Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy.
Aesthetic Plast Surg. 2022 Oct;46(5):2164-2173. doi: 10.1007/s00266-021-02615-7. Epub 2021 Oct 1.
Breast remodeling following breast-conserving surgery (BCS) and radiation therapy (RT) is challenging and often burdened by complications due to irradiated tissue atrophy. The authors present a case-control study to compare the central mound mastopexy (CMM) to more conventional techniques, applying it to different patterns of skin excision.
A variation of the original central mound technique is presented separately addressing glandular and cutaneous deformities. Between 2012 and 2018, 17 consecutive patients presenting defects following unilateral BCS and RT underwent breast remodeling with CMM technique. Immediate and long-term complications together with patient-reported outcomes were evaluated and compared to a matched control group of sixteen patients who underwent superior pedicle mammoplasty. Two independent plastic surgeons reviewed pre- and postoperative photographs and rated the cosmetic outcomes on a visual analog scale from 1 to 5.
In the study group, different patterns of skin excision, i.e., inverted-T pattern (41.2%), circumareolar (23.5%), skin-sparing type V (17.65%), omega (11.77%), and J (5.88%), were used to correct various breast deformities, and a decisional algorithm was developed. No major complications were registered. Retraction recurrence rate was higher in the control group (p = 0.037). Cosmetic results were considered more satisfying in the CMM group by both patients (4.18 vs 3.00, p<0.001) and surgeons (4.06 vs 2.69, p=0.001).
The CMM technique is an advanced approach that addresses breast remodeling after BCS-RT surgery yielding reliable results. Following our algorithm, several patterns of skin excision, tailored to pre-existing scars, can be considered and safely performed.
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保乳手术后（BCS）和放射治疗（RT）后的乳房重塑具有挑战性，并且由于放射治疗引起的组织萎缩，常常伴有并发症。作者报告了一项病例对照研究，比较了中央丘乳晕成形术（CMM）与更传统的技术，将其应用于不同的皮肤切除模式。
作者提出了一种中央丘技术的变体，分别针对腺体和皮肤畸形。在 2012 年至 2018 年间，17 例单侧 BCS 和 RT 后出现缺陷的连续患者接受了 CMM 技术的乳房重塑。评估了即刻和长期并发症以及患者报告的结果，并与 16 例接受上蒂乳晕成形术的匹配对照组进行了比较。两名独立的整形外科医生回顾了术前和术后的照片，并使用 1 到 5 的视觉模拟量表对美容结果进行评分。
在研究组中，使用了不同的皮肤切除模式，即倒置 T 形（41.2%）、乳晕周围（23.5%）、保留皮肤的 V 形（17.65%）、Ω形（11.77%）和 J 形（5.88%），以矫正各种乳房畸形，并制定了决策算法。未发生重大并发症。对照组的回缩复发率较高（p=0.037）。患者（4.18 比 3.00，p<0.001）和外科医生（4.06 比 2.69，p=0.001）均认为 CMM 组的美容效果更令人满意。
CMM 技术是一种先进的方法，可对 BCS-RT 手术后的乳房重塑产生可靠的效果。根据我们的算法，可以考虑并安全地进行几种针对现有疤痕的皮肤切除模式。
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