Kelahmetoglu Osman, Firinciogullari Remzi, Yagmur Caglayan, Yildiz Kemalettin, Guneren Ethem
Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey.
Department of Plastic, Reconstructive and Aesthetic Surgery, Ozel Ege Şehir Hastanesi, Izmir, Turkey.
Aesthetic Plast Surg. 2017 Dec;41(6):1311-1317. doi: 10.1007/s00266-017-0933-9. Epub 2017 Jul 11.
Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger's horizontal septum and inferior pedicle techniques.
This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger's horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm.
The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g).
This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
乳房缩小技术取决于蒂部的血运情况。对于乳房缩小整形术而言，保留乳头乳晕复合体（NAC）的血运至关重要，因为NAC是乳房最重要的美学和功能单元。下蒂技术是乳房缩小最常用的方法；然而，使用该技术后蒂部长度可能增加，并在巨乳症和乳房肥大患者中引发与NAC存活相关的问题。在本研究中，我们介绍通过结合维林格水平隔和下蒂技术来保留NAC存活的技术方法。
本研究纳入了60例女性患者（平均年龄39.71±10.52岁），她们在2012年4月至2016年1月期间接受了维林格水平隔和下蒂联合乳房缩小手术。所有患者术前均采用预制的怀斯模板在站立位进行标记。蒂部基底在乳房下皱襞水平标记，宽度为8cm。
患者平均随访5.6±3.3个月。右侧和左侧的切除重量分别为1406±566g和1340±563g。5例（8.3%）出现静脉功能不全，其中1例（1.6%）导致部分NAC坏死。未出现NAC完全坏死的病例。15例乳房（12.5%）被描述为巨乳症（切除重量>2000g）。
这种联合方法可能会使下蒂乳房缩小术获得更安全、更令人满意的效果。
证据等级IV：本刊要求作者为每篇文章指定证据等级。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
