| Purpose: The breast is an important female sexual organ, and is an important condition of female curve of beauty, which plays a significant role in Feminine charm. Nowadays, due to lots of factors such as the social work, the excessively high life pressure, and the changes of the geographical environments, patients suffering mammary tumors increase day by day, and most of the cases are the carcinoid. The surgical treatment is the most rational therapy method. However, the scars caused by the breast surgery are harmful to the image of beautiful breast, which is hard to be endured by the female patients, that is, most of all the females hope to leave no scars after their breast surgeries. However, the surgery usually generates severe incision skin scar, and will causes the life-long regret to the patient, especially for the beauty-liking female enduring the psychology shadow. Through the study in this paper, we hope to investigate the cosmetic effects of the incisions in the different positions and directions of breast, and appeal the surgeons to pay much attention to the patients'feelings and use the more covert incisions in the mammary gland surgeries.Methods:The reexamined cases which were treated in our hospital taking the mammary gland benign goitre excision surgery between January 2006 and September 2006 were selected. The ages of cases are between 14 and 59, with the average age being 32. The paraffin section pathologies show that all the cases are carcinoid, the mammary fibromas presented in 147 cases, and the papillomas in the memmary ducts presented in 10 cases. The incisions near the areola mammaes are completed in 64 cases, the radial incisions above the breast completed in 37 cases, the cambered incisions above the breast completed in 23 cases, the radial incisions below the breast completed in 12 cases, the cambered incisions above the breast completed in 20 cases.Before surgeries, the Supersonic localizations were carried out. (DP-8800 digital ultrasonic diagnosis system provided by Shenzhen Mindray Medical International Limited Company, frequency: 10MHz liner prober). Preliminary judge the tumor natures and determinate the positions of the tumors, then design the incision positions. Taking the nipple as the center, half of the breast radius as the radius, we can draw a concentric circle of the breast basis. If the tumour is inside the concentric circle, the incision near the areola mammae is carried out, and if the tumor outside the concentric circle, the radial or cambered incision is carried out, which is helpful to remove the tumor with the minimal loss. The detailed steps of the surgical operations are: applying the conventional disinfection, doing the local infiltration anesthesia used the 0.5% xylocaine, removing the mass and the surrounding normal mammary tissues(the magnitudes of the removed normal tissues are according to the patients'ages. for young patients, the glandular organs should be preserved as much as possible according to the non-invasive principle, the damage reduced and the gland function kept, for elder patients, the normal tissues around the pathological changes should be removed according to the non-tumor principle. The mammary tissues and subcutaneous tissue are sutured discontinuously after the hematischesis, and the intracutaneous suture is carried out using the 0 type mersilk. After surgery, the incision is bound upon pressure by 2-4d, the antibiotics 3d is taken orally, the dressing is changed every other day, and the stitches are taken out ten days later. The scar widths in the center of the incisions are measured when revisiting two year later.The obtained width is shown as the average value±the standard deviation. The cambered incisions above the breasts are 3.9±0.3mm, the average width of the radial incisions above the breast being 4.5±0.3mm, the average width of the cambered incisions below the breasts being 2.8±0.3mm, the average width of the radial incisions below the breasts being 3.3±0.2mm, and the average width of the incisions surrounding the areola mammaes being 2.4±0.2. The group t-test was used in the comparison among groups, and the value of P<0.05 is taken as the difference that has the statistical significance.Because the cicatrization situations of the patients'incisions are associated with the patients'ages, the bodily foundational conditions (chronic diseases such as the accompanying diabetes, hepatitis, and malnutrition patient), the healing problems of the incisions caused by the surgery reasons, only the middle-aged and young patients who were confirmed to be carcinoid by the pathology and healed at the first period after the surgeries are included after . Results: The cases are screened out according to the marks in the follow up clinics after surgeries, and the central widths of the incisions are measured and handled statistically when the qualified cases revisit two years later. The number of the total qualified cases is 156, the ages being 14~59, the average age being 32, The pathologies after surgeries show that the mammary fibromas are presented in 147 cases, and the papillomas in the memmary ducts are presented in 10 cases. In all the cases, the incisions near the areola mammaes are completed in 64 cases, the radial incisions above the breast completed in 37 cases, the cambered incisions above the breast completed in 23 cases, the radial incisions below the breast completed in 12 cases, the cambered incisions above the breast completed in 20 cases.The widths of the radial and cambered incisions in the different positions of breast are compared: the average width of the cambered incisions above the breasts are 3.9±0.3mm, the radial incisions above the breast being 4.5±0.3mm, the average width of the cambered incisions below the breasts being 2.8±0.3mm, the average width of the radial incisions below the breasts being 3.3±0.2mm, and the average width of the incisions surrounding the areola mammaes being 2.4±0.2. All the incisions healed in the first periods after operations, and the scars are at the same level or a little sunken in comparison with the surrounding tissue when revisiting tow years later.Through measuring the central width of the incisions it can be seen that, the incisions surrounding the areola mammaes are superior to the incisions in other positions and orientation of the breasts. There are differences among the incisions above, below breasts and surrounding the areola mammaes, that is, the incisions above the breasts are 4.2±0.4 mm, the incisions below are 3.0±0.6 mm, the incisions above the breasts are relatively wide and have no obvious cosmetology effect. There are also differences among different directions of the breasts, and the comparison results concerning the total mammary data and the incision widths in different directions above and below the breasts show that the cambered incisions are 3.4±0.6mm wide, the radial incisions are 4.2±0.6 mm wide, the cambered incisions heal better than the radial incisions, while above the breasts(the average width of the incisions above the breasts is 3.9±0.3mm, and that of the radial incisions is 4.5±0.3mm) this difference is not obvious.Conclusion:1. radial incisions are clearly superior to the incisions in other positions and directions of the breasts and the margins of the areola mammaes are the mammary natural contour lines, additionally there are wrinkle of skin and the tied nodular sebaceous glands near the areola mammaes, thus, the radial incisions surrounding the areola mammaes are the first choice. The widths of the incisions surrounding the areola mammaes and the cambered incisions below the breasts are smaller than those of the incisions above the breasts and the radial incisions below the breasts at the scar stabilization period.2. The incision above the breasts is relatively wide and has no clear cosmetic effect, which can be seen as the result that the tension force of the skin above breast is large; totally the cambered incisions healed better than the radial incisions, which may be caused by the fact that the cambered incisions above or below the breasts are consistent with the Langer dermatoglyph, but the difference are not clear above the breasts.3. The radial incisions in the Y axis above and below the breasts are almost perpendicular to the tension lines, the scars after surgeries clear, and the vertical scars have significant influence on the patients'subjective perception of the mammary aesthetics.
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