Goldammer F, Bodin F, Bruant-Rodier C, Ruffenach L, Dissaux C
Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France.
Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France.
Ann Chir Plast Esthet. 2020 Apr;65(2):116-123. doi: 10.1016/j.anplas.2020.01.005. Epub 2020 Mar 10.
The need of iterative surgeries, the proximity of two anatomical areas, the combination of an aesthetic surgery with a surgery covered by health insurance are the reasons which motivated the authors to provide a simultaneous procedure on arms and breast in patients achieving massive weight loss. We propose a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision to treat the excess skin and subcutaneous tissue of the lateral chest wall, either by resection, or by increasing the breast with the patients own autologous tissue.
Between 2010 and 2017, twelve patients aged between 31 and 56 years, with 42 being the average, have undergone a technique that utilises a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision: transverse skin incisions and free nipple transplantation for correction of extreme gynaecomastia (2 cases), mastopexy with resection of the excess tissue of the lateral chest wall (8 cases), autologous breast augmentation by the use of intercostal artery perforator flaps (2 cases). Mean body mass index (BMI) was 24kg/m [23; 32] after average weight loss of 56kg [14; 112] following diet (3 cases) or bariatric surgery (9 cases).
Mean operative time was 4hours [3: 6], mean length of hospital stay was 4 days [2; 9]. We observed one major complication (hematoma) and one minor complication (wound dehiscence). At a mean follow-up of 21 months (ranged from 15 days to 84 months), the lateral flank scarring was well tolerated, with the additional benefit of reducing flank fullness.
The extended lateral flank scar allows reducing the excess skin and subcutaneous tissue of the lateral chest wall, while being easily concealable. This technique offers an elegant solution to this excess that used to persist after multistage surgeries.
多次手术的需求、两个解剖区域的临近性、美容手术与医疗保险覆盖手术的结合，是促使作者为大量减重患者同时进行手臂和乳房手术的原因。我们建议将外侧乳房上提术切口向上垂直延续，并与同期的上臂整形术切口相连，以通过切除或利用患者自身自体组织增大乳房的方式，处理外侧胸壁多余的皮肤和皮下组织。
2010年至2017年期间，12名年龄在31至56岁之间（平均年龄42岁）的患者接受了一种技术，该技术将外侧乳房上提术切口向上垂直延续，并与同期的上臂整形术切口相连：采用横向皮肤切口和游离乳头移植来矫正严重男性乳房发育症（2例），乳房上提术并切除外侧胸壁多余组织（8例），使用肋间动脉穿支皮瓣进行自体乳房增大术（2例）。在通过节食（3例）或减重手术（9例）平均减重56kg[14；112]后，平均体重指数（BMI）为24kg/m²[23；32]。
平均手术时间为4小时[3；6]，平均住院时间为4天[2；9]。我们观察到1例主要并发症（血肿）和1例轻微并发症（伤口裂开）。平均随访21个月（范围从15天至84个月），外侧胁腹瘢痕耐受良好，还有减少胁腹丰满度的额外益处。
延长的外侧胁腹瘢痕能够减少外侧胸壁多余的皮肤和皮下组织，同时易于隐藏。该技术为过去在多阶段手术后仍持续存在的这种多余情况提供了一种优雅的解决方案。
