Fernandez Sarah, Coady Loretta, Cohen-Shohet Rachel, Molas-Pierson Justine, Mast Bruce A
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL.
Ann Plast Surg. 2016 Jun;76 Suppl 4:S328-31. doi: 10.1097/SAP.0000000000000732.
Multiple techniques exist for reduction mammoplasty, but no singular consensus exists as to which method is the most effective in providing an aesthetically pleasing breast. We reviewed our institution's reduction mammoplasty experience over a 2-year period to evaluate aesthetic and surgical outcomes comparing superiorly based pedicles with skin excisions resulting in either an inverted T or vertical scar.
An IRB-approved retrospective review of our institution's surgical database identified patient characteristics and outcomes of all breast reductions performed over a 2-year period (n = 104). A subgroup analysis of patients with complete preoperative and postoperative photographs (n = 56) evaluated postoperative aesthetics on a scale of 1 to 5 (1, poor; 5, excellent).
Techniques included a superomedial pedicle with an inverted T-pattern skin excision (n = 81) and pure vertical reduction (n = 23). There was no significant difference in complications between techniques. Common patient risk factors (age, body mass index [BMI], and smoking status) did not correlate with postoperative complications. In the photograph analysis subgroup, inverted T scar pattern reductions had a significantly better scar quality score (3.5 vs 3.2, P < 0.05). In analysis of all subjects, volume of tissue resected was a significant factor in determining overall aesthetic score, with resections of less than 1300 g being significantly associated with an overall aesthetic score of 4 or higher. Logistic regression demonstrated patient age younger than 40 years was a significant contributor to aesthetic score of 4 or higher (P < 0.05).
We reviewed our institution's experience with 2 common breast reduction techniques. Better scarring was associated with inverted T scar pattern versus vertical pattern. Additionally, rather than pedicle type or skin excision pattern, patient age and weight of tissue resected were the most important contributors to an aesthetically optimal outcome. This study suggests that a single superlative technique does not exist. Rather, inherent patient characteristics are most important in provision of the best aesthetic outcome.
乳房缩小成形术存在多种技术，但对于哪种方法在塑造美观乳房方面最有效尚无统一共识。我们回顾了本机构在两年期间的乳房缩小成形术经验，以评估采用上蒂法与皮肤切除法（导致倒T形或垂直瘢痕）的美学和手术效果。
经机构审查委员会批准，对本机构手术数据库进行回顾性分析，确定了两年期间所有乳房缩小手术（n = 104）的患者特征和手术效果。对有术前和术后完整照片的患者亚组（n = 56）进行分析，以1至5分的标准（1分，差；5分，优）评估术后美学效果。
技术包括采用倒T形皮肤切除的上内侧蒂法（n = 81）和单纯垂直缩小法（n = 23）。两种技术在并发症方面无显著差异。常见的患者风险因素（年龄、体重指数[BMI]和吸烟状况）与术后并发症无关。在照片分析亚组中，倒T形瘢痕模式的缩小手术瘢痕质量评分显著更高（3.5对3.2，P < 0.05）。在所有受试者的分析中，切除组织的体积是决定总体美学评分的重要因素，切除组织少于1300克与总体美学评分为4分或更高显著相关。逻辑回归显示，年龄小于40岁的患者对美学评分为4分或更高有显著贡献（P < 0.05）。
我们回顾了本机构两种常见乳房缩小技术的经验。与垂直模式相比，倒T形瘢痕模式的瘢痕效果更好。此外，对美学最佳效果而言，患者年龄和切除组织的重量比蒂型或皮肤切除模式更重要。本研究表明不存在一种最优技术。相反，患者的固有特征对实现最佳美学效果最为重要。
