Department of Plastic Reconstructive & Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Aesthet Surg J. 2012 Jul;32(5):578-90. doi: 10.1177/1090820X12448657.
Successful breast reduction involves remodeling the breast parenchyma and creating a pedicle to maintain blood supply to the nipple-areola complex (NAC). Although vascular compromise is generally venous in breast reduction surgery, clear anatomical descriptions of the breast veins are lacking in textbooks.
The author designed an NAC flap based on arterial and venous territories defined in a cadaver study and subsequently assessed the technique in a series of live patients.
Dynamic venous angiography was performed on hemithorax specimens from 6 fresh female cadavers. A new septum-based pedicle (the "central pillar") was designed, which protected the periareolar vein polygon along with the breast septum. Sixty-seven patients underwent breast reduction with this technique between 2005 and 2010.
The patients were followed for an average of 26.4 months. Sixty-two of the 67 patients underwent bilateral reduction. The average reduction in tissue per breast was 910.7 g (range, 440-1935 g), and the average nipple transposition was 9.6 cm (range, 6-17 cm). The most common complications were delayed healing of the vertical "puckered" suture line (16 patients), seroma (7 patients), hematoma (2 patients), and unilateral deepithelialization of the NAC following transient venous congestion (2 patients). The patient satisfaction rate was high.
The central pillar technique is a promising alternative for young patients with glandular breasts that require gross reduction and high-transposition NAC, who are not good candidates for the "free nipple graft" technique.
成功的乳房缩小术需要重塑乳房实质并形成蒂，以维持乳头乳晕复合体（NAC）的血液供应。尽管在乳房缩小术中，血管损伤通常是静脉性的，但教科书中缺乏对乳房静脉的明确解剖描述。
作者根据尸体研究中定义的动脉和静脉区域设计了一种 NAC 皮瓣，随后在一系列活体患者中评估了该技术。
对 6 具新鲜女性尸体的半胸标本进行了动态静脉血管造影。设计了一种基于新的隔膜蒂（“中央支柱”）的技术，该技术保护了乳晕周围静脉多边形以及乳房隔膜。2005 年至 2010 年期间，有 67 例患者接受了该技术的乳房缩小术。
患者平均随访 26.4 个月。67 例患者中有 62 例接受了双侧缩小术。每侧乳房的平均组织减少量为 910.7 克（范围，440-1935 克），乳头转位平均为 9.6 厘米（范围，6-17 厘米）。最常见的并发症是垂直“皱缩”缝线延迟愈合（16 例）、血清肿（7 例）、血肿（2 例）和 NAC 单侧表皮脱落，继短暂静脉淤血（2 例）。患者满意度高。
中央支柱技术对于需要大量减少和高转移 NAC 的年轻腺体型乳房患者是一种有前途的替代方法，对于“游离乳头移植物”技术来说，这些患者不是很好的选择。
