mastopexy involves invagination and tailor tacking of the excess skin after implant placement and then making a pattern around the tailor-tacked tissues for previsualization of the total area to be resected. This contrasts with first making a pattern for the mastopexy, resecting the skin, and then tailor tacking the tissues together. Over a 7-year period, 55 women had simultaneous augmentation mastopexy with this approach. Saline implants were placed in the subpectoral dual-plane position before the mastopexy was started. All surgeries were performed with the patient under general anesthesia, and the patients were discharged the same day. In a retrospective chart review, breast implant size, degree of preoperative asymmetry, length of procedure, and complications were recorded. The patient follow-up period ranged from 3 months to 7 years (median, 9 months).
Symmetric, aesthetic results were achieved for all the patients. The range of saline implants used was 375-775 ml (average, 500 ml). Of the 55 women, 15 had two different size implants measuring at least 50 ml or larger, with the greatest size disparity in a patient being 225 ml (left breast, 700 ml; right breast, 475 ml). Six of the patients (10.9%) had small areas that healed by secondary intention, occurring mostly at the inferior junction of the inverted T. Only two patients (3.6%) had recurrence of breast ptosis, and only one patient (1.8%) had a mildly hypertrophic scar. There were no incidences of hematoma, infection, rippling, malposition of the nipple-areolar complex (NAC), NAC loss, capsular contraction, implant malposition, or dissatisfaction with implant size. The bilateral augmentation/mastopexy surgery time ranged from 2 h and 29 min to 4 h and 30 min (average, 3 h and 8 min).
The described technique maximizes the amount of tissue to be resected in simultaneous augmentation mastopexy for moderately to severely ptotic breasts. Symmetry is more easily achieved with this approach regardless of the implant size used or the amount of skin to be resected. This technique minimizes the chance of tissue necrosis from devascularized skin edges. It also may shorten the inverted T scar and reduce the operative time.
对于中重度乳房下垂的患者，同时进行乳房增大和乳房悬吊术具有挑战性，需要确定在放置植入物后应切除多少多余的皮肤，以实现对称并提供最大的皮肤收紧效果，同时又不影响组织的血运。
同时进行乳房增大和乳房悬吊术时，在放置植入物后将多余的皮肤向内折叠并使用裁缝别针固定，然后围绕裁缝别针的组织制作一个模板，以预先确定要切除的总面积。这与先为乳房悬吊术制作模板、切除皮肤，然后再将组织缝合在一起的方法不同。在 7 年的时间里，有 55 名女性接受了这种同时进行乳房增大和乳房悬吊术的治疗。在开始乳房悬吊术之前，将盐水植入物置于胸肌下双平面位置。所有手术均在全身麻醉下进行，患者当天出院。在回顾性病历审查中，记录了乳房植入物的大小、术前不对称程度、手术时间和并发症。患者的随访时间为 3 个月至 7 年（中位数为 9 个月）。
所有患者均获得对称、美观的效果。使用的盐水植入物的范围为 375-775 毫升（平均 500 毫升）。在 55 名女性中，有 15 名患者使用了至少两种不同尺寸的植入物，其差值至少为 50 毫升，最大差值为 225 毫升（左侧乳房 700 毫升，右侧乳房 475 毫升）。6 名患者（10.9%）有小面积的愈合不良，主要发生在倒 T 形的下交界处。只有 2 名患者（3.6%）出现乳房下垂复发，只有 1 名患者（1.8%）出现轻度肥厚性瘢痕。无血肿、感染、波纹、乳头乳晕复合体（NAC）位置不正、NAC 丢失、包膜挛缩、植入物位置不正或对植入物大小不满意的情况发生。双侧隆胸/乳房悬吊术的手术时间为 2 小时 29 分钟至 4 小时 30 分钟（平均 3 小时 8 分钟）。
本研究描述的技术可最大程度地切除中重度乳房下垂患者同时进行乳房增大和乳房悬吊术中的组织量。与使用的植入物大小或要切除的皮肤量无关，该方法更容易实现对称。这种技术可最大限度地减少因皮缘无血管而导致的组织坏死的机会。它还可以缩短倒 T 形瘢痕并缩短手术时间。
