Zavrides Harris
From the Harris Zavrides Plastic Surgery Center, Nicosia, Cyprus.
Ann Plast Surg. 2017 Nov;79(5):433-437. doi: 10.1097/SAP.0000000000001145.
Mammaplasty surgery has been modified in the past few years, as plastic surgeons worked to improve and maintain the breast shape and especially the "bottoming out" of the gland. The classic Pitanguy's technique has been shown to be an anatomically safe technique in the management of the breast. However, as first described, cannot be applied in gigantomastia or in severe breast ptosis cases or in cases of dense breast parenchyma or for a long-lasting breast lift result. Using 2 different modifications, the Pitanguy technique can be applied for breasts of all sizes and for all cases of breast ptosis.
A retrospective study of 140 patients who underwent the Pitanguy method and its 2 modifications was performed. The first modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nac. The medial flap is then advanced superiorly, rotated 90 degrees, and sutured to point A, whereas the lateral flap is placed below the medial one. The second modification describes an inferior chest wall-based flap for achieving a desirable shape that can be maintained over a long period. The inferior flap is based only in the thoracic wall vasculature, completely detached from surrounding structures, maintaining a good volume. The upper flap of the breast covers the inferior flap.
The follow-up included 140 patients and the follow-up period ranged from 1 to 10 years. Five patients were operated on less than 4 months ago and were not involved in this study. All patients gained natural-shaped breasts, and they were pleased with the results. Serious complications, including flap necrosis, were avoided because caution was used to preserve the internal mammary perforators while performing the Pitanguy's technique and its 2 modifications.
The classic Pitanguy technique and its 2 modifications provide a versatile, well-vascularized pedicle that allows elevation of the nipple areola complex at the desired height. Using these 2 modifications, the Pitanguy's technique can be applied for breasts of all sizes and for all cases of breast ptosis.
在过去几年中，乳房整形手术有所改进，整形外科医生致力于改善和维持乳房形状，尤其是腺体的“下垂”。经典的皮坦吉技术已被证明在乳房处理中是一种解剖学上安全的技术。然而，如最初所描述的，它不能应用于巨乳症、严重乳房下垂病例、乳腺实质致密的病例或无法获得持久的乳房提升效果的情况。通过两种不同的改良方法，皮坦吉技术可应用于各种大小的乳房以及所有乳房下垂病例。
对140例行皮坦吉方法及其两种改良术式的患者进行回顾性研究。第一种改良方法是将乳房上极垂直向胸大肌筋膜方向解剖，并向外侧至乳晕复合体。然后将内侧皮瓣向上推进，旋转90度，缝合至A点，而外侧皮瓣置于内侧皮瓣下方。第二种改良方法描述了一种基于胸壁下方的皮瓣，以获得可长期维持的理想形状。下方皮瓣仅基于胸壁血管系统，与周围结构完全分离，保持良好的容积。乳房的上方皮瓣覆盖下方皮瓣。
随访包括140例患者，随访时间为1至10年。5例患者在不到4个月前接受手术，未纳入本研究。所有患者均获得了自然形状的乳房，对结果满意。由于在实施皮坦吉技术及其两种改良术式时谨慎保留了胸廓内穿支，避免了包括皮瓣坏死在内的严重并发症。
经典的皮坦吉技术及其两种改良方法提供了一个多功能、血运良好的蒂，可将乳头乳晕复合体提升至所需高度。通过这两种改良方法，皮坦吉技术可应用于各种大小的乳房以及所有乳房下垂病例。
