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[摘要]目的：介绍一种安全易行，无纵向手术瘢痕的巨大乳房缩小术。方法：自2013年10月至2016年6月笔者科室共应用该法治疗9名巨乳患者，共18只乳房。该术式重新设计乳头乳晕位置，距乳头下方6.5cm设计新乳房下皱襞线，原乳头乳晕宽下蒂，去表皮，切除新乳房下皱襞与下蒂之间的乳房组织， 原乳头乳晕通过上部皮瓣缝合至新的乳头乳晕位置。结果：术后乳头乳晕血供良好，手术瘢痕隐藏在乳房下皱襞，避免了纵向瘢痕。结论：本术式对于缩小重度巨乳或严重下垂的乳房，安全易行，并且手术瘢痕隐蔽，值得临床推广。
[关键词]巨乳；乳房下垂；乳房缩小；纵向瘢痕
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2017）09-0040-03
Reduction Mammaplasty Avoiding a Longitudinal Scar
YU Xiao-jiang1，GUO Meng-jie2，TAO Cheng-man2，YANG Jian-rong2，ZHAO Yan-ting2，XU Xing-jun2，YUAN Qing-ri2，MENG Xiang-hong2，SHEN Gan2
（1.Helie Community Health Center，Binghu District，Wuxi 214100，Jiangsu，China；2.Department of Plastic Surgery，the Second Affiliated Hospital of Nanjing Medical University，Nanjing 210003，Jiangsu，China）
Abstract： Objective To introduce a safe and easy method for reduction of large breast without longitudinal scar. Methods From October 2013 to June 2016， this technique was applied for 9 patients with macromastia or severe mastoptosis， 18 breasts were included totally. New position of nipple areola nipple was designed， a new inframammary line（IML） which 6.5cm below the new nipple was marked， a wide lower pedicle which carried the original the nipple-areola complex （NAC） was deepithelialized， breast tissue between new IML and lower pedicle was resected ，then the NAC was passed under the upper apron flap through its new opening. Results The amount of resected breast tissue was large， the average weight of breast tissue excised was 798g per side. The blood supply for nipple areola was good， and surgery scar was hidden in IML， to avoid vertical scar. Only minor complications was found in 2 patients. Conclusion This technique was a safe and easy method for the severe macromastia or severe mastoptosis， and the surgery scar was concealed.it is worthy of clinical promotion.
Key words： macromastia； mastoptosis；reduction mammaplasty；longitudinal scar
乳房縮小术式到目前为止有十余种[1-2]，但都或多或少存在缺陷。乳房缩小术最突出的一个并发症就是瘢痕遗留，会在乳房下部产生明显的倒“T”形瘢痕。自2005年起，笔者科室应用改良上蒂乳房缩小术[3]，但依然可在乳房遗留纵形瘢痕，有些患者无法接受，而且对于重度乳房增大或乳房严重下垂的患者，此法的应用受到限制。自2013年10月，笔者科室使用无纵向手术瘢痕的巨乳缩小术，对重度巨乳或严重下垂的乳房进行修复重建，效果满意，现报道如下。
1 资料和方法
1.1 一般资料：本组病例共9例，女性，年龄29～53岁，手术乳房共18只，均为重度乳房肥大并伴有重度下垂，锁骨中点至乳头的平均距离为31cm，且左右不对称。
1.2 手术方法
1.2.1 手术设计：①乳头位置：患者取站立位，标记锁骨中点到乳头的轴线，新乳头的位置在该轴线上，距离锁骨中点19～22cm，并且通常是乳房中轴线与乳房下皱襞线交点的乳房体表投影点，以乳头为中心，画出乳晕周线，新乳晕直径为3～4cm；②乳房下皱襞线：从新乳头中心向下方6.5cm，标记弧形新乳房下皱襞线；③乳头乳晕下蒂及切除范围：标记原乳房下皱襞线，以原有乳头为中心，保留乳晕直径约4～5cm，在该外缘上方平行于新乳房下皱襞线同样标记一弧形线，该线与原乳房下皱襞线交汇，两线间区域为去表皮范围（如图1～2中斜线标记部分），称之为乳头乳晕下蒂，宽度为80%～90%的原乳房下皱襞线；两平行弧线之间的区域为切除范围（如图1～2中小圆圈标记部分）。
