Meme Küçültme Ameliyatında Wise Patern ve Vertikal Skarsız Yöntemin Sonuçlarının Karşılaştırılması: Sekiz Yıllık Deneyim

Öz

Meme hipertrofisi veya makromasti, kadınların cerrahi düzeltme gerektiren bir sağlık problemidir. Cilt insizyonlarına (Ters T, vertikal, circumareolar, vertikal skarsız, kartopu yöntemleri) ve pediküllerine (inferior, süperior, süperomedial, süperolateral, yatay bipedikül, dikey bipedikül) göre pek çok prosedür tanımlanmış olsa da her yöntemin kendine göre avantajları ve dezavantajları olduğu için kullanımda standart bir yaklaşım bulunmamaktadır. Hastanın beklentileri, memenin şekli ve büyüklüğü, cerrahın bilgi ve deneyimi, yöntem seçiminde karar vermede etkilidir. Çalışmamıza, tek cerrah tarafından, 2012 -2020 yılları arasında opere edilen 65 vaka dahil edilmiştir. 20 vaka Vertikal Skarsız (NVS) teknikle, 45 vaka ters T, Wise Paterni (WP) tekniği ile opere edilmiştir. NVS teknikle opere edilen tüm vakalarda inferior pedikül uygulanmıştır. WP tekniğinde tüm pediküller kolayca uygulanabilir olsa da çalışmaya eşitlik olması açısında inferior pedikül kullanılan vakalar seçilmiştir. Tüm vakalar operasyon sonrası 1. 3. 6. ayda, 1. yılda ve sonrasında her yıl kontrole çağırılmıştır. Takiplerde erken ve geç komplikasyonlar gibi objektif kriterlerin yanında, semptomların rahatlaması ve memnuniyet gibi sübjektif kriterler de kontrol edilmiştir. Hastaların ortalama yaşı 42.7 olarak tespit edilmiştir (WP: 42, NVS:44.2). Ortalama çıkarılan doku miktarı WP için 2594 gr, NVS için 2248 gr’dır. Operasyon öncesi sternal çentik- nipple arası ölçümü WP için 33.1, NVS için 32.5’dir. WP için erken komplikasyon oranı %17.7, geç komplikasyon oranı %18.8’dir. NVS için erken komplikasyon oranı %13, geç komplikasyon oranı %17.6’dır. Tüm vakalarda komplikasyon oranı %30 olarak tespit edilmiştir. Hasta memnuniyeti açısından WP vakaların %75.5 çok memnun, %22.3 memnun, %2.2 memnun değil olarak belirlenmiştir. Memnun olmayan vakada devam eden ağrı şikayeti mevcuttur. NVS vakaları %80 çok memnun, %20 memnun olarak gözlenmiştir. Her iki teknik de hastayı ve cerrahı memnun eden tekniklerdir.

Anahtar Kelimeler

• Meme Küçültme
• Wise patern
• vertikal skarsız teknik
• inferior pedikül

A comparison of outcomes between wise pattern reduction mammaplasty and no vertical scar reduction mammaplasty: eight years of experience.

Öz

Macromastia or breast hypertrophy is a significant health problem for women and requires surgical correction. Many procedures have been described for reduction mammaplasty (RM) with specific skin incisions (such as inverted T scar, vertical scar, no vertical scar, circumareolar scar, snowball shape incision), or blood supply to the nipple-areolar complex (NAC) (such as inferior, superior, medial, lateral, superomedial, superolateral pedicle or horizontal bipedicle, vertical bipedicle). Since each method has its advantages and disadvantages there is no standard guideline to be applied. Patient expectations, the shape and size of the breast, as well as the surgeon’s knowledge, and experience are important in decision-making. In the study, 65 patients underwent RM operation from 2012 to 2020. All the surgeries were performed by a single surgeon. While 20 cases were operated by no vertical scar (NVS) technique, the operations of 45 cases were performed by inverted T scar, wise pattern (WP) technique. Inferior pedicle was chosen as a pedicle in all NVS cases. Although all pedicles can be used easily with a WP only cases using inferior pedicle included in this study. The patients were followed up as outpatients at 1, 6, 12 months and yearly afterwards. In the follow-up controls, the subjective criteria such as relief of symptoms and patient satisfaction were checked along with the objective criteria such as early and late complications. The average age of the patients was 42.7 years (42 years for WP; 44.2 years for NVS). The average total reduction for patients was 2594 g for WP and 2248 g for NVS. Preoperatively, the average distance from the sternal notch to the nipple was 33.1 cm for WP and 32.5 cm for NVS. While the early complication rate in patients operated with WP was 17.7% and the late complication rate was 18,8%. On the other hand the early complication rate of NVS patients was 2,5% and the late complication rate was 15%. It was found that the total early complication rate was 13% and the total late complication rate was 17.6% considering all cases. In total, complications occured in 30% of all patients. Among the patients who underwent WP operation, 75.5% were very satisfied, 22,3% were satisfied, 2.2% were not satisfied. The complaint of the dissatisfied patient was permanent pain. 80% of the patients who underwent NVS were very satisfied, 20% were satisfied. Patient and surgeon satisfaction was very high in both techniques.

Anahtar Kelimeler

• reduction mammaplasty
• wise pattern
• no vertical scar
• inferior pedicle

Kaynakça

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