保留乳腺导管的乳头缩小术

目的 探索一种既保留乳头功能又缩小肥大乳头的高度和直径的乳头缩小术式.方法 自2009年1月至2011年1月,对21例乳头肥大患者行保留乳头头部皮肤和大部分乳腺导管并缩小乳头的手术.通过切除肥大乳头侧面一个"W"形的皮肤和皮下组织,形成基底部和颈部各3个三角形皮瓣,保留中央乳腺导管的方法来缩小乳头的直径和高度.结果 术后随访21例患者3～18个月,其中仅1例患者双侧乳头不对称,再次手术矫正后满意;余20例患者其术后乳头的直径和高度均明显减小,手术切口均Ⅰ期愈合,且瘢痕不明显,乳头感觉和勃起功能正常,效果均满意.结论 该术式在保留大部分乳腺导管的同时缩小了乳头的直径和高度,手术过程操作简单,术后效果可靠,是一种值得推广的新术式.     

改良双环加楔形切除法乳头缩小术

目的:探讨一种既保留乳头正常功能又能缩小肥大乳头的术式。方法:切除肥大乳头内侧面楔形皮肤和皮下组织,注意保留中央乳腺导管,环形去除乳头基部及少许外围表皮,从而缩小乳头的直径和高度。结果:术后随访18例患者3~18个月,效果均满意,瘢痕不明显,乳头感觉及勃起功能正常。结论:本术式保留了大部分乳头的乳腺导管,保证乳头血供破坏少,可同时减小乳头直径和高度,手术操作不复杂,术后效果好,值得进一步推广应用。     

乳头肥大缩小整形的新方法

目的　介绍一种具有较好外形及功能的乳头肥大缩小整形的新方法。方法　局部麻醉下按设计线切除肥大的乳头顶部多余的皮肤及皮下组织 ,注意不要伤及乳腺管 (特别是对未哺乳的患者 ) ,在皮下分离乳头基底部组织 ,对皮下组织肥厚者可切除部分皮下组织。结果　为 17例双侧乳头肥大者行乳头缩小整形术 ,均取得满意效果。结论　这种新方法可以使乳头肥大且两侧形态、大小各异的乳头缩小 ,形成符合美学标准的乳头 ,满足了患者的要求 ,并且愈合快、肿胀轻 ,不破坏乳头的感觉及血运 ,术后不影响哺乳     

乳头肥大缩小整形的新方法

目的介绍一种具有较好外形及功能的乳头肥大缩小整形的新方法.方法局部麻醉下按设计线切除肥大的乳头顶部多余的皮肤及皮下组织,注意不要伤及乳腺管(特别是对未哺乳的患者),在皮下分离乳头基底部组织,对皮下组织肥厚者可切除部分皮下组织.结果为17例双侧乳头肥大者行乳头缩小整形术,均取得满意效果.结论这种新方法可以使乳头肥大且两侧形态、大小各异的乳头缩小,形成符合美学标准的乳头,满足了患者的要求,并且愈合快、肿胀轻,不破坏乳头的感觉及血运,术后不影响哺乳.     

乳头肥大缩小整形的新方法

目的 介绍一种具有较好外形及功能的乳头肥大缩小整形的新方法。方法 局部麻醉下按设计线切除肥大的乳头顶部多余的皮肤及皮下组织，注意不要伤及乳腺管(特别是对未哺乳的患者)，在皮下分离乳头基底部组织。对皮下组织肥厚者可切除部分皮下组织。结果 为17例双侧乳头肥大者行乳头缩小整形术，均取得满意效果。结论 这种新方法可以使乳头肥大且两侧形态、大小各异的乳头缩小，形成符合美学标准的乳头，满足了患者的要求，并且愈合快、肿胀轻，不破坏乳头的感觉及血运，术后不影响哺乳。     

垂直切口上蒂法治疗乳房肥大的临床效果研究

目的:探讨垂直切口上蒂法治疗乳房肥大的临床效果.方法:2017年5月-2019年6月,采用垂直切口上蒂法治疗乳房肥大56例(112侧),根据术前设计去除蒂部表皮,切除多余的皮肤及乳腺组织,自下而上对合内外侧乳腺,V-Y推进乳头乳晕复合瓣至适当位置,固定乳头乳晕后,逐层缝合.结果:术后随访6～18个月,40例患者对术后乳...     

