Application of modified vertical incision with medial-superior pedicle technique in breast reduction plasty
改良垂直切口内上蒂法在乳房缩小成形术中的应用

摘要

目的 塑造上极饱满度是乳房缩小成形术的基本目标之一，在保证乳房NAC血供的前提下尽可能多地切除皮肤、腺体，术后塑造美观的乳房外形。上蒂法（superior-pedicle, S-P）能为上极带来额外组织，但过长蒂部的折叠可能危及乳头-乳晕复合体（nipple-areola complex, NAC）的血运。内上蒂法（superior-pedicle, SM-P）无需折叠乳房蒂部，但其缺陷在于无法增加上极组织量。我们通过整合S-P与SM-P方法的优势，设计了一种新术式，旨在增加巨乳缩小术后乳房上级的饱满度。方法 取自2022年3月至2025年3月，新疆维吾尔自治区人民医院整形外科对20例乳房肥大患者采用垂直切口传统内上蒂法行乳房缩小上提矫正作为对照组，采用改良SM-P/S-P方法的20名乳房缩小术的患者作为实验组，由两名不了解具体术式的整形外科医师，对所有患者术前术后照片的上极丰满成功率进行盲法评估。成功率评分采用1-10分量表，依据术前术后上极丰满度差异程度进行判定：<5分为无差异（失败），5-7分为中等差异（一般），8-10分为显著差异（成功）。患者照片拍摄角度包括五个方位：正位、左右斜位及左右侧位。结果 10例患者中，研究组平均得分为8.2±1.2，对照组,7.1±1.8，所有患者均未观察到重大并发症，包括腺体坏死、乳头乳晕复合体（NAC）坏死及感觉不良。结论 采用改良垂直切口内上蒂法矫正肥大下垂的乳房，蒂部血供安全，行个性化操作，充分切冗余组织，术后瘢痕隐蔽，乳房外形饱满对称，对部分轻度、所有中度及大部分重度乳房肥大伴下垂患者，可显著提升乳房上级饱满度，目前我们对术后缩小重塑的乳房仍存在不满意的方面，还有许多细节需要进一步改进。进入乳房缩小术的ERAS流程，使患者获得安全、美观、舒适的感受是我们最终努力追寻的目标。

Abstract

Objective One of the fundamental goals of breast reduction plasty is to create fullness in the upper pole of the breast. The procedure aims to resect as much excess skin and glandular tissue as possible while ensuring the blood supply to the nipple-areola complex (NAC), and to achieve an aesthetically pleasing breast shape postoperatively. The superior-pedicle (S-P) technique can provide additional tissue for the upper pole; however, folding of an excessively long pedicle may compromise the blood supply to the NAC. The medial-superior pedicle (SM-P) technique avoids the need to fold the breast pedicle, but its limitation lies in its inability to increase the amount of tissue in the upper pole. By integrating the advantages of the S-P and SM-P techniques, we designed a new surgical method to enhance the fullness of the upper pole of the breast after reduction mammoplasty for macromastia.
Methods From March 2022 to March 2025, the Department of Plastic Surgery at People's Hospital of Xinjiang Uygur Autonomous Region enrolled 40 patients with macromastia. Among them, 20 patients underwent breast reduction and uplift correction using the traditional medial-superior pedicle technique with a vertical incision (control group), and the other 20 patients were treated with the modified SM-P/S-P technique (experimental group). Two plastic surgeons who were unaware of the specific surgical methods performed a blinded evaluation of the success rate of upper pole fullness based on pre- and postoperative photographs of all patients. The success rate was scored on a 1-10 scale, determined by the degree of difference in upper pole fullness between pre- and postoperative periods: a score of <5 indicated no difference (failure), 5-7 indicated a moderate difference (average), and 8-10 indicated a significant difference (success). Photographs of the patients were taken from five angles: anterior view, left and right oblique views, and left and right lateral views.
Results Among all patients, the average score in the experimental group was 8.2 ± 1.2, while that in the control group was 7.1 ± 1.8. No major complications were observed in any patient, including glandular necrosis, NAC necrosis, or sensory disturbance.
Conclusion   The modified vertical incision with the medial-superior pedicle technique for correcting hypertrophic and ptotic breasts ensures the safety of pedicle blood supply, allows personalized operation, and enables sufficient resection of redundant tissue. Postoperative scars are inconspicuous, and the breast shape is full and symmetrical. For patients with mild (partial cases), moderate (all cases), and severe (most cases) macromastia complicated with ptosis, this technique can significantly improve the fullness of the upper pole of the breast. Currently, there are still aspects of the reduced and reshaped breasts that are not satisfactory postoperatively, and many details need further improvement. Integrating this technique into the Enhanced Recovery After Surgery (ERAS) protocol for breast reduction plasty, to provide patients with a safe, aesthetically pleasing, and comfortable experience, is our ultimate goal.