赵敬国 赵翌君 周壮 闫书禄 刘赢银 张梅 杨丽萍 陈德法 李富强

[摘要]目的：探討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例患者对术后乳房形态，对称性及瘢痕满意;6例（8侧）出现了皮下脂肪液化，切口延期愈合;10例（12侧）切口出现瘢痕增生，患者基本满意。结论：对于乳房肥大患者，术前根据乳房肥大下垂程度设计乳头的位置，术中在减小乳房体积前提下，确保乳头乳晕血运，最大程度保留乳头乳晕感觉及乳房的泌乳功能，尽可能减少术后切口瘢痕及恢复双侧乳房的良好外形和对称性。

[关键词]乳房肥大;乳房缩小术;上蒂;垂直切口;乳头乳晕复合体;并发症

[中图分类号]R655.8    [文献标志码]A    [文章编号]1008-6455（2021）01-0018-03

Clinical Study of Superior Pedicle Method Combined with Vertical Incision in the Treatment on Hypermastia

ZHAO Jing-guo1，ZHAO Yi-jun2，ZHOU Zhuang1，YAN Shu-lu1，LIU Ying-yin1，ZHANG Mei1，

YANG Li-ping1，CHEN De-fa1，LI Fu-qiang1

（1.Department of Cosmetic and Plastic Surgery，Chongqing Hua Mei Plastic Surgery Hospital，Chongqing 400010，China;

2.Infant and Child Development and Research Laboratory，University of California，Santa Cruz，Santa Cruz 95064，State of California，America）

Abstract： Objective  To explore the application of superior pedicle method combined with vertical incision in the treatment of hypermastia. Methods  From May 2017 to June 2019， 56 cases （112 sides） with hypermastia were treated by superior pedicle method combined with vertical incision. According to preoperative design， the epidermis of the pedicle， the excess skin and glandular tissue were removed. From bottom to top， the inner and outer mammary glands were closed and V-Y pushed the nipple areola to the proper position. After the fixation of nipple areola， the incision was closed layer by layer. Results  Fifty-six cases were followed-up for 6 to 18 months. 40 patients were satisfied with breast shape， symmetry and scar. Fat liquefaction occurred in 6 patients （8 breasts） and healed after multiple dressing changes. Scar hyperplasia occurred in 10 patients （12 breasts）. The patients were satisfied with the postoperative outcomes. Conclusion  For patients with hypermastia， the new location of nipples should be determined according to the degree of mastoptosis and hypermastia. Under the premise of reducing the volume of breast， ensured the blood supply of nipple areola， reserved the feeling of nipple areola and the lactation function of breast to the greatest extent， reduced the scar of incision and restored the good shape and symmetry of bilateral breast.

Key words： hypermastia; reductive mammoplasty; superior pedicle; vertical incision; nipple areola complex; complications

乳房肥大症，俗称巨乳症，是指乳房过度发育使乳房的体积过度增大。乳房肥大常伴有乳房下垂、肩背部酸痛、乳房间以及乳房下皱襞区湿疹皮炎，严重影响生活和工作，需要进行手术矫正。笔者医院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），经6～18个月随访，效果确切。现报道如下。

1  资料和方法

1.1 临床资料：本组患者共56例（112侧乳房），均为女性，年龄20～48岁，根据Lalardrie乳房肥大分度法[1]，其中轻度8例，中度32例，重度16例。本研究经重庆华美整形美容医院伦理委员会批准（2020-01）。……