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

Yıl 2023, Cilt: 2 Sayı: 2, 66 - 77, 31.08.2023

Nihal İşleyen

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

• Kuran,I. (2019). Estetik meme cerrahisi. İstanbul: Avrupa Tıp Kitabevi.
• Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg. 1994;94:100–14.
• Hall-Findlay EJ. Vertical breast reduction with a medially based pedicle. Oper Strategies Aesthetic Surg J. 2002;22:185–95.
• White CP, Hynes NM. The horizontal breast reduction: surgical tips for maintaining projection. Can J Plast Surg. 2013;21(3):167-172
• Hidalgo DA. Vertical mammaplasty. Plast Reconstr Surg. 2005;115:1179-97
• Lalonde DH, Lalonde J, French R. The no vertical scar breast reduction: a minör variation that allows you remove vertical scar portion of the inferior pedicle wise pattern T scar. Aesth Plast Surg. 2003;27:335-344
• Movassaghi K, Liao EC, Ting VE, et al. Eliminating the vertical scar in breast reduction- Boston modification of the Robertson Technique. Aesthet Surg J. 2006;26:687-96
• Savacı N. Reduction mammaplasty by the central pedicle, avoiding a vertical scar. Turkiye klinikleri J Plast Surg Special Topics. 2009;1(1):29-34
• Corduff N, Taylor GI. Subglandular breast reduction: the evalution of a minimal scar approach to breast reduction. Plast Reconstr Surg. 2004;113:175-184
• Regnault P. Breast reduction: B technique. Plast Reconstr Surg 1980;65:840.
• Theodor Billroth, Klinik C, Wein (1869-1876) Erfahrungen aus dem Gebiete der praktischen Chirurgie. 1868. ISBN 0-691-07053-9.
• Alfred Pousson. de la mastopexie, Bulletins et me'moires de la socie'te'de chirurgie de Paris 23. 1897. pp. 507–8.
• Hippolyte Morestin. De l'ablation esthe'tique des tumeurs be'nignes du sein. Presse me'dicale. 1902;10:975–77.
• Hollander E. die: Operation der mammahypertrophie und der Hangeburst. Dtsch Med Wochenschr. 1924;50:1400.
• Lexer E. Correcion de los pechos pendulose(mastoptose) por medio de la grasa. Guipuzcoa Medica. 1921;6:210.
• Kraske H. Die Operation der Atrophischen und Hypertrophischen Hangeburst. Munch Med Wochenschr. 1923;70:672.
• Thorek M. Possibilities in the reconstruction of the human form. NY Med J. 1922;116:572.
• Wise RJ. A preliminary report on a method of planning the mammaplasty. Plast Reconstr Surg. 1956;17:367.
• Wise RJ, Gannon JP, Hill JR. Further experience with reduction mammaplasty. Plast Reconstr Surg. 1963;32:12
• Robbins TH. A reduction mammaplasty with the nipple areola based on an inferior dermal pedicle. Plast Reconstr Surg. 1977;59:64.
• Brown RH, Izaddoost S, Bullocks JM. Preventing the "bottoming out" and "stargazing" phenomena in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere. Aesthetic Plast Surg. 2010;34:760–767.
• Kankaya Y, Oruç M, Sungur N, Colak Aslan O, Gürsoy K, Ozer K, Kocer U. Four flap suspension technique for prevention of bottoming out after breast reduction. Ann Surg Treat Res. 2016 Jan; 90(1): 10–15. Published online 2015 Dec 29. doi: 10.4174/astr.2016.90.1.10
• Pitanguy I. Surgical treatment of breast hypertrophy. Br J Plast Surg. 1967;20:78.
• Skoog T. A technique for breast reduction: Transposition of the nipple on a cutaneous vascular pedicle. Acta Chir Scand. 1963;126:453.
• McKissock P. Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg. 1972;49:245
• Hester TR, Bostwick J, 3rd, Miller L, Cunningham SJ. Breast reduction utilising the maximally vascularised central breast pedicle. Plast Reconstr Surg. 1985;76:890.
• Arie G. Una nueva tecnica de mastoplastia. Rev Iber Latino Am Cir Plast. 1957;3:28.
• Lassus C. A 30-year experience with vertical mammaplasty. Plast Reconstr Surg. 1996;97:373–80.
• Passot R. La correction esthetique du prolapsus mammarie par le procede de la transposition du mamelon. Presse Med. 1925;33:317-8
• Yousif NJ, Larson DL, Sanger JR. Elimination of the vertical scar in reduction mammoplasty. Plas Reconsrt Surg. 1992;89:459-67
• Savaci N. Reduction mammoplasty by the central pedicle, avoiding a vertical scar. Aesthetic Plast Surg 1996;20:171-5
• Koltz PF, Myers RP, Shaw RB, et al. Adolescent breast reduction: indications, techniques, and outcomes. Plast Reconstr Surg. 2011;127:158e–159e
• Xue AS, Wolfswinkel EM, Weathers WM, et al. Breast reduction in adolescents: indication, timing, and a review of the literature. J Pediatr Adolesc Gynecol. 2013;26:228–233.
• Kulkarni K, Egro FM, Kenny EM, Stavros AG, Grunwaldt LJ. Reduction mammaplasty in adolescents: a comparison of wise and vertical incision patterns. Plast Reconstr Surg. 2019 Dec 7(12):e2516
• Lee MC, Lehman JA, Jr, Tantri MD, et al. Bilateral reduction mammoplasty in an adolescent population: adolescent bilateral reduction mammoplasty. J Craniofac Surg. 2003;14:691–695.
• Dancey A, Khan M, Dawson J, et al. Gigantomastia: a classification and review of the literatüre. J Plast Reconstr Aesthet Surg. 2008;61:493-502
• Brent R. DeGeorge, Jr., David L. Colen, Alexander F. Mericli, David B. Drake. Reduction mammaplasty operative techniques for improved outcomes in the treatment of gigantomastia.Eplasty. 2013; 13: e54
• Serletti JM, Davenport MS, Herrera HR, Caldwell EH. Efficacy of prophylactic antibiotics in reduction mammoplasty. Ann Plast Surg. 1994;33:476-480
• Horndeski GM, Gonzalez E. No Vertical Scar Breast Weight Transfer. Plast Reconstr Surg Glob Open. 2017 Dec 28;5(12):e1593.
• Hee Su Shin, Yong Hae Lee, Sung Gyun Jung, Doo Hyung Lee, Young Roe, Jong Hyun Cha. Semicircular Horizontal Approach in Breast Reduction: Clinical Experience in 38 Cases. Arch Plast Surg . 2015 Jul;42(4):446-52.
• Gonzales MA, Glickman LT, Aladegbami B, et al. Quality of life after breast reduction surgery: a 10-year retrospective analysis using the breast Q questionnaire: does breast size matter?. Ann Plast Surg. 2012;69:361-3
• Spector JA, Singh SP, Karp NS. Outcomes after breast reduction: does size really matter?. Ann Plasr Surg. 2008;60:505-9
• Hall-Findlay Discussion: A Matched Cohort Study of Superomedial Pedicle Vertical Scar Breast Reduction (100 Breasts) and Traditional Inferior Pedicle Wise-Pattern Reduction (100 Breasts): An Outcomes Study over 3 Years. Plast Recontr Surg. 2013;132(5):1077–79