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Liang D, Edwards V, Di Taranto G. Breast Reduction with Implants or Augmentation Reduction: Patient-Reported Outcomes from a Single-Centre Retrospective Cohort Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:743. [PMID: 38792926 PMCID: PMC11122802 DOI: 10.3390/medicina60050743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/07/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. Materials and Methods: A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. Results: Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300-455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire (p < 0.001). Conclusions: Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain.
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Affiliation(s)
- Derek Liang
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK; (D.L.); (V.E.)
| | - Vicky Edwards
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK; (D.L.); (V.E.)
- Hammersmith Private Hospital, Enhance Medical Group, The Triangle, 5-17 Hammersmith Grove, London W6 0LG, UK
| | - Giuseppe Di Taranto
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK; (D.L.); (V.E.)
- Hammersmith Private Hospital, Enhance Medical Group, The Triangle, 5-17 Hammersmith Grove, London W6 0LG, UK
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Byun IH, Jung JE, Shin IS, Park SH. Periareolar Augmentation Mastopexy: Finding the Aesthetic Level of Breast Lifting. J Cutan Aesthet Surg 2023; 16:286-291. [PMID: 38314368 PMCID: PMC10833489 DOI: 10.4103/jcas.jcas_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Ptosis and volume atrophy of the breasts are common symptoms for various ages of women and may induce a considerable amount of stress in daily life. Periareolar augmentation mastopexy is an effective procedure for such conditions, and planning the new nipple position is very important. Aim To provide a simple, straightforward planning and walkthrough of this operation in a journey to find the ideal level of breast lifting for natural upper fullness. Materials and methods From January 2019 to December 2021, a total of 193 patients with volume deflation and ptosis of the breast received periareolar augmentation mastopexy in our institute. We retrospectively reviewed data on demographics, surgical procedures, outcomes, and complications. Results All operations were done with periareolar incisions, and the mean follow-up period was 29.48 ± 9.11 months. The Likert scale of outcome satisfaction scored 9.02 ± 0.61. Complications were minimal, and no symmastia or bottoming out occurred. Conclusion We present our basic strategies of periareolar augmentation mastopexy with a slight modification of the design. We believe that lifting the nipple to 3-4 cm above the inframammary fold (IMF) (making the top of the areola about 5-6 cm above the IMF) yields satisfactory aesthetic results.
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Affiliation(s)
- Il Hwan Byun
- Department of Plastic and Reconstructive Surgery, ID Hospital, Seoul, South Korea
| | - Ji Eun Jung
- Department of Plastic and Reconstructive Surgery, ID Hospital, Seoul, South Korea
| | - In Seok Shin
- Department of General Surgery, ID Hospital, Seoul, South Korea
| | - Sang Hoon Park
- Department of Plastic and Reconstructive Surgery, ID Hospital, Seoul, South Korea
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Mallucci P, Bistoni G. Experience and Indications for the Use of the P4HB Scaffold (GalaFLEX) in Aesthetic Breast Surgery: A 100-Case Experience. Aesthet Surg J 2022; 42:1394-1405. [PMID: 35880823 DOI: 10.1093/asj/sjac198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The popularity of utilizing mesh in the breast has varied over the years. It is well described, and yet there has been poor uptake of its utilization in aesthetic breast surgery. Poly-4-huydroxybutarate (P4HB; GalaFLEX, Galatea, Lexington, MA) has recently been described as a useful adjunct in supporting poor tissue quality with positive early outcomes and low complication rates. OBJECTIVES The authors sought to determine the outcome and range of indications of PH4B in aesthetic breast surgery to document its effectiveness in assisting with long-term outcomes in mastopexy. METHODS Firstly, an observational study was undertaken standardizing mastopexy techniques with P4HB included in the procedure. Photographic measurements were taken to determine the extent of lower pole descent and lower pole stretch at 3 months and 1 year postoperative to observe change over time. Secondly, other indications were explored, including the correction of secondary defects such as inferior malposition and symmastia. RESULTS The results of the mastopexy study were highly encouraging and comparable with those previously published in the literature, confirming sustained stability of the lower pole over time for mastopexies and implant mastopexies. In addition, the GalaFLEX was successfully employed in correcting many secondary defects. CONCLUSIONS P4HB is extremely versatile and easy to utilize and has low complication rates. The results have led to a change in practice, with routine incorporation of GalaFLEX for all routine mastopexies. It has also replaced the utilization of acellular dermal matrices in aesthetic breast surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Giovanni Bistoni
- assistant professor, Sapienza University of Rome, Department of Surgery, Plastic and Reconstructive Surgery Unit, Rome, Italy
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4
