Étude rétrospective des complications et imperfections : à propos de 100 cas de mammoplastie de réduction à pédicule supérieur

Thrombotic thrombocytopenic purpura following plastic surgery: A case report

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, and potential multi-organ involvement. Typically, TTP is associated with underlying conditions such as autoimmune diseases, infections, cancer, or hereditary factors. To date, very few cases of post-operative TTP have been reported. We report the first known case of TTP following plastic surgery. A 19-year-old female initially recovered uneventfully after breast reduction surgery but presented on postoperative day 7 with a persistent hematoma, worsening anemia, and thrombocytopenia. The diagnosis of TTP was confirmed following hematoma evacuation, with laboratory results showing severe hemolysis and a marked reduction in ADAMTS13 activity. The patient was promptly treated with plasma exchange, corticosteroids, and rituximab, which led to significant clinical improvement and resolution of hematological abnormalities. This case underscores the rarity of TTP following plastic surgery, where it is more often linked to other medical conditions. Early recognition and management of TTP, particularly with plasma exchange, are crucial to preventing complications and improving patient outcomes. Although endothelial damage during surgery may contribute to the onset of TTP, the causal link in this case remains uncertain. Awareness of TTP as a potential postoperative complication is essential, especially when dealing with persistent anemia, bleeding, or thrombocytopenia.

Juvenile breast hypertrophy: Successful breast reduction with a loss of 16 % of body weight, with no recurrence observed at 2-year follow-up, a rare case report

INTRODUCTION AND IMPORTANCE

Juvenile breast hypertrophy, also known as juvenile macromastia or juvenile gigantomastia, is a rare disorder characterized by rapid, excessive breast growth in prepubertal or peripubertal girls, with no apparent cause. Juvenile breast hypertrophy is considered one of the most challenging mastopathies to manage.

CASE PRESENTATION

We present the case of a 12-year-old Moroccan girl with virginal breast hypertrophy, who was successfully treated.

CLINICAL DISCUSSION

Juvenile breast hypertrophy is a benign disorder characterized by breast enlargement without the presence of masses. It can present diagnostic challenges for physicians and necessitates a multidisciplinary approach for accurate diagnosis, supported by histological findings of stromal and ductal hyperplasia. Additionally, it may lead to significant physical and psychological effects on young girls. Surgery is regarded as the preferred treatment and may involve either breast reduction or bilateral mastectomy. This approach is warranted due to the size of the breasts and their associated physical and psychological impacts, as experienced by our patient.

CONCLUSIONS

This report aims to share knowledge about this rare case and may also pave the way for further research to understand the underlying mechanisms better and standardize the treatment of juvenile breast hypertrophy.

Breast Reduction with Deskinning of a Superomedial Pedicle: A Retrospective Cohort Study

BACKGROUND

In most breast reduction techniques, the pedicle of the nipple-areola complex (NAC) is de-epithelialized to preserve the subdermal plexus, thereby decreasing the risk of NAC necrosis. However, deskinning the pedicle is faster and makes it more pliable, which potentially improves the aesthetic outcome. There is no scientific evidence regarding the beneficial effects of de-epithelialization. In this study, we present data from patients undergoing breast reduction with deskinning of a superomedial pedicle.

METHODS

In the period June 2013 to March 2019, a single surgeon performed all breast reductions using a superomedial glandular pedicle. The patients were included retrospectively and data were collected by reviewing the medical records. The NAC necrosis rate was compared with data from the literature through a systematic review.

RESULTS

The cohort consisted of 142 consecutive patients. The median resection weight was 287 g (interquartile range (IQR), 197-399) per breast. No complete NAC necroses occurred during the follow-up period, but two patients (1.4%) developed partial NAC necrosis. In the literature, the rate of NAC necrosis (complete or partial) was 1.5% of patients undergoing breast reduction with de-epithelialization.

CONCLUSION

The rate of NAC necrosis after breast reduction with deskinning of the pedicle was comparable with breast reductions with de-epithelialization that has been reported in the literature. Our findings support that the pedicle in breast reduction surgery can be deskinned safely in patients with low resection weights.

[Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft]

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.