Department of Plastic Reconstructive and Aesthetic Surgery, Private Acıbadem Maslak Hospital, 34457, Sarıyer, İstanbul, Turkey.
Aesthetic Plast Surg. 2024 Mar;48(5):905-913. doi: 10.1007/s00266-022-03241-7. Epub 2023 Jan 3.
Despite the advantages of the superior pedicles in breast reduction, there are some limitations with this technique. The mobility of the pedicle may be augmented by liposuction in the pedicle area which may relieve tissue resistance and decrease pedicle compression in order to overcome circulation problems. In fact, the indications of breast reduction using superior pedicles may be expanded by liposuction in the pedicle area.
The patients who underwent breast reduction with superior pedicle techniques between March 2014 and November 2020 and whose pedicle resistances were decreased by liposuction were included in this study. Internal breast morphology was classified into three groups based on the morphology of the periareolar tissues. Group 1 breasts were lipomatous, Group 2 breasts were lipo-glandular and Group 3 breasts were fibroglandular. During the short-term follow-up, the circulation of the nipple-areola complex (NAC) was evaluated both clinically and with an hand held Doppler device. The long-term aesthetic results were evaluated at the postoperative twelfth month with a visual analogue scale.
One hundred eighty-nine patients with either Group 1 or Group 2 breasts were included in this study. The mean age of the patients was 38.3 years. The mean follow-up period was 31.7 months. Neither partial nor total NAC loss was observed and none of the patients had bottoming-out deformity.
Liposuction to the pedicle area is an effective and reliable method that both reduces the resistance in the pedicle and overcomes the circulation problems in certain patient groups (groups 1 and 2), increases the mobilization of the pedicle, reduces the breast to the desired size and prevents bottoming-out in the long term and increases the use of superior pedicle techniques. According to our clinical results, it was demonstrated that pedicle vascular mapping with preoperative Doppler sonography was not necessary in these patients.
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尽管在乳房缩小术中使用优势皮瓣有很多优势，但这种技术也存在一些局限性。通过在皮瓣区域内进行吸脂术，可以增加皮瓣的活动性，减轻组织阻力，减少皮瓣压迫，从而克服循环问题。事实上，通过在皮瓣区域内进行吸脂术，可以扩大使用优势皮瓣进行乳房缩小术的适应证。
本研究纳入了 2014 年 3 月至 2020 年 11 月间接受优势皮瓣技术乳房缩小术的患者，且其皮瓣阻力通过吸脂术降低。根据乳晕周围组织的形态将乳房内部形态分为三组。第 1 组乳房为脂肪瘤型，第 2 组乳房为脂肪腺体型，第 3 组乳房为纤维腺体型。在短期随访中，通过临床和手持多普勒设备评估乳头乳晕复合体（NAC）的循环情况。术后第 12 个月通过视觉模拟评分评估长期美学效果。
本研究纳入了 189 例第 1 组或第 2 组乳房的患者。患者的平均年龄为 38.3 岁。平均随访时间为 31.7 个月。未观察到部分或完全 NAC 丢失，也没有患者出现底部凹陷畸形。
向皮瓣区域进行吸脂术是一种有效且可靠的方法，既可以降低皮瓣阻力，又可以克服某些患者群体（第 1 组和第 2 组）的循环问题，增加皮瓣的活动度，将乳房缩小到所需的大小，并在长期内防止底部凹陷，增加使用优势皮瓣技术的机会。根据我们的临床结果，在这些患者中，术前多普勒超声皮瓣血管造影术并不是必需的。
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