摘要目的:探讨改良新乳头定位法在中重度乳房肥大乳房缩小整形术中的应用效果。方法:回顾性分析2015年1月至2024年12月在南京医科大学附属妇产医院整形外科接受乳房缩小整形术的17例（34侧）中重度乳房肥大女性患者的临床资料。在传统的新乳头定位法的基础上，用修正乳房中线的方法纠正了原方法术后乳头偏外或偏内的问题，根据切除组织量下调新乳头位置以纠正原方法术后乳头位置过高的问题，对新乳头设计定位方法进行了改良。记录患者手术切口愈合等级及愈合时间。所有患者术后随访时间不少于6个月，以评估切口瘢痕形成情况及乳房形态（如下垂）的改善与维持效果。采用乳房相关生活质量问卷（BREAST-Q）量表评估患者术后乳房满意度、社会心理健康、性健康及身体健康状况。同时，统计术后并发症发生情况，并应用视觉模拟评分（VAS）评估患者对手术效果的满意度。结果:17例34侧乳房缩小整形术均圆满完成，切口均Ⅰ期愈合，乳头乳晕位置正常，无血运障碍。乳房组织切除量单侧（752.9±448.4）ml。术后平均随访2.98年（0.50~10.00年），有2例患者术后早期双侧乳头乳晕位置偏高，1~2年后乳头乳晕位置下移到满意高度。BREAST-Q量表乳房满意度（80.2±7.9）分、社会心理健康（83.5±7.2）分、性健康（78.6±8.8）分、身体健康（81.5±8.4）分，均较术前改善［分别为（46.1±10.0）分、（57.6±11.2）分、（49.3±10.5）分和（53.2±10.7）分］（均 P<0.05）。VAS评估结果：非常满意10例（58.8%）、满意5例（29.4%）、一般2例（11.8%）。 结论:改良的新乳头定位方法在乳房缩小整形术中应用，能得到满意的手术效果和术后乳房外观。

abstractsObjective:To investigate the application and outcomes of a modified new nipple positioning method in breast reduction mammoplasty.Methods:A retrospective analysis was performed on 17 female patients (34 breasts) with moderate to severe macromastia who underwent bilateral reduction mammaplasty at the Department of Plastic Surgery, Women′s Hospital of Nanjing Medical University from January 2015 to December 2024. On the basis of the traditional new nipple positioning method, the problem of postoperative nipple deviation (either outward or inward) caused by the original method was corrected by modifying the breast midline. Meanwhile, the new nipple position was adjusted downward according to the amount of resected tissue to correct the problem of excessively high postoperative nipple position associated with the original method, thereby improving the design and positioning method of the new nipple. The healing grade and healing time of the surgical incisions were recorded for all patients. All patients were followed up for a minimum of 6 months to assess scar formation, as well as the improvement and long-term maintenance of breast morphology (including ptosis). The BREAST-Questionnaires (BREAST-Q) questionnaire was used to assess patients′ postoperative breast satisfaction, psychosocial well-being, sexual health, and physical health status. Postoperative complications were recorded, and patient satisfaction with surgical outcomes was evaluated using visual analogue scale (VAS).Results:Reduction mammoplasty was successfully completed in all 17 patients (34 breasts). All incisions healed by primary intention, with normal nipple-areola complex (NAC) position and no evidence of vascular compromise was found. The mean volume of resected breast tissue per breast was (752.9±448.4) ml. The mean follow-up duration was 2.98 years (range, 0.50-10.00 years). Postoperatively, 2 patients exhibited transient mild over-positioning of the bilateral NAC in the early stage, which spontaneously descended to a satisfactory level within 1 to 2 years. Postoperative patient-reported outcomes with BREAST-Q revealed significant improvements in breast satisfaction [(80.2±7.9) vs (46.1±10.0) points], psychosocial health [(83.5±7.2) vs (57.6±11.2) points], sexual health [(78.6±8.8) vs (49.3±10.5) points], and physical health [(81.5±8.4) vs (53.2±10.7) points] compared with the preoperative values (all P<0.05). According to the VAS, the surgical outcomes were rated as excellent in 10 patients (58.8%), good in 5 patients (29.4%), fair in 2 patients (11.8%). Conclusion:The modified nipple localization technique yields favorable surgical outcomes and achieves satisfactory postoperative breast morphology in reduction mammoplasty for moderate to severe macromastia.