Ulusal Betul Gozel, Alper Ince
Department of Plastic Reconstructive and Aesthetic Surgery, Balikesir University, Çagis Yerleskesi, Balıkesir, Turkey.
Aesthetic Plast Surg. 2018 Apr;42(2):412-421. doi: 10.1007/s00266-017-1067-9. Epub 2018 Jan 16.
Gigantomastia is defined as extreme hypertrophy of the female breast. It is a disabling condition that presents unique challenges to plastic surgeons. Initial breast volume is an important factor affecting the success of the reduction. Usually, it is difficult to achieve small-sized breasts, and long-term results are often unsatisfactory, resulting in complications such as "bottoming-out" deformities.
This paper presents a case series involving 40 patients (mean age 44.2 ± 12.5) with gigantomastia. Reductions were performed by superior nipple-areola complex pedicle with or without liposuction. Total resection weight ranged from 2050 to 5398 g (mean 3066 ± 944.2). Generally, the literature emphasizes the unreliability of the long superior pedicle when used to reduce the size of very large breasts. The technical steps for this procedure have been clearly described, and ways in which to overcome technical difficulties and attain effective volume reduction with minimal complications were presented.
The technique described here is applicable to all gigantomastia cases; even very large, pendulous breasts could be effectively reduced. Physical symptoms rapidly improved during the early postoperative period, patients' aesthetic satisfaction scores were high (4.6/5), and none of the patients complained of flat breasts. The rate of partial areola necrosis was 5%, and the rate of complete areola necrosis was 2.5%. These rates are comparable to those in the literature.
Using the technique described above, superior pedicle can be applied to all gigantomastia cases and enhanced aesthetic results can be obtained with minimal complications.
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巨乳症被定义为女性乳房的极度肥大。它是一种致残性疾病，给整形外科医生带来了独特的挑战。初始乳房体积是影响缩小手术成功的一个重要因素。通常，很难实现小尺寸的乳房，长期效果往往不尽人意，会导致诸如“乳房下垂”畸形等并发症。
本文介绍了一组涉及40例（平均年龄44.2±12.5岁）巨乳症患者的病例系列。采用带或不带抽脂的乳头乳晕复合体上蒂法进行乳房缩小术。总切除重量为2050至5398克（平均3066±944.2克）。一般来说，文献强调当使用长上蒂来缩小非常大的乳房尺寸时其不可靠性。已清楚描述了该手术的技术步骤，并提出了克服技术困难以及以最小并发症实现有效体积缩小的方法。
这里描述的技术适用于所有巨乳症病例；即使是非常大的下垂乳房也能有效缩小。术后早期身体症状迅速改善，患者的美学满意度评分很高（4.6/5），且没有患者抱怨乳房变平。乳晕部分坏死率为5%，乳晕完全坏死率为2.5%。这些比率与文献中的相当。
使用上述技术，上蒂可应用于所有巨乳症病例，并能以最小并发症获得更好美学效果。
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