乳房肥大下垂矫正术后继发畸形的临床分型及个体化修复策略研究OA

Objective To systematically summarize the clinical characteristics and causes of common secondary deformities after correction of macromastia with ptosis,establish a scientific clinical classification system,and propose targeted individualized repair strategies.Methods The complete clinical data of 30 patients with secondary deformities after correction of macromastia with ptosis admitted to the Department of Plastic Surgery of Henan Provincial People's Hospital from January 2022 to January 2025 were collected and analyzed.Two chief senior plastic surgeons evaluated the deformities using the double-blind method,formulated a clinical classification based on the characteristics and causes of the deformities,and developed and implemented individualized repair surgical plans for different classifications.A postoperative follow-up was conducted,and the repair efficacy was comprehensively evaluated using the Vancouver Scar Scale(VSS),complication rate,Breast-Q Scale,and 5-point Likert Satisfaction Scale.Results The secondary deformities of the 30 patients after correction of macromastia with ptosis were divided into three types:Type Ⅰ"pseudo-correction type"(double bubble deformity)in 8 cases(26.7%),whose core cause was incorrect surgical procedure selection in the primary operation;Type Ⅱ"flattened and lateralized type"(pie-shaped deformity)in 12 cases(40.0%),mainly caused by the mismatch between the surgical procedure and the severity of the deformity and inadequate glandular management;Type Ⅲ"recurrence with local deformity type"(dog ear deformity complicated with ptosis)in 10 cases(33.3%),mainly resulting from technical deviations in the primary surgical execution.Corresponding individualized repair strategies were adopted for each type:"prosthesis adjustment/removal combined with definitive mastopexy"for Type Ⅰ,"incision conversion combined with glandular remodeling"for Type Ⅱ,and"local revision combined with glandular re-fixation"for Type Ⅲ.The 12-month postoperative follow-up showed that the deformities of all patients were significantly improved,and the scar condition at the breast surgical incisions was markedly ameliorated(P<0.05).The overall complication rate was 13.3%,including only 3 cases of local delayed wound healing and 1 case of seroma,all of which were cured after symptomatic treatment;no severe complications such as hematoma,infection,or nipple necrosis occurred.At 3 months after the repair surgery,the scores of breast appearance satisfaction,mental health,social health,sexual health,and physical health of the 30 patients were significantly increased compared with those before the surgery(P<0.05).The overall patient satisfaction rate reached 93.3%(60.0%extremely satisfied,33.3%satisfied).Conclusion The three-type classification method based on the characteristics and causes of deformities can fully cover the common secondary deformities after correction of macromastia with ptosis.The individualized repair strategies formulated accordingly are characterized by rigorous logic and strong targeting,which can effectively improve the accuracy and clinical efficacy of repair surgeries and enhance patient satisfaction.This study provides a reliable reference and standardized clinical pathway for the standardized clinical management of such complex repair surgeries.