双平面法隆乳术切口及入路改进.doc

双平面法隆乳术切口及入路改进[摘要]目的:探讨双平面法隆乳术手术切口及入路的选择。 方法:由2008年1月～2009年6月期间应用经乳晕中线垂直切口行双平面法双侧隆乳术28例,术中于乳腺上极垂直切开乳腺腺体,沿胸大肌肌纤维方向分离并部分离断胸大肌起点,将假体下半部分置于乳腺后间隙,上半部分置于胸大肌后间隙。结果:28例患者随访3～6个月,术后恢复良好,切口愈合好,瘢痕隐蔽。结论:应用乳晕中线切口,纵行剖开乳腺腺体上极并沿胸大肌方向分离并离断部分胸大肌进行双平面法硅凝胶假体植入隆乳术,术野清晰,解剖层次显露好。为一种较好的手术方法。 [关键词]隆乳术;切口;手术 [中图分类号]R655.8[文献标识码]A[文章编号]1008-6455(2010)01-0007-03 The incision and method of dual plane breast augmentation mammoplasty LONG Xiao,ZENG Ang,ZHANG Hai-lin,LIU Zhi-fei,QIAO Qun (Division of Plastic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijng 100730,China) Abstract:ObjectiveTo investigate the ideal methods of dual-plane breast augmentation mammoplasty. MethodsA total of 28 patients had dual plane breast augmentation from January 2008 to June 2009 by vertical incision in the areola. During the operation, mammary gland beyond the nipple was cut vertically and pectoralis major was separated and partially cut off from the starting point.ResultsAt 3-to 6-month follow up, the surgical outcomes were satisfactory. There were no complications and the incision healed well with no hyperplasia.ConclusionsVertical incision in the areola can provide a clear surgical view in dual plane breast augmentation mammoplasty. A clear surgical field and anatomy level can be shown by vertically separated the mammary gland. The method has improved the surgical result. Key words: augmentation mammoplasty;incision;operation 假体隆乳的常用方法为将乳房假体置于胸大肌后间隙或乳腺后间隙。Tebbetts等[1]在2001年最早报道了双平面隆乳的手术方法,认为该方法术后效果良好。我院从2003年开始应用乳晕下缘切口进行双平面法硅凝胶假体置入隆乳术, 2008年1月～2009年6月期间改进了切口及手术入路,选择经乳晕中线,环乳头基底的垂直切口,术中于乳腺上极垂直切开乳腺腺体,并沿胸大肌肌纤维方向分离并离断部分胸大肌起点,假体由该入路部分置于乳腺后间隙,部分置于胸大肌后间隙。在此期间共应用该方法隆乳28例(56侧)。28例患者术后随访3～6个月,乳房形态良好,手感自然,切口瘢痕隐蔽。 1资料和方法 1.1 临床资料:28例患者共56侧,年龄24～36岁,术前诊断:小乳症。2例患者为双侧胸大肌后硅凝胶假体植入隆乳术后形态不满意,为行假体置换入院。1例为双侧乳房聚丙烯酰胺水凝胶取出术后1年半,为行隆乳再次入院。其余患者就诊前未经治疗。 1.2 手术方法 1 2.1 术前设计:站立位测量患者身高、肩宽、胸围、胸乳线、锁乳线、乳房的各个径线、乳头及乳晕的直径。根据测量结果及患者要求,选择合适的圆形毛面假体。本