同时减小直径和高度的乳头缩小整形术

目的:探索一种能够有效减小直径和高度的乳头缩小方法。方法:在局麻下,于乳头圆柱体侧方楔形切除部分乳头组织(楔形顶端不超过乳腺导管开口)及与之相连的三角形乳晕区皮肤,再于乳头圆柱体下部环形切除乳头皮肤,切口对位间断缝合。结果:15例患者的30只乳头体积显著缩小,术后7天拆线时无乳头坏死,全部乳头感觉存在。11例于术后3个月～1年获得随访,乳头外形良好,切口瘢痕不明显,患者对术后效果表示满意。结论:本方法能够有效缩小乳头圆柱体的直径和高度,从而显著缩小乳头体积,具有简便、安全及最大限度保留乳头功能的特点。     

乳头缩小术的研究进展

目前,国内外对多种乳头缩小的手术方法均有报道.有一部分就医者因乳房萎缩和乳头肥大同时存在,或乳房发育不良与乳头肥大同时存在,故采用联合双侧乳房硅凝胶假体置入隆乳术,或自体脂肪游离移植隆乳术,同期矫正小乳畸形和乳头肥大畸形[1-3].现笔者就乳头缩小手术方法的研究进展,综述如下.     

乳头缩小术的研究进展

目前,国内外对多种乳头缩小的手术方法均有报道.有一部分就医者因乳房萎缩和乳头肥大同时存在,或乳房发育不良与乳头肥大同时存在,故采用联合双侧乳房硅凝胶假体置入隆乳术,或自体脂肪游离移植隆乳术,同期矫正小乳畸形和乳头肥大畸形[1-3].现笔者就乳头缩小手术方法的研究进展,综述如下.     

内上腺体蒂乳房缩小成形术

目的 探讨一种能够保持乳房功能和形成良好外观的乳房缩小成形术。方法 根据乳房肥大的程度设计不同类型的皮肤切口，采用内上腺体蒂技术，切除外上方和下方过多的乳腺组织，将保留的乳腺组织重新塑形，切除多余的皮肤后缝合切口。结果 本组36例72侧乳房术后形态良好，无并发症，乳头乳晕感觉良好，效果满意。结论 内上腺体蒂技术是一种安全、有效的手术方法，能获得持久的塑形效果，通过选择不同类型的皮肤切口可以适用于各种程度乳房肥大的矫治。     

舌形瓣法乳头男性化手术临床应用体会

目的:探讨女复男易性病患者乳头男性化的舌形瓣法手术治疗效果。方法:在原乳头12点方向及6点方向设计两个蒂在乳头基底部的对称舌形皮瓣,皮瓣蒂部宽约8mm,皮瓣长约6mm,手术切除两舌形瓣之间多余的乳头组织,舌形瓣对应间断缝合,形成新男性化乳头。结果:对78例女复男易性病患者实施了舌形瓣法乳头缩小术,乳头组织瓣血运好,全部成活,新乳头大小约5mm×4 mm,取得男性化的满意效果,无乳头坏死现象。结论:乳头舌形瓣设计灵活、血运可靠,方法易掌握,乳头男性化外观逼真,是女复男易性病及男性乳头肥大患者行乳头缩小美容的良好选择。     

