Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
Aesthetic Plast Surg. 2017 Aug;41(4):773-781. doi: 10.1007/s00266-017-0867-2. Epub 2017 Apr 3.
Healthy breast surgery constitutes an important step to achieve symmetry in unilateral implant-based reconstructions. We analysed long-term results of breast symmetry obtained with reduction mammaplasties, and we evaluated whether different glandular pedicles may better preserve long-term stability.
Between 2006 and 2012, 90 patients underwent mastectomy and immediate reconstruction with tissue expanders and simultaneous contralateral reduction mammaplasty. In 30 patients, a superior nipple-areola pedicle was harvested (GROUP A), in another 30 patients a medial pedicle was performed (GROUP B), and an inferior pedicle was used in the remaining 30 women (GROUP C). An objective evaluation of the reconstructed breast and the reduced one was performed at 1 and 24 months after surgery. One-way ANOVA and Tukey's HSD tests were used for analysis. Furthermore, three independent plastic surgeons filled out a questionnaire to assess aesthetic results.
Measurements of the reconstructed breasts showed similar variations between 1- and 24-month evaluations within the three groups with no significant difference (P value >0.05). Measurements of the reduced breast at the 1- and 24-month follow-up (Tukey's test) revealed significant differences among the three groups. Patients from GROUP C showed a significantly higher decrease in Δ nipple-lower clavicle margin distance and Δ nipple-inframammary fold compared to GROUP A and B (P value = 0.01). Surgeons' assessments revealed no statistically significant difference between the three groups.
Superior or medial pedicle reduction mammaplasties seem to better preserve breast shape and position, and they maintain a more similar appearance to the contralateral prosthetic breast over time.
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健康的乳房手术是实现单侧植入物重建对称的重要步骤。我们分析了通过乳房缩小术获得的乳房对称性的长期结果，并评估了不同的腺体蒂是否可以更好地保持长期稳定性。
2006 年至 2012 年期间，90 例患者接受了乳房切除术和即刻组织扩张器重建术，并同时进行对侧乳房缩小术。在 30 例患者中，采用了上乳头乳晕蒂（A 组），在另外 30 例患者中采用了内侧蒂（B 组），而在其余 30 例患者中采用了下蒂（C 组）。在手术后 1 个月和 24 个月对重建乳房和缩小乳房进行了客观评估。采用单因素方差分析和 Tukey 的 HSD 检验进行分析。此外，三位独立的整形外科医生填写了一份问卷，以评估美容效果。
三组患者的重建乳房测量值在 1 个月和 24 个月评估之间显示出相似的变化，无显著差异（P 值>0.05）。在 1 个月和 24 个月的随访中（Tukey 检验），缩小乳房的测量值在三组之间存在显著差异。C 组患者的乳头-锁骨下缘距离和乳头-乳晕下褶皱距离的Δ值下降显著高于 A 组和 B 组（P 值=0.01）。外科医生的评估显示三组之间无统计学差异。
上蒂或内侧蒂乳房缩小术似乎能更好地保持乳房的形状和位置，并随着时间的推移，与对侧假体乳房保持更相似的外观。
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