| Background:Based on the evidence-based medicine meta-analysis research, we conducted this study to provide the quantitatively synthesised estimates of the postoperative complications of inferior pedicle technique, round block technique, and vertical bipedicle technique reduction mammaplasty, to obtain more accurate estimations of these three operation modes postoperative complications.Methods:A search of the literature using China National Knowledge Infrastructure (CNKI), WANFANG DATA, VIP, PubMed, MEDLINE, and Cochrane Library databases was performed to identify studies which estimated the postoperative complications of the targeted surgical methods. The pooled risk ratio (RR) along with the corresponding 95% confidence intervals (CI) were assessed using a fixed effects model.Result:11 studies involving 291 patients were retrieved and analyzed. The results revealed that there was a significant statistical difference in pooled analysis (inferior pedicle technique with round block technique vs. vertical bipedicle technique, RR=3.63, 95%CI:2.11-6.25, P=0.000) and in stratified analyses (inferior pedicle technique vs. vertical bipedicle technique, RR=3.64,95% CI:1.59-8.36, P=0.002; round block technique vs vertical bipedicle technique, RR=3.35,95% CI:1.72-6.54, P=0.000; inferior pedicle technique with round block technique vs vertical bipedicle technique in anesthesia of nipple and areola, RR=2.43,95% CI:1.16-5.09, P=0.019; inferior pedicle technique with round block technique vs vertical bipedicle technique in avascular necrosis, RR=3.27,95% CI:1.32-8.13, P=0.011), except in stratified analysis of inferior pedicle technique vs round block technique (RR=1.11,95% CI:0.21-5.83, P=0.906).Conclusion:Our research reveal that the postoperative complication of vertical bipedicle technique have a higher incidence compared with inferior pedicle technique’s and round block technique’s.Objective:To study blood supply and nerve distribution of adult female nipple-areola complex and observe breast fixed structure, in order to provide anatomical basis for breast reduction surgery and improve the operation.Methods:Breast specimens of 6 adult female cadaver were included in our study with gross and microsurgical anatomy. Observe the breast fixed structure, the distribution and origin of cutaneous branches of the intercostal nerves dominant nipple-areola complex. The chest walls of another 6 adult female cadaver were completely removal, and vascular casting agent was perfused in ubclavian artery. The pattern of angioarchitecture of nipple-areola complex was recorded.Results:1. Nerve distributed on the nipple and areola origins from 3rd,4th,5th of the lateral cutaneous branch and anterior cutaneous branch of intercostal nerve. The main dominant sensory nerve of nipple is the 4th of the lateral cutaneous branch of intercostal nerve.2. The nipple-areola complex is supplied by the shallow and deep blood vessels. The deep arteries are from perforator of internal and lateral thoracic artery in superficial pectoral fascia, which is the main deep blood source of nipple-areola complex. The shallow arteries are from the 2-4 intercostal perforator of internal thoracic artery, branches of lateral thoracic artery and perforator of intercostal artery. The shallow and deep blood vessels under the areola integrate vascular network of nipple and areola.3. The surrounding breast ligaments are around breast basal circumference. They consist of bag-shaped connective tissue fibers circled around breast substrate. Their lower and outer fibers are thickening and compactness. The ligaments play the main role of fixing mammary gland. In addition, fusion between part of surrounding breast ligaments and superficial fascia can also help to fix breast.Conclusion:1. The main dominant sensory nerve of nipple is the 4th of lateral and anterior cutaneous branch of intercostal nerve, and the lateral one is more important because of the large dominant nipple and areola range. To avoid nipple and areola sensation disorders, the 4th of lateral cutaneous branch of intercostal nerve should be protected in breast reduction and plastic surgery.2. Blood supply of nipple-areola complex has multi-source with shallow and deep blood vessels from perforator of internal thoracic artery, branch of lateral thoracic artery and perforator of intercostal artery. Pedicle direction selection, peel tissue and skin glands resection should be taking into account blood supply of nipple-areola complex in breast reduction and plastic surgery, so as to avoid blood circulation disorder in nipple and areola.3. Breast fixed structure consists of skin, superficial fascia and breast suspensory ligaments (surrounding breast ligaments). Breast suspensory ligament penetrated from peripheral mammary is the most important for fixing breast. These ligaments and fascia together fix the breast from different directions, so that the breast can have certain activities, as well as not droop.Objective:To explore a reduction mammaplasty with inferior pedical,we combine with the applied anatomical results of blood supply pattern and nerve distribution of nipple-areola complex, as well as the results of breast fixed structure,so as to improve operation method, reduce the incidence of postoperative complications and inform a method of reduction mammaplasty which ensures well nipple-areola lactation function,adequate blood supply and good medial fullness and projection.The effect of the operation is evaluated through follow-up study.Methods:Retrospective analysis of 2011,11 to 2013,8 by using the clinical data of reduction mammaplasty with inferior pedical for hypertrophy breast reduction plasty, summarize the clinical experience of the technology applying, to take corresponding measures according to the reasons of postoperative effects of poor, take inferior pedicle combined with the dermal suspension sling technique for breast reduction surgery. And evaluate the postoperative effect of the two kinds of operative methods through preoperative postoperative objective data measurement, questionnaire survey and rating scale.Results:The clinical symptoms of 24 cases with breast hypertrophy in both groups were obviously improved after operation, The shapes of breasts were good and symmetrical in all patients after operation.(1) In improved group, blood supply and sensory function in nipple and areola recovered satisfactorily in all patients; no necrosis was found in the nipple and areola; postoperative bleeding in one side and healed after incision and drainage in 1 case; scar hyperplasia in 1 case; all cases were satisfactory with breast shape and no very excessive fullness or ptosis of breasts after 6-12 months follow-up. (2)In the traditional group, areola epidermis necrosis in both sides in 2 cases which scar healing after treatment; hematoma in both sides in 2 cases which improved after puncture, pressure dressing; nipple hypoesthesia in 2 cases after 1 month follow-up; incisional scar hyperplasia in 3 cases which improved by local drug injection; 9cases were followed up for 6-12 months, including 2 cases with excessive fullness and ptosis breasts.Conclusion:Dermal suspension and horizontal dermal placation provides a structural foundation to the inferior pedicle. It is an effective method of treatment for breast reduction, in that the sensation and lactation function of nipple and areola complex get further guaranteed, have nice breast projection and shape, and can be applied to all cases of breast reduction. |
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