하추체진피피판술(Inferior Pyramidal Dermal Technique)을 이용한 유방축소술의 장기 추적

Abstract

The inferior pyramidal dermal technique has many advantages in various reduction mammoplasty procedures. It has been possible to increase the amount of breast tissue removed, which enhances the quality of the final result. However, the main disadvantage of this method is the large and long reverse T scars, particularly in Asian women. Twenty breasts of 10 patients, who underwent an operation by the inferior pyramidal dermal technique with several modification from March 1989 to March 2001 were followed up. The mean age was 35 and the mean follow up period was 5.5 years. The mean resection amount was 692 gm per breast. In order to prevent a boxy breast, the inferior margin of the medial flap had a gentle curve, and the lateral flap had a "lazy S" contour. A small triangle of the skin was leaved with its base on the inframammary fold to relieve the T-junctional tension. In order to ensure nipple projection, the skin was deepithelialized at the recipient site for the relocated nipple-areola complex and 2 cm around areola. Because the vascular supply to the nipple-areola complex of the pyramidal flap was derived from the intercostal perforating vessels, the full-thickness removal of the skin from the pyramidal flap was made to reduce the operation time. A sufficient parenchyma resection beneath the lateral flap was performed to minimize a boxy breast. A postoperative hyperpigmented scar became light after 2 years and was inconspicuous after 3 years. An immediate postoperative boxy breast was noticed. However, it has been observed that there was gradual increase in the distance from the inframammary fold to the areola, because of the descent of the breast parenchyma due to gravity, along with the displacement of the nipple-areola complex superiorly. It is believed that this problem can be overcome by pedicle trimming, medial and superior fixation sutures with the nipple areola complex 1-2cm being situated below the expected position.

저자들은 하후체진피피판경을 이용한 유방축소술로써 유방비대 환자들을 교정하였다. 이 방법은 수술 중에 유방 크기와 형태의 조절이 쉽고, 혈행장애, 감각소실이나 수유장애를 남기지 않고 비교적 많은 양의 유방실질을 절제할 수 있어, 수술 후에 이상적인 유방 모양과 큰 유방에 의한 증상의 경감에 좋은 방법으로 널리 알려져 있음에도 불구하고 특별히 동양인에서 역T자형반흔이 문제가 될 수 있으므로 사용을 꺼려왔다. 이 연구에서 역T자반흔을 장기간 추적관찰하였을 때 수술 후 2년이 지나면 색이 옅어지다가 수술 후 3년부터는 눈에 잘 띄지 않았다. 유방의 모양은 수술 후 상자 모양이지만 추적관찰 기간동안 중력에 의하여 유방 하부가 불룩해 지면서 유두유륜복합체가 상방 이동하여 자연스러운 유방 모양을 보이다가 피판이 더 처지면 유두유륜복합체와 유방아래주름 사이의 거리가 너무 길어지므로 하추체진피피판의 부피를 줄이면서 내측 상방의 유방실질과 고정봉합하여 하수를 줄이고 유두유륜복합체의 중앙점을 1-2cm 더 아래에 위치시킨다면 수술 후에 자연스러운 모양을 유지시킬 수 있을 것으로 생각한다.