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Manie TM, Youssef M, Taha SN, Rabea A, Farahat AM. Batwing mammoplasty: a safe oncoplastic technique for breast conservation in breast cancer patients with gigantomastia. Ann R Coll Surg Engl 2019; 102:115-119. [PMID: 31538808 DOI: 10.1308/rcsann.2019.0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surgical management of breast cancer with gigantomastia can be challenging when planning breast conservation, as major breast reduction is required. Complex oncoplastic procedures can carry an additional surgical risk in this situation. We suggest batwing mammoplasty as a simple and safe oncoplastic procedure for those patients. MATERIALS AND METHODS Fourteen patients with gigantomastia diagnosed with breast cancer were included in this prospective cohort study. All underwent batwing mammoplasty and contralateral symmetrisation procedure between May 2016 and June 2018. Patient satisfaction assessed by the Breast-Q questionnaire. RESULTS All patients had a body mass index above 30kg/m2 with a mean of 36.7kg/m2 (range 31.6-44.9kg/m2). The mean distance from midclavicular point to nipple was 42cm (range 38-50cm). The mean operative time was 83 minutes for procedures done by a single surgeon. Mean specimen weight was 1.2kg (ranging from 1.035-1.63kg). Postoperative complications occurred in 14.2% of patients. Nipple-areola complex viability was not compromised nor sensation impaired. The mean Breast-Q score for patient satisfaction with breasts was 68.6 (range 61-74). The mean score for physiological wellbeing was 77.3 (range 64-84) and the mean score for physical wellbeing was 35 (range 31-40). CONCLUSION Batwing mammoplasty is a safe and simple oncoplastic procedure in patients who have breast cancer with gigantomastia. It has short operative time and low complications rate. In our cohort of patients, there was no delay in the delivery of adjuvant treatment. The cosmetic outcome was favourable with a high patient satisfaction.
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Affiliation(s)
- T M Manie
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mmg Youssef
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Breast Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - S N Taha
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - A Rabea
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - A M Farahat
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Thiénot S, Bertheuil N, Carloni R, Méal C, Aillet S, Herlin C, Watier E. Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia. Aesthetic Plast Surg 2017; 41:531-541. [PMID: 28204931 DOI: 10.1007/s00266-017-0810-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple-areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle. MATERIALS AND METHODS All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed. RESULTS Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m2. In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found. CONCLUSIONS We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because of its low rate of major complications and favorable functional and esthetic results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sophie Thiénot
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France.
- STROMAlab, UMR5273 CNRS/UPS/EFS - INSERM U1031, Rangueil Hospital, Toulouse, France.
| | - Raphaël Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nicolle Hospital, University of Rouen, Rouen, France
| | - Cécile Méal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Sylvie Aillet
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Christian Herlin
- Department of Plastic and Burn Surgery, CHU of Montpellier, Montpellier, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
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Khalil HH, Malahias M, Shetty G. Triangular lipodermal flaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis. Plast Surg (Oakv) 2016; 24:191-194. [PMID: 28439509 DOI: 10.4172/plastic-surgery.1000975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although Wise pattern reduction mammoplasty is one of the most prevalent procedures providing satisfactory cutaneous reduction, it is at the expense of inevitable lengthier scars and wound complications, especially at the inverted T junction. OBJECTIVE To describe a novel technique providing tension-free closure at the T junction through performing triangular lipodermal flaps. The aim is to alleviate skin tension, thus reducing skin necrosis, dehiscence and excessive scarring at the T junction. METHODS One hundred seventy-three consecutive procedures were performed on 137 patients between 2009 and 2013. Data collected included demographics, perioperative morbidity and resected breast tissue weight. The follow-up period ranged from three to 30 months; early and late postoperative complications and patient satisfaction were recorded. RESULTS Superficial epidermolysis without T-junction dehiscence was experienced in eight (4.6%) procedures while five (2.9%) procedures developed full-thickness wound dehiscence. Ninety-four percent of patients were highly satisfied with the outcome. CONCLUSIONS The technique is safe, versatile and easy to execute, providing a tension-free zone and acting as internal dermal sling, thus providing better wound healing with more favourable aesthetic outcome and maintaining breast projection.