纤维松解结合乳腺组织瓣矫治重度乳头内陷

目的：探索一种效果持久地矫治重度乳头内陷的方法，以降低重度乳头内陷的复发率。方法：通过直视下充分松解乳头下周围的纤维并切断短缩的乳头纤维组织，而后用乳腺组织瓣支撑以使乳头丰满的双重作用达到矫治重度乳头内陷的效果。结果：2001年1月至2004年4月采用此方法共治疗8例重度乳头内陷的患者，效果满意，术后切口，Ⅰ期愈合，无乳头血运障碍发生。远期随访乳头的感觉及勃起功能正常，乳房外形满意，无明显瘢痕。结论：该手术方法矫正重度乳头内陷效果确切，简单易行，大大降低了重度乳头内陷的复发率。     

A method for correcting an inverted nipple with an artificial dermis

Various methods have been reported to correct an inverted nipple. Although a satisfactory outcome has been reported with most techniques, each method carries a drawback inherent in the technique itself, including complicated operative technique, sensory disturbance of the nipple, marked scarring of the nipple areola and other donor regions, destruction of breast function, and incomplete correction.This report describes a simple method for correcting an inverted nipple. It incorporates a new concept of using artificial dermis for tissue augmentation and is performed without sacrificing any donor site and complex design. It was applied to four nipples in two nulliparous cases. For all four corrected inverted nipples, good results were obtained, and there have been no complications. There were no deformities of the nipples or the areolas after this procedure, and the surgical scars were inconspicuous.     

Nipple-sparing mastectomy: lessons from ex vivo procedures

Moderate size series have reported successful nipple-sparing mastectomy using a variety of surgical techniques. This study aimed to understand which aspects of these techniques are safe, necessary, and successful. Eight skin-sacrificing mastectomy specimens were used as ex vivo models of nipple-sparing mastectomy. After inking the resection margins of the specimen, the skin ellipse was elevated in the subcutaneous plane using a scalpel. The retroareolar breast tissue was taken as a margin specimen. The nipple was inverted and the nipple core removed. The hollowed-out nipple remnant (which would have remained with the patient in a true nipple-sparing mastectomy) was submitted for confirmatory histopathologic analysis. Precise identification of the duct margin directly beneath the nipple proved difficult once the duct bundle had been divided. Successful retroareolar margin identification was achieved by grasping the duct bundle with atraumatic forceps as soon as it became exposed. A cut made below and above the forceps resulted in a full cross-section of the duct bundle. Nipple core tissue was difficult to excise in one piece and cannot be oriented, thus complete evaluation of the specimen required examination of multiple levels. Histologic artifacts caused by freezing may be present in frozen sections of nipple core and retroareolar margin specimens; the impact of such changes must be considered when developing institutional protocols for this procedure. Evaluation of the hollowed-out nipple revealed that the inverted nipple must be substantially thinned to remove all ducts. Modification of technique resulted in more complete excision of duct tissue. This series of ex vivo procedures provides information that can be used to modify surgical and pathologic techniques for nipple-sparing mastectomy. When performing nipple-sparing mastectomy for breast cancer, these measures may be advisable as complements to careful patient selection.     

乳头颈缩窄加克氏针支撑法矫正重度乳头内陷

目的：介绍一种矫正重度乳头内陷的方法一乳头颈缩窄加克氏针支撑法。方法：2010年1月-2013年1月对25～35岁先天性重度内陷患者手术治疗11例22侧乳头。手术通过上下左右对称梭形切除乳头颈部分组织,松解不切断乳头下挛缩纤维束及乳腺管,乳头基底部荷包缝合,收紧基底部组织,克氏针穿过乳头基底支撑乳头,一个月后拔出克氏针。结果：术后乳头外形好,乳头挺拔,无勃起功能障碍,切口均为I期愈合,无乳头坏死及感染,除1例术后再次轻度内陷,其余均无复发。结果：本组11例中,术后门诊随访6个月～2年,无1例发生乳头感染、坏死,切口均为I期愈合,术后基本不影响哺乳功能。除1例患者术后一侧轻度回缩,其余患者均未复发。结论：乳头颈缩窄加克氏针支撑法矫正重度乳头内陷效果良好,可作为治疗重度乳房内陷的治疗方法之一。     

