Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Plast Reconstr Aesthet Surg. 2024 Aug;95:7-14. doi: 10.1016/j.bjps.2024.04.012. Epub 2024 Apr 15.
The choice of pedicle in reduction mammaplasty is highly variable with prior studies demonstrating high patient satisfaction in most cases. This study aimed to examine the impact of pedicle type on clinical and patient-reported outcomes in patients undergoing reduction mammaplasty.
A total of 588 patients underwent bilateral reduction mammaplasty with Wise pattern or modified Robertson incision by 13 surgeons at a single institution. Clinical outcomes were compared according to the pedicle type in all patients and BREAST-Q responders (32% response rate). Survey respondents were sub-grouped by resection volume, and the BREAST-Q satisfaction scores were compared.
Among all included reduction mammoplasties, 439 (75%) were performed using inferior pedicles, and 149 (25%) using superior or superomedial pedicles. Responders and non-responders were similar in preoperative characteristics including age, body measurements, and comorbidities. Although a higher incidence of infection occurred among the responders, clinical outcomes were comparable across all pedicle types. A total of 187 patients completed the BREAST-Q. Compared to the superior pedicle group, respondents in the inferior pedicle group reported higher nipple satisfaction, even when adjusted for resection weight over 500 g. In contrast, the superior pedicle group had better sexual well-being scores, which persisted in resection weight less than 500 g (all p values <0.05).
Inferior pedicles were associated with greater nipple satisfaction and superior pedicles were associated with greater sexual satisfaction. Our findings suggest that those with resections less than 500 g were more satisfied with superior pedicles whereas those with greater resections were more satisfied with inferior pedicles.
缩乳术的皮瓣选择差异较大，既往研究表明大多数情况下患者满意度较高。本研究旨在探讨皮瓣类型对接受缩乳术患者的临床和患者报告结果的影响。
共有 588 名患者在一家机构由 13 名外科医生行双侧缩乳术，皮瓣类型采用 Wise 或改良 Robertson 切口。比较了所有患者和 BREAST-Q 应答者（应答率 32%）的皮瓣类型的临床结果。根据切除体积对调查受访者进行亚组分析，并比较 BREAST-Q 满意度评分。
在所有纳入的缩乳术中，439 例（75%）采用下蒂皮瓣，149 例（25%）采用上蒂或上内蒂皮瓣。应答者和非应答者在术前特征（包括年龄、身体测量和合并症）方面相似。尽管应答者中感染发生率较高，但所有皮瓣类型的临床结果相似。共有 187 名患者完成了 BREAST-Q。与上蒂皮瓣组相比，下蒂皮瓣组的应答者报告乳头满意度更高，即使调整了 500g 以上的切除重量也是如此。相比之下，上蒂皮瓣组的性健康评分更高，在切除重量小于 500g 时仍然存在（所有 p 值均<0.05）。
下蒂皮瓣与更高的乳头满意度相关，而上蒂皮瓣与更高的性满意度相关。我们的研究结果表明，切除重量小于 500g 的患者对上蒂皮瓣更满意，而切除重量较大的患者对下蒂皮瓣更满意。
