青少年缩乳术：“Wise”法与垂直切口模式的比较
Reduction Mammaplasty in Adolescents: A Comparison of Wise and Vertical Incision Patterns.
作者信息
Kulkarni Kritika, Egro Francesco M, Kenny Elizabeth M, Stavros Alexander G, Grunwaldt Lorelei J
机构信息
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
出版信息
Plast Reconstr Surg Glob Open. 2019 Dec 31;7(12):e2516. doi: 10.1097/GOX.0000000000002516. eCollection 2019 Dec.
BACKGROUND
Reduction mammaplasty was shown to ameliorate physical and psychological problems in adolescents suffering from macromastia. However, benefits of the Wise compared to the vertical incision pattern have not yet been established in this population. The aim of this study is to compare the outcomes of these 2 techniques in adolescents undergoing reduction mammaplasty.
METHODS
A retrospective study of adolescents undergoing breast reduction by a single surgeon between 2011 and 2017 was conducted. Wise and vertical reduction techniques were compared based on demographics, surgical outcomes, patient satisfaction, and aesthetic outcomes. Patient satisfaction was determined using the validated BREAST-Q survey, and aesthetic outcomes using the validated ABNSW system.
RESULTS
A total of 60 adolescents underwent reduction mammaplasty (Wise/inferior pedicle = 80.0%, Wise/superior medial pedicle = 1.7%, vertical/superior medial pedicle = 18.3%). Patients who reported preoperative pain (Wise = 95.9%, vertical = 72.7%, = 0.039) were more likely to undergo Wise reduction. Patients with Wise reductions also were more likely to undergo bilateral reduction (Wise = 93.9%; vertical = 63.6%, = 0.017). The major and minor complication rates were 1.7% (Wise = 2.0%, vertical = 0%, = NS) and 23.3% (Wise = 20.4%, vertical = 36.4%, = NS), respectively. Adolescents undergoing Wise incision demonstrated statistically significant improvement in NAC contour (Wise = 61%, vertical = 47%, = 0.028) and overall aesthetic outcome (Wise = 25%, vertical = 17%, = 0.008) with scarring not being a negative factor (Wise = -16%; vertical = -35%, = 0.004). Patient satisfaction was comparable in both groups.
CONCLUSIONS
Reduction mammaplasty is a safe, effective treatment for adolescent macromastia. The similarity in complication and satisfaction rates between Wise and vertical patterns suggests that both techniques can be safely performed in the adolescent population and allow for overall improvements in aesthetic outcomes.
背景
乳房缩小术已被证明可改善患有巨乳症青少年的身体和心理问题。然而，在该人群中，与垂直切口模式相比，“Wise”切口模式的优势尚未得到证实。本研究的目的是比较这两种技术在接受乳房缩小术的青少年中的效果。
方法
对2011年至2017年间由单一外科医生进行乳房缩小术的青少年进行回顾性研究。基于人口统计学、手术结果、患者满意度和美学效果对“Wise”和垂直缩小技术进行比较。使用经过验证的BREAST-Q调查问卷确定患者满意度，使用经过验证的ABNSW系统确定美学效果。
结果
共有60名青少年接受了乳房缩小术（“Wise”/下蒂 = 80.0%，“Wise”/上内侧蒂 = 1.7%，垂直/上内侧蒂 = 18.3%）。报告术前疼痛的患者（“Wise” = 95.9%，垂直 = 72.7%，P = 0.039）更有可能接受“Wise”缩小术。接受“Wise”缩小术的患者也更有可能接受双侧缩小术（“Wise” = 93.9%；垂直 = 63.6%，P = 0.017）。主要和次要并发症发生率分别为1.7%（“Wise” = 2.0%，垂直 = 0%，P = 无统计学意义）和23.3%（“Wise” = 20.4%，垂直 = 36.4%，P = 无统计学意义）。接受“Wise”切口的青少年在乳头乳晕复合体轮廓（“Wise” = 61%，垂直 = 47%，P = 0.028）和整体美学效果（“Wise” = 25%，垂直 = 17%，P = 0.008）方面有统计学显著改善，瘢痕不是负面因素（“Wise” = -16%；垂直 = -35%，P = 0.004）。两组患者满意度相当。
结论
乳房缩小术是治疗青少年巨乳症的一种安全、有效的方法。“Wise”和垂直模式在并发症和满意度方面的相似性表明，这两种技术都可以在青少年人群中安全实施，并能整体改善美学效果。
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