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Ptosis and Bottoming out Following Mastopexy and Reduction Mammoplasty. Is Synthetic Mesh Internal Breast Support the Solution? A Systematic Review of the Literature. Aesthetic Plast Surg 2022; 46:25-34. [PMID: 34297171 DOI: 10.1007/s00266-021-02398-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Relying on soft tissues with low structural strength to provide long-term support of the breasts following aesthetic mammoplasty may be inadequate in many instances. To address the inherent weakness of tissues still present after surgery, use of synthetic non-autologous additional tissue reinforcement has been described. The current review is aimed at analyzing available evidence about safety and effectiveness of mesh support in various reduction mammoplasty, mastopexy, or augmentation-mastopexy. METHODS An advanced PubMed and Medline search was conducted to identify clinical studies about the use of synthetic mesh in aesthetic breast surgery. An additional search of breast symmetrization and synthetic mesh was also conducted. Ten studies were identified and judged to be relevant to this review. RESULTS Retrieved studies were relatively few, characterized by marked heterogeneity, lack of well-defined outcome end points, poor outcome measures, and inherent bias in outcome documentation providing low level of evidence. CONCLUSION Despite reported relative safety and some promising results, available data indicate that meshes do not effectively prevent recurrent ptosis and bottoming out; they may not be superior to described techniques with superior pedicle and hammocks or "balcony" flaps. Well-conducted studies are yet to be conducted comparing internal bra technique to procedures with innovative autologous tissue support. LEVEL OF EVIDENCE III 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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The Periareolar Approach: All Seasons Technique for Multiple Breast Conditions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3693. [PMID: 34422516 PMCID: PMC8376345 DOI: 10.1097/gox.0000000000003693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
The periareolar approach was first introduced by Hollander in 1924 and, since then, numerous contributions have been reported by different authors. Despite all the strengths associated with this versatile technique, the periareolar approach still poses three main problems: large areolar diameter with poor quality scar, flattening of the breast cone, and poor stability of the results. The purpose of this article is to show how this surgical technique, with a good patient selection, can be applied to different situations and obtain excellent results.
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Li JJ, Yang Y, Wan Q, Li H, Long QM, Zhang PR. Clinical observation of the regeneration process of defects after breast cancer resection. BMC WOMENS HEALTH 2021; 21:99. [PMID: 33676505 PMCID: PMC7936498 DOI: 10.1186/s12905-021-01219-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/10/2021] [Indexed: 11/11/2022]
Abstract
Background The present study aims to use two different kinds of filling materials, oxidized regenerated cellulose and gelatin sponge, to repair defects of breast-conserving surgery due to breast cancer, and compare the clinical efficacy, cosmetic effect and complication rate among groups. Methods A total of 125 patients, who had breast -conserving surgery due to breast cancer, were enrolled into the present study. Postoperative efficacy was assessed by a doctor and patient, according to the Harvard/NSABP/RTOG Breast Cosmetic Grading Scale. Results Among these patients, 41 patients received conventional breast-conserving surgery, and 84 patients received breast-conserving surgery plus filling implantation (41 patients in the oxidized regenerated cellulose group and 43 patients in the gelatin sponge group). All patients had small to medium sized breasts (cup size A and B). The average weight of tumor tissues was 56.61 ± 11.57 g in the conventional breast-conserving surgery group, 58.41 ± 8.53 g in the oxidized regenerated cellulose group, and 58.77 ± 9.90 g in the gelatin sponge group. The difference in pathological factors, average operation time, length of stay and local infection rate was not statistically significant among the three groups. 18 patients in the oxidized regenerated cellulose group and 15 patients in the gelatin sponge group were evaluated to have a good cosmetic effect by the surgeon and patient, while 12 patients in the conventional breast-conserving surgery group were evaluated to be have good cosmetic effect by the surgeon and patient. The cosmetic effects in the oxidized regenerated cellulose group and gelatin sponge group were comparable, and these were superior to those in the conventional breast-conserving surgery group. Conclusion The use of oxidized regenerated cellulose and gelatin sponge is a feasible approach for defect repair after breast-conserving surgery.
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Affiliation(s)
- Jun-Jie Li
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China
| | - Ye Yang
- Department of Medical Oncology, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Qi Wan
- Jinjiang Maternity and Child Health Hospital, Chengdu, 610065, Sichuan, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China
| | - Qi-Ming Long
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China
| | - Pu-Rong Zhang
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China.
