假体置入联合乳腺瓣固定矫正筒状乳房畸形(1)
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[摘要]目的：介绍采用乳腺底面放射状切开固定，同期在胸大肌后间隙置入硅凝胶假体，矫正伴有乳腺发育不良的筒状乳房畸形的方法和经验。方法：经乳房下皱襞切口，乳腺底面放射状切开，形成4个乳腺瓣，向下固定于胸大肌筋膜上，胸大肌后间隙置入硅凝胶假体。结果：2002年1月～2010年12月采用该方法共治疗3例伴有乳腺发育不良的筒状乳房畸形的患者，无血肿、感染、乳头乳晕坏死等并发症发生。术后随访1～3年，乳房丰满挺拔，畸形得到矫正，乳头乳晕感觉功能正常。结论：该术式在增大乳房体积的同时矫正筒状乳房畸形，对伴有乳腺发育不良的筒状乳房畸形患者可作为一种理想的整形方法。
[关键词]筒状乳房；乳腺瓣;乳房假体
[中图分类号]R655.8[文献标示码]A [文章编号]1008-6455(2011)05-0717-0
Correction of tubular breast deformity using breast augmentation and glandular flap fastening
TANG Xin-hui,ZHAO Zheng-jie,LI Xiao-dong
(Dongguan Myfun Aesthetic ﹠Plastic Hospital,Dongguan 523008,Guangdong,China)
Abstract: Objective To introduce a new methodology for surgical treatment of tubular breast deformity accompanying with mammarydysplasia by using breast augmentation and glandular flap fastening. Methods Through the inferolateral breast fold incision, the underside of mammary gland was cut open in a radial pattern. Four glandular flaps were formed and fastened to pectoralis major fascia. The silicon gel breast implants were implanted subpectoral plane. Results3 cases of tubular breast deformity accompanying with mammarydysplasia were performed the operation using this method during 2002.1 to 2010.12. There were no complications related to surgery such as hematoma, infection, nipple-alveolar complex necrosis. Postoperative follow-up for 1～3 years showed that satisfactory results were achieved, such as pretty breast shape, correction of breast deformity and normal sense of nipple areola. Conclusion Breast augmentation and fastening of glandular flap were performed at the same time in the method .This an ideal operation for tubular breast deformity accompanying with mammarydysplasia.
Key words: tubular breast; glandular flap;breast prosthesis
筒状乳房是一种罕见的乳房畸形，由于乳晕下乳腺组织在青春期过度发育所致，依其畸形的不同程度而有不同的命名，如：筒状乳房、管状乳房、筒样不对称乳房、疝样乳头乳晕、穹窿样乳头、乳头样乳房及“窥探样”乳房等[1]。伴有乳腺发育不良的筒状乳房畸形尤为少见，探讨其手术治疗方法的文献亦不多见。2002年1月～2010年12月笔者采用假体置入联合乳腺瓣固定共治疗3例伴有乳腺发育不良的筒状乳房畸形的患者，效果满意。
1临床资料
本组3例6侧，年龄19～24岁，均未生育哺乳。双侧乳房为筒状(圆柱形)而不是圆锥形，乳房基底范围小呈竹笋状；形成第二乳房皱襞较短而且位置较高，与同侧乳头的距离为3～4.5cm；乳腺发育不良，用排水法测量单侧乳房体积约为35～60ml；乳晕大而前突，直径为5～8cm。其中1例伴有漏斗胸。术前经彩超或核磁共振检查排除乳房肿瘤等疾患。术中置入假体大小为180～235g，其中光面圆形假体1对，毛面圆形假体1对，毛面解剖型假体1对。
2手术方法
2.1 术前设计：站立位设计新的乳房下皱襞线，根据患者个体差异，其最低点位于第5或第6肋骨表面。在此新的乳房下皱襞线上设计弧形手术切口，长约5～6cm ......
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