乳晕浅深层旋转三角形皮瓣和筋膜组织瓣治疗重度乳头内陷

目的 探讨矫正女性重度乳头内陷的手术治疗新方法.方法 首先在乳头区中央部标出重建乳头顶部位,再于其上、下两侧乳晕部分别设计浅深层的带蒂旋转三角形皮瓣和筋膜组织瓣,厚度约0.5 cm.皮瓣的血供来自乳晕皮下动脉网;筋膜组织瓣的血供来自乳腺深部.深层组织瓣经乳头基底部隧道水平推进或向上推进,以改善颈部高度和宽度,并加强其支撑力量.浅层三角形皮瓣顺时针旋转推进并包绕颈部,以使乳头颈充分成形.结果 全部病例术后伤口均愈合良好,康复快,没有出现血肿、感染和血运障碍所致的乳头坏死等并发症.随访3～6个月,患者均对乳头外形感到满意,无复发.结论 乳晕浅深层旋转三角形皮瓣和筋膜组织瓣法是矫正重度乳头内陷和术后复发的一种较好手术治疗方法,有推广应用价值.     

RESULTS OF NIPPLEAREOLA RECONSTRUCTION

Reconstruction of the nipple-areola complex is being performed for about a quarter of postmastectomy breast reconstruction patients. The methods used and results achieved in thirteen reconstructions were reviewed. Full thickness skin grafts from the upper inner thigh were used for the areola, with 100% success. For the nipple proper, most (eight) had a composite graft from the opposite nipple, with 100% take if the dressing was kept in place for 10–12 days. Earlobe tissue made an excellent nipple reconstruction for bilateral cases (four). It is concluded that nipple-areola reconstruction is safe, simple and predictable. A second operation is recommended for this surgery to ensure symmetry of nipple position, a fundamental requirement for a good result.     

3D areola dermopigmentation (nipple‐areola complex)

Surgical techniques for reconstructing the nipple‐areola complex (NAC) pose disadvantages such as areola necrosis, loss of nipple projection, depression or local necrosis, temporary leave from professional activities due to convalescence, and operational costs, all of which are factors that may discourage patients from undergoing them. In this context, dermopigmentation stands out as an emerging nonsurgical option. It is an inexpensive outpatient procedure that mimics the nipple‐areola complex by means of defining the areolar contour, Montgomery's tubercles, and a variety of colors that allow for individualization and contralateral symmetry. In this pioneering study, we propose to validate the 3D dermopigmentation technique as a preferential technique in the NAC reconstruction process. We selected 30 women with previous breast cancer who underwent conservative breast surgeries or mastectomy with NAC removal more than 6 months prior to their participating in our study. We employed the dermopigmentation technique, which we evaluated with the aid of questionnaires intended for patients, doctors, and tattooists. Among specialists, results were considered good and excellent with regard to overall esthetics (76.07%) and color (72.5%); whereas among patients, results were considered good and excellent with regard to overall satisfaction (95%) and color (100%); no adverse events were observed. Three‐dimensional dermopigmentation proved to be a promising nonsurgical technique for nipple‐areola complex reconstruction.     

Combination of the square flap method and the dermal sling to correct flat or inverted nipples

A technique for the correction of flat or inverted nipples is presented. The procedure is a combination of the square flap method, which better shapes the corrected nipple, and the dermal sling, which provides good support for the repaired nipple.     

Simple Technique for Inverted Nipple Correction

Several different techniques have been developed and currently are in use for correction of the inverted nipple. The diversity of techniques indicates the lack of a good, sustainable, and durable solution for this quite common problem. This report discusses a new technique in which two flaps are inserted beneath the nipple through a small tunnel. The advantages of this procedure are its simplicity, the creation of a durable support for the nipple, and the lack of transverse scars in the areola surrounding the nipple. The follow-up period up to 4 years for 11 patients (18 nipples) demonstrates the validity of this technique.