Kanjoor James Roy, Jain Aakansh, Pakkiri Sathya
Roys Cosmetic Surgery Centre, Coimbatore, Tamil Nadu, India.
Indian J Plast Surg. 2024 Jun 20;57(6):440-446. doi: 10.1055/s-0044-1787721. eCollection 2024 Dec.
Reduction of very huge breast-gigantic macromastia-is a challenge to breast surgeons in choosing the right procedure to obtain an optimal outcome. The feasibility of a superomedial pedicle (SMP) with some modifications proves to be a good option to achieve a viable nipple areolar complex (NAC) with good size and shape after good resection above 800 g. Out of the 35 patients with 70 breast reductions, 15 can be considered gigantic macromastia with reductions above 800 g. A retrospective analysis of 30 breast reductions in these 15 patients from 2010 to 2023 was done. All cases were done using SMP with some modifications. The sternal notch to the nipple, the new NAC site, pedicle length, resection weight, and complications were analyzed. The modifications followed were lowering the new NAC, narrowing the distance between medial and lateral pillar width, medializing the pedicle, and lengthening the vertical limb. There was no total necrosis of the NAC. Partial necrosis occurred in three patients that were managed conservatively and one case of fat necrosis needed debridement. All of them had a good size, shape, and form. SMP is a versatile technique with flexibility to modify the dimensions to get a robust blood supply to the NAC, after obtaining an adequate resection.
对于乳房外科医生而言，缩小非常巨大的乳房——巨乳症——是一项挑战，即要选择合适的手术方式以获得最佳效果。改良后的超内侧蒂（SMP）技术在切除超过800克的乳腺组织后，被证明是一种可行的选择，能够使乳头乳晕复合体（NAC）保持良好的大小和形状。在35例接受70次乳房缩小手术的患者中，有15例可被视为巨乳症，其切除的乳腺组织超过800克。对这15例患者在2010年至2023年间进行的30次乳房缩小手术进行了回顾性分析。所有病例均采用改良后的SMP技术。分析了胸骨切迹至乳头的距离、新乳头乳晕复合体的位置、蒂的长度、切除的重量以及并发症情况。所采用的改良措施包括降低新乳头乳晕复合体的位置、缩小内侧和外侧支柱的宽度、将蒂向内侧移位以及延长垂直肢。乳头乳晕复合体未出现完全坏死的情况。3例患者出现了部分坏死，经保守治疗后痊愈，1例脂肪坏死患者需要进行清创处理。所有患者的乳头乳晕复合体大小、形状和形态均良好。SMP技术是一种多功能技术，在进行充分切除后，能够灵活调整尺寸，为乳头乳晕复合体提供充足的血供。