[关键词]巨乳；乳房下垂；乳房缩小；纵向瘢痕
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2017）09-0040-03
Reduction Mammaplasty Avoiding a Longitudinal Scar
YU Xiao-jiang1，GUO Meng-jie2，TAO Cheng-man2，YANG Jian-rong2，ZHAO Yan-ting2，XU Xing-jun2，YUAN Qing-ri2，MENG Xiang-hong2，SHEN Gan2
（1.Helie Community Health Center，Binghu District，Wuxi 214100，Jiangsu，China；2.Department of Plastic Surgery，the Second Affiliated Hospital of Nanjing Medical University，Nanjing 210003，Jiangsu，China）
Abstract： Objective To introduce a safe and easy method for reduction of large breast without longitudinal scar. Methods From October 2013 to June 2016， this technique was applied for 9 patients with macromastia or severe mastoptosis， 18 breasts were included totally. New position of nipple areola nipple was designed， a new inframammary line（IML） which 6.5cm below the new nipple was marked， a wide lower pedicle which carried the original the nipple-areola complex （NAC） was deepithelialized， breast tissue between new IML and lower pedicle was resected ，then the NAC was passed under the upper apron flap through its new opening. Results The amount of resected breast tissue was large， the average weight of breast tissue excised was 798g per side. The blood supply for nipple areola was good， and surgery scar was hidden in IML， to avoid vertical scar. Only minor complications was found in 2 patients. Conclusion This technique was a safe and easy method for the severe macromastia or severe mastoptosis， and the surgery scar was concealed.it is worthy of clinical promotion.
Key words： macromastia； mastoptosis；reduction mammaplasty；longitudinal scar
乳房縮小术式到目前为止有十余种[1-2]，但都或多或少存在缺陷。乳房缩小术最突出的一个并发症就是瘢痕遗留，会在乳房下部产生明显的倒“T”形瘢痕。自2005年起，笔者科室应用改良上蒂乳房缩小术[3]，但依然可在乳房遗留纵形瘢痕，有些患者无法接受，而且对于重度乳房增大或乳房严重下垂的患者，此法的应用受到限制。自2013年10月，笔者科室使用无纵向手术瘢痕的巨乳缩小术，对重度巨乳或严重下垂的乳房进行修复重建，效果满意，现报道如下。
1 资料和方法
1.1 一般资料：本组病例共9例，女性，年龄29～53岁，手术乳房共18只，均为重度乳房肥大并伴有重度下垂，锁骨中点至乳头的平均距离为31cm，且左右不对称。
1.2 手术方法
1.2.1 手术设计：①乳头位置：患者取站立位，标记锁骨中点到乳头的轴线，新乳头的位置在该轴线上，距离锁骨中点19～22cm，并且通常是乳房中轴线与乳房下皱襞线交点的乳房体表投影点，以乳头为中心，画出乳晕周线，新乳晕直径为3～4cm；②乳房下皱襞线：从新乳头中心向下方6.5cm，标记弧形新乳房下皱襞线；③乳头乳晕下蒂及切除范围：标记原乳房下皱襞线，以原有乳头为中心，保留乳晕直径约4～5cm，在该外缘上方平行于新乳房下皱襞线同样标记一弧形线，该线与原乳房下皱襞线交汇，两线间区域为去表皮范围（如图1～2中斜线标记部分），称之为乳头乳晕下蒂，宽度为80%～90%的原乳房下皱襞线；两平行弧线之间的区域为切除范围（如图1～2中小圆圈标记部分）。