Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel-Aviv, Israel.
Aesthetic Plast Surg. 2021 Apr;45(2):375-385. doi: 10.1007/s00266-020-01973-y. Epub 2020 Sep 22.
Reduction mammoplasty in patients with gigantic breast hypertrophy runs a high risk of complication. Traditionally, inferior pedicle reductions or free nipple grafting techniques have been recommended for gigantic breasts on the basis of measurements and expected resection weights. The superiomedial pedicle (SMP) technique has been less commonly used, due to concerns of vascular inadequacy. This study examines the outcomes of SMP in large reductions and outlines suggested modifications for enhanced safety.
This is a retrospective review of all patients who underwent SMP breast reduction in our institution between 2005 and 2016. Included are cases with resection weights greater than 800 g.
A total of 173 patients with 341 breasts were included. Mean sternal notch to nipple (SNN) distance was mean 35.0 ± 6.6 cm (range 23-44.5) on the left and 34.9 ± 6.6 cm (range 18-46) on the right. Mean resection weight was 1152.2 ± 368.6 g (range 810-2926) on the left and 1159.4 ± 326.6 g (range 800-2528) on the right. The total complication rate was 22.7%. Minor complications occurred in 63 (18.6%) breasts. Major complications occurred in 12 (4.1%) breasts. NAC congestion and partial necrosis occurred in 1.8% and total NAC necrosis in 0.9%.
The SMP reduction technique is a safe option for gigantic breast reduction with comparable complication rates to other techniques. Preoperative measurements or resection weights are not reliable risk factors alone. High tissue density may be a significant risk factor. High-risk breasts mandate surgical planning and should be tailored to include technical modifications as described.
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巨大乳房肥大症患者的缩乳术存在较高的并发症风险。传统上，根据测量和预期切除重量，建议采用下蒂或游离乳头移植技术来处理巨大乳房。由于担心血管不足，内侧上蒂（SMP）技术的应用较少。本研究检查了 SMP 在大切除术中的效果，并提出了增强安全性的建议修改。
这是对我们机构 2005 年至 2016 年间接受 SMP 乳房缩小术的所有患者进行的回顾性研究。纳入的病例切除重量大于 800g。
共纳入 173 例患者，341 只乳房。左侧胸骨切迹到乳头（SNN）的平均距离为 35.0±6.6cm（范围 23-44.5），右侧为 34.9±6.6cm（范围 18-46）。左侧的平均切除重量为 1152.2±368.6g（范围 810-2926），右侧为 1159.4±326.6g（范围 800-2528）。总并发症发生率为 22.7%。63 只（18.6%）乳房出现轻微并发症。12 只（4.1%）乳房发生严重并发症。NAC 淤血和部分坏死发生率为 1.8%，NAC 完全坏死发生率为 0.9%。
SMP 缩小技术是巨大乳房缩小的安全选择，其并发症发生率与其他技术相当。术前测量或切除重量本身并不是可靠的危险因素。高组织密度可能是一个显著的危险因素。高危乳房需要进行手术规划，并应根据需要进行技术修改，包括描述的修改。
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