Bourne Debra A, Ahuja Naveen, Gimbel Michael L
Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Plastic Surgery Arts of New Jersey, New Brunswick, NJ, USA.
J Plast Reconstr Aesthet Surg. 2016 Jan;69(1):23-9. doi: 10.1016/j.bjps.2015.08.022. Epub 2015 Sep 4.
Skin-sparing mastectomy designs for immediate autologous breast reconstruction include racquet, Wise, and vertical mammaplasty incisions. The vertical design addresses ptosis while maintaining viable skin flaps. This study compares the racquet to the vertical incision.
Immediate skin-sparing autologous breast reconstructions by a single surgeon using either vertical or racquet incisions from August 2006 to September 2011 were analyzed. Aesthetic scoring was based on a Likert-scale assessment of scar appearance, shape, preoperative versus postoperative aesthetic comparison, and overall aesthetic outcome. Responses were analyzed using the Mann-Whitney test.
Seventy-seven patients (48 racquets and 29 vertical) were included. Patient demographics and complications did not differ. Vertical design reconstructions were used for patients with higher-grade ptosis (p < 0.001). Significantly better-appearing scars (3.8 vs. 3.5; p = 0.04) were observed in the vertical group. Vertical reconstructions showed a trend toward significance in cosmetic improvement compared with preoperative appearance (3.2 vs. 3.0; p = 0.06). There was no difference in shape (vertical 3.6, racquet 3.6; p = 0.86) or in postoperative aesthetic result (vertical 3.6, racquet 3.4; p = 0.41).
Shape and overall postoperative aesthetic appearance did not significantly differ despite greater ptosis preoperatively in the vertical group, demonstrating the efficacy of the vertical design in reconstruction. Vertical design reconstructions were rated aesthetically superior to their pre-mastectomy appearance. Significantly better scar scores in the vertical group reflect the camouflaged nature of vertical incisions. These results demonstrate that the aesthetic outcome of the vertical design reconstruction in ptotic breasts is as good as and potentially superior to the racquet design reconstruction in non-ptotic breasts.
用于即刻自体乳房重建的保留皮肤乳房切除术设计包括球拍状、Wise和垂直乳房成形术切口。垂直设计在维持皮瓣存活的同时解决了乳房下垂问题。本研究比较了球拍状切口和垂直切口。
分析了2006年8月至2011年9月期间由同一外科医生采用垂直或球拍状切口进行的即刻保留皮肤自体乳房重建。美学评分基于对瘢痕外观、形状、术前与术后美学比较以及总体美学结果的李克特量表评估。使用曼-惠特尼检验分析反应。
纳入77例患者（48例采用球拍状切口，29例采用垂直切口）。患者人口统计学特征和并发症无差异。垂直设计重建用于乳房下垂程度较高的患者（p<0.001）。垂直组观察到瘢痕外观明显更好（3.8对3.5；p=0.04）。与术前外观相比，垂直重建在美容改善方面有显著意义的趋势（3.2对3.0；p=0.06）。形状（垂直组3.6，球拍状组3.6；p=0.86）或术后美学结果（垂直组3.6，球拍状组3.4；p=0.41）无差异。
尽管垂直组术前乳房下垂更严重，但形状和术后总体美学外观无显著差异，证明了垂直设计在重建中的有效性。垂直设计重建在美学上被评为优于乳房切除术前的外观。垂直组显著更好的瘢痕评分反映了垂直切口的隐蔽性。这些结果表明，下垂乳房中垂直设计重建的美学效果与非下垂乳房中球拍状设计重建的美学效果一样好，甚至可能更优。
