Smoot E C
Division of Plastic and Reconstructive Surgery, University of Tennessee at Memphis, 38163, USA.
Ann Plast Surg. 1998 Oct;41(4):378-83. doi: 10.1097/00000637-199810000-00005.
Skin redundancy following mastectomy for gynecomastia does not shrink and resolve in a predictable manner. Excess skin can be addressed best with resection at the time of the original operation if the scar can be minimized. Previously described techniques for resection of skin have shortcomings that include unacceptable scars, poor nipple positioning, and bulkiness of redundant, folded dermal tissue. The current technique for grade 2 and some grade 3 gynecomastias is performed with the creation of a 20-mm-diameter nipple-areolar complex based as a cephalad flap and designed eccentrically around the existing nipple. Eccentric skin resection in the vertical and horizontal planes is performed below the areolar flap. Wide access for completion of mastectomy is gained. The wound is then closed with a subcutaneous purse-string suture and inset of the areolar flap so that the scars are confined to the circumareolar area. This allows immediate skin recontouring with minimal skin scar. The patient does not have to endure prolonged anxiety while awaiting skin contracture, and this procedure eliminates the possible need for secondary surgery to resect redundant skin.
男性乳房肥大症乳房切除术后的皮肤冗余不会以可预测的方式收缩和消退。如果能将瘢痕最小化，在初次手术时进行切除是处理多余皮肤的最佳方法。先前描述的皮肤切除技术存在缺点，包括不可接受的瘢痕、乳头定位不佳以及冗余、折叠的真皮组织臃肿。目前针对2级和部分3级男性乳房肥大症的技术是，制作一个直径20毫米的乳头乳晕复合体作为头侧皮瓣，并围绕现有乳头偏心设计。在乳晕皮瓣下方进行垂直和水平平面的偏心皮肤切除。获得了完成乳房切除术的广泛入路。然后用皮下荷包缝合关闭伤口并植入乳晕皮瓣，使瘢痕局限于乳晕周围区域。这可以立即进行皮肤重塑，同时使皮肤瘢痕最小化。患者无需在等待皮肤挛缩的过程中忍受长时间的焦虑，并且该手术消除了二次手术切除多余皮肤的可能性。
