Mett Tobias R, Krezdorn Nicco, Luketina Rosalia, Boyce Maria K, Henseler Helga, Ipaktchi Ramin, Vogt Peter M
Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Aesthetic Plast Surg. 2017 Dec;41(6):1295-1302. doi: 10.1007/s00266-017-0941-9. Epub 2017 Jul 19.
INTRODUCTION: The reconstruction of the body shape after post-bariatric surgery or high-grade gynecomastia involves, besides skin tightening, the repositioning of anatomical, apparent landmarks. The surgeon usually defines these during the preoperative planning. In particular, the positions of the nipple-areola complexes (NAC) should contribute to the gender-appropriate appearance. While in the female breast numerous methods have been developed to determine the optimal position of the NACs, there are only a few, metric and often impractical algorithms for positioning the nipples and areoles in the male. With this study, we show the accuracy of the intuitive positioning of the nipple-areola complex in men. MATERIAL AND METHODS: From a pre-examined and measured quantity of 10 young and healthy men, six subjects were selected, which corresponded, on the basis of their chest and trunk dimensions, to the average of known data from the literature. The photographed frontal views were retouched in two steps. Initially, only the NACs were removed and the chest contours were left. In a second step, all contours and the navel were blurred. These pictures were submitted to resident and consultant plastic surgeons, who were asked to draw the missing NACs without any tools. The original positions of the nipples were compared with the inscriptions. Furthermore, the results were compared between the contoured and completely retouched pictures and between the residents and consultants. RESULTS: A total of 8 consultants and 7 residents were included. In the contoured and completely retouched images, a significant deviation of the marked positions of the missing features was found. The height of the NAC was determined somewhat more precisely than the vertical position. There was no significant difference between the contoured and completely retouched images, with a discretely more accurate tendency on the contoured images. In comparison with the professional experience, the consultants were tangentially more precise, but without a statistically significant impact. DISCUSSION: The intuitive determination of the NACs is a challenge for the plastic surgeon. In this study, a statistically significant deviation was seen in almost all dimensions, although the clinical relevance cannot be conclusively assessed. We found a positional relationship of the NAC to the infraclavicular groove ("Mohrenheim pit") in the vertical and 4-4.5 cm above the submammary fold. The position of the NAC can be satisfactorily determined by a combination of plastic surgical intuition, patient wishes and practical metric methods using the Mohrenheim-Estimated-Tangential-Tracking-Line (METT-Line). LEVEL OF EVIDENCE V: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
引言:减肥手术后或重度男性乳房肥大后的身体塑形,除了皮肤紧致外,还涉及解剖学上明显标志的重新定位。外科医生通常在术前规划时确定这些标志。特别是乳头乳晕复合体(NAC)的位置应有助于呈现符合性别特征的外观。虽然在女性乳房方面已经开发出多种方法来确定NAC的最佳位置,但在男性中用于定位乳头和乳晕的方法却很少,且往往不实用。通过本研究,我们展示了男性乳头乳晕复合体直观定位的准确性。 材料与方法:从预先检查和测量的10名年轻健康男性中,选取了6名受试者,根据他们的胸部和躯干尺寸,这些受试者与文献中已知数据的平均值相对应。拍摄的正面视图分两步进行修饰。首先,仅去除NAC,保留胸部轮廓。第二步,将所有轮廓和肚脐模糊处理。将这些图片提交给住院医师和整形外科顾问医师,要求他们不借助任何工具画出缺失的NAC。将乳头的原始位置与所画位置进行比较。此外,还比较了有轮廓图片和完全修饰图片之间的结果,以及住院医师和顾问医师之间的结果。 结果:共纳入8名顾问医师和7名住院医师。在有轮廓图片和完全修饰图片中,发现缺失特征的标记位置存在显著偏差。NAC的高度确定得比垂直位置稍精确一些。有轮廓图片和完全修饰图片之间没有显著差异,有轮廓图片的趋势是稍微更准确一些。与专业经验相比,顾问医师的表现稍更精确,但没有统计学上的显著影响。 讨论:NAC的直观确定对外科整形医生来说是一项挑战。在本研究中,几乎所有维度都出现了统计学上的显著偏差,尽管临床相关性无法最终评估。我们发现NAC与锁骨下沟(“莫伦海姆凹”)在垂直方向上以及在乳房下皱襞上方4 - 4.5厘米处存在位置关系。NAC的位置可以通过整形外科直觉、患者意愿以及使用莫伦海姆估计切线追踪线(METT线)的实用测量方法相结合来令人满意地确定。 证据水平V:本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述,请参阅目录或在线作者指南www.springer.com/00266 。
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