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Affiliation(s)
- Haitham H Khalil
- Department of Oncoplastic and Reconstructive Surgery, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Marco Malahias
- Department of Oncoplastic and Reconstructive Surgery, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Geeta Shetty
- Department of Breast Oncoplasty Surgery, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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Khalil HH, Malahias M, Shetty G. Triangular lipodermal flaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Although Wise pattern reduction mammoplasty is one of the most prevalent procedures providing satisfactory cutaneous reduction, it is at the expense of inevitable lengthier scars and wound complications, especially at the inverted T junction. Objective To describe a novel technique providing tension-free closure at the T junction through performing triangular lipodermal flaps. The aim is to alleviate skin tension, thus reducing skin necrosis, dehiscence and excessive scarring at the T junction. Methods One hundred seventy-three consecutive procedures were performed on 137 patients between 2009 and 2013. Data collected included demographics, perioperative morbidity and resected breast tissue weight. The follow-up period ranged from three to 30 months; early and late postoperative complications and patient satisfaction were recorded. Results Superficial epidermolysis without T-junction dehiscence was experienced in eight (4.6%) procedures while five (2.9%) procedures developed full-thickness wound dehiscence. Ninety-four percent of patients were highly satisfied with the outcome. Conclusions The technique is safe, versatile and easy to execute, providing a tension-free zone and acting as internal dermal sling, thus providing better wound healing with more favourable aesthetic outcome and maintaining breast projection.
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Affiliation(s)
- Haitham H Khalil
- Department of Oncoplastic and Reconstructive Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Marco Malahias
- Department of Oncoplastic and Reconstructive Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Geeta Shetty
- Department of Breast Oncoplasty Surgery, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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Rancati A, Irigo M, Angrigiani C. Management of the Ischemic Nipple–Areola Complex After Breast Reduction. Clin Plast Surg 2016; 43:403-14. [DOI: 10.1016/j.cps.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robert G, Duhamel A, Alet JM, Pelissier P, Pinsolle V. Complications des réductions mammaires à propos de 715 seins. ANN CHIR PLAST ESTH 2014; 59:97-102. [DOI: 10.1016/j.anplas.2014.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Boufettal H, Khalkane L, Dlia H, Mahdaoui S, Hermas S, Noun M, Ezzoubi M, Samouh N. Gigantomastie gravidique bilatérale : à propos d’un cas. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Allah KC, Kossoko H, Assi Djè Bi Djè V, Yéo S, Kadio MR. [Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft]. ACTA ACUST UNITED AC 2011; 40:363-6. [PMID: 21255945 DOI: 10.1016/j.jgyn.2010.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 12/02/2010] [Accepted: 12/08/2010] [Indexed: 11/26/2022]
Abstract
Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft. Juvenile gigantomastia or virginal hypertrophy is a volume anomaly of breast of the teenager. It is unsightly. But often, it is pain, impaired spinal posture and the shoulder girdle and the psychological effects that bring the teenager to make an application for aesthetic surgery. We report two cases of juvenile and bilateral gigantomastia in adolescents aged 13 years old and unresolved. They have lost their hope before surgical procedure. In both cases, treatment consisted of a reduction mammaplasty with nipple-areola complex graft according to the technique of Thorek. The total resection was 3500 and 2900 g of breast tissue in one and 4000 g per breast in the other. Satisfaction regarding the shape, size and symmetry of the reconstructed breast was good. Although the effects on breastfeeding remain patent, the psychological impact was favorable in all cases.
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Affiliation(s)
- K C Allah
- Service de chirurgie plastique reconstructrice et esthétique, chirurgie de la main et brûlologie, CHU de Treichville, 01 BP V 3, Abidjan 01, Côte d'Ivoire.
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Loury J, Piquet M, Letertre P, Pauchot J, Tropet Y. Étude rétrospective des complications et imperfections : à propos de 100 cas de mammoplastie de réduction à pédicule supérieur. ANN CHIR PLAST ESTH 2010; 55:187-94. [DOI: 10.1016/j.anplas.2009.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 06/13/2009] [Indexed: 11/16/2022]
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Breast Reduction in Gigantomastia Using the Posterosuperior Pedicle: An Alternative Technique, Based on Preservation of the Anterior Intercostal Artery Perforators. Plast Reconstr Surg 2010; 125:32-43. [DOI: 10.1097/prs.0b013e3181c49561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dancey A. Letter to the Editor. J Plast Reconstr Aesthet Surg 2009. [DOI: 10.1016/j.bjps.2008.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mojallal A, Moutran M, Martin E, Braye F. Re: Gigantomastia--a classification and review of the literature. J Plast Reconstr Aesthet Surg 2008; 62:262-3; author reply 263-4. [PMID: 19010105 DOI: 10.1016/j.bjps.2008.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 07/04/2008] [Indexed: 10/21/2022]
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