Simultaneous Augmentation Mastopexy: A Technique for Maximum En Bloc Skin Resection Using the Inverted-T Pattern Regardless of Implant Size, Asymmetry, or Ptosis
Simultaneous Augmentation Mastopexy: A Technique for Maximum En Bloc Skin Resection Using the Inverted-T Pattern Regardless of Implant Size, Asymmetry, or Ptosis
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DOI：
10.1007/s00266-011-9796-7
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发表时间：
2012-04-01
影响因子：
2.4
通讯作者：
Eisenberg, Ted
中科院分区：
文献类型：
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作者：
Eisenberg, Ted
对于中度到重度上睑下垂的乳房，同时隆乳固定术面临的挑战是确定植入后应去除多少多余的皮肤以创造对称性，并在不影响组织血管的情况下最大限度地收紧皮肤。同时隆乳固定术涉及植入后多余皮肤的内陷和裁剪缝合，然后在缝合的组织周围制作图案，以预视待切除的总面积。这与首先制作乳房固定术的图案，切除皮肤，然后将组织缝合在一起形成鲜明对比。在7年的时间里，55名女性同时接受了这种方法的乳房隆起术。在乳房固定术开始前，将生理盐水植入胸骨下双平面位置。所有手术均在患者全身麻醉下进行，患者于当天出院。在一份回顾图表中，记录了乳房假体的大小、术前不对称程度、手术时间和并发症。患者随访3个月至7年，中位数为9个月，所有患者均获得对称性、美观效果。生理盐水植入范围375~775毫升，平均500毫升。在55名女性中，15名接受了两种不同大小的植入物，其大小至少为50毫升或更大，其中患者的最大尺寸差异为225毫升(左乳房为700毫升；右乳房为475毫升)。6例(10.9%)有小面积二次创面愈合，多发生在T内陷的下缘，仅2例(3.6%)复发，1例(1.8%)轻度增生性瘢痕。无血肿、感染、皱纹、乳头乳晕复合体(NAC)错位、NAC丢失、包膜收缩、种植体错位或对种植体大小不满意等并发症。双侧隆乳手术时间分别为2小时和29分钟至4小时30分钟(平均为3小时和8分钟)，最大限度地增加了同时隆乳术中切除的组织数量。无论植入物的大小或要切除的皮肤量如何，这种方法更容易实现对称性。这项技术最大限度地减少了断流皮肤边缘造成的组织坏死的机会。可缩短T形倒置瘢痕，缩短手术时间。
Simultaneous augmentation mastopexy for moderately to severely ptotic breasts presents the challenge of determining how much excess skin should be removed after implant placement to create symmetry and provide for maximal skin tightening without compromising tissue vascularization.Simultaneous augmentation mastopexy involves invagination and tailor tacking of the excess skin after implant placement and then making a pattern around the tailor-tacked tissues for previsualization of the total area to be resected. This contrasts with first making a pattern for the mastopexy, resecting the skin, and then tailor tacking the tissues together. Over a 7-year period, 55 women had simultaneous augmentation mastopexy with this approach. Saline implants were placed in the subpectoral dual-plane position before the mastopexy was started. All surgeries were performed with the patient under general anesthesia, and the patients were discharged the same day. In a retrospective chart review, breast implant size, degree of preoperative asymmetry, length of procedure, and complications were recorded. The patient follow-up period ranged from 3 months to 7 years (median, 9 months).Symmetric, aesthetic results were achieved for all the patients. The range of saline implants used was 375-775 ml (average, 500 ml). Of the 55 women, 15 had two different size implants measuring at least 50 ml or larger, with the greatest size disparity in a patient being 225 ml (left breast, 700 ml; right breast, 475 ml). Six of the patients (10.9%) had small areas that healed by secondary intention, occurring mostly at the inferior junction of the inverted T. Only two patients (3.6%) had recurrence of breast ptosis, and only one patient (1.8%) had a mildly hypertrophic scar. There were no incidences of hematoma, infection, rippling, malposition of the nipple-areolar complex (NAC), NAC loss, capsular contraction, implant malposition, or dissatisfaction with implant size. The bilateral augmentation/mastopexy surgery time ranged from 2 h and 29 min to 4 h and 30 min (average, 3 h and 8 min).The described technique maximizes the amount of tissue to be resected in simultaneous augmentation mastopexy for moderately to severely ptotic breasts. Symmetry is more easily achieved with this approach regardless of the implant size used or the amount of skin to be resected. This technique minimizes the chance of tissue necrosis from devascularized skin edges. It also may shorten the inverted T scar and reduce the operative time.