Maillard G F, Garey L J
Plast Reconstr Surg. 1987 Sep;80(3):396-408. doi: 10.1097/00006534-198709000-00010.
Subcutaneous mastectomy is becoming an operation of choice in certain cases of premalignant and other breast pathology. We describe a technique for simultaneous subcutaneous mastectomy and retropectoral implantation of a silicone prosthesis. Gentle blunt prepectoral, retromammary dissection is performed through an axillary incision as far inferiorly as the inframammary fold, where a fibrous bridge between the anterior surface of the pectoralis major muscle and the skin prevents dissection any lower. Through the same incision, the retropectoral space is dissected to about 5 cm below the inframammary fold. A second incision is made in the inframammary fold to join the retromammary plane of the first dissection. The gland is then dissected subcutaneously and removed through the inframammary incision. A silicone implant is introduced retropectorally through the axillary incision, thus avoiding splitting the pectoralis major. Satisfactory results have been obtained in 23 bilateral and 14 unilateral cases; it is important that the dissection be performed carefully in order to prevent the implant from riding up too high in its musculoaponeurotic sling.
皮下乳房切除术在某些癌前病变及其他乳腺疾病的治疗中逐渐成为首选手术。我们描述一种同时进行皮下乳房切除术及硅凝胶假体胸肌后植入的技术。通过腋窝切口轻柔钝性分离胸肌前、乳腺后间隙，向下至乳房下皱襞，此处胸大肌前表面与皮肤之间的纤维桥阻止了更低位置的分离。通过同一切口，将胸肌后间隙分离至乳房下皱襞以下约5厘米处。在乳房下皱襞处做第二个切口以连接第一次分离的乳腺后平面。然后在皮下分离腺体并通过乳房下切口取出。通过腋窝切口将硅凝胶假体植入胸肌后，从而避免劈开胸大肌。23例双侧及14例单侧手术均取得了满意效果；重要的是分离操作要仔细，以防止假体在其肌肉腱膜吊带中向上移位过高。