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Kagaya Y, Shiokawa I, Karasawa H, Ono K, Momosawa A. Nipple-Areolar Complex Position in Female-to-Male Transsexuals After Non-skin-excisional Mastectomy: A Case-Control Study in Japan. Aesthetic Plast Surg 2019; 43:1195-1203. [PMID: 31144007 DOI: 10.1007/s00266-019-01409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mastectomy is performed in female-to-male transsexual (FTM TS) patients as a surgical treatment to make a female thorax resemble a male thorax; however, no studies have examined the nipple-areolar complex (NAC) position in FTM TS patients after mastectomy. PATIENTS AND METHODS The NAC position in 41 FTM TS patients before and after non-skin-excisional mastectomy was examined and compared with that in 50 age- and BMI-matched biologically male subjects as controls. The factors affecting the NAC position after the operation were also examined and verified by multiple regression analysis. RESULTS AND CONCLUSIONS After non-skin-excisional mastectomy, the NAC in the FTM TS patients was positioned significantly more medially (horizontal NAC position ratio {('internipple distance'/'width of thorax') × 100} [HNPR]: preoperatively, 70.07% ± 4.19%; postoperatively, 63.28% ± 3.79%) and cranially (vertical NAC position ratio {('distance from sternal notch to nipple height'/'distance from sternal notch to umbilicus') × 100} [VNPR]: preoperatively, 43.87% ± 3.68%; postoperatively, 41.37% ± 3.15%). Postoperatively, the NAC in the FTM TS patients was located significantly more medially than that in the control subjects (HNPR: 63.28% ± 3.79% to 66.79% ± 4.82%), although the height of the NAC was the same. Multiple regression analysis revealed that the NAC position on breasts characterized by ptosis, a high projection, and lateral leaning (low skin elasticity and a substantial amount of skin between the nipples) tended to be positioned more medially after non-skin-excisional mastectomy. Laterally deviated eccentric circular type mastectomy may be a good option for FTM TS patients who have moderately sized breasts with such features. 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)
- Yu Kagaya
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ichiro Shiokawa
- Department of Plastic and Reconstructive Surgery, Yamanashi University Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3863, Japan
| | - Hiroki Karasawa
- Keiseikai Clinic, 1-7-30 Higashi-shinsaibashi, Chuo-ku, Osaka-shi, Osaka, Japan
| | - Kentaro Ono
- Skin Clinic Fujieda, 1-3-1 Maejima, Fujieda-shi, Shizuoka, Japan
| | - Akira Momosawa
- Department of Plastic and Reconstructive Surgery, Yamanashi University Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3863, Japan.
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9
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Manero I, Rodriguez-Vega A, Labanca T. Combined Breast Reduction Augmentation. Aesthetic Plast Surg 2019; 43:571-581. [PMID: 30725197 DOI: 10.1007/s00266-019-01318-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/20/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Numerous methods have been designed to reduce breasts size and weight. The goal today is to not only to reduce size but also to create a pleasing shape. Breast reduction techniques do not obtain the desired upper pole fullness, and commonly recurrent ptosis develops. To improve and maintain breast shape in the late postoperative period, we combine breast reduction with implants. METHODS Three hundred and sixty-six patients who underwent combined breast reduction or mastopexy with implants from January 2014 to November 2017 at IM Clinic were retrospectively reviewed. We present the indications, surgical technique, and outcomes of these patients to determine the safety and efficacy of our technique. RESULTS No major complications were noted in an average of 2 years of follow-up (range 2 months to 4 years). Minor complications occurred in 61 patients, of whom 46 required revision surgery (12.6%). The most common tissue-related complications were dog ears (7.6%) and poor scarring (4.9%). The most common implant-related complication was capsular contracture (0.8%). CONCLUSIONS Breast reduction with implants is a reliable option to provide additional volume to the upper pole of the breast to improve long-term breast shape and avoid ptosis recurrence. Our study indicates that the procedure is safe and has complication and revision rates comparable to traditional breast reduction or augmentation mastopexy techniques. 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)
- Ivan Manero
- Department of Plastic and Reconstructive Surgery Dr. Ivan Mañero, Institute of Plastic Surgery, Barcelona, Spain
| | - Ana Rodriguez-Vega
- Department of Plastic and Reconstructive Surgery Dr. Ivan Mañero, Institute of Plastic Surgery, Barcelona, Spain.
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Breast Reduction: The Superolateral Dermoglandular Pedicle Revisited. Aesthetic Plast Surg 2019; 43:36-45. [PMID: 30259167 DOI: 10.1007/s00266-018-1225-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Breast hypertrophy, generally found in association with ptosis, is a common problem in postadolescent women. Beyond the psychological burden of excessively heavy, droopy breasts, physical symptoms compound the condition, with neck, shoulder and back pain. Reduction mammaplasty is one of the most common cosmetic operations, especially to improve patient's musculoskeletal symptoms, with proven benefits in patient satisfaction and self-esteem postoperatively. Multiple techniques exist for breast reduction, with no clear evidence of benefit of one over another. METHODS We review the senior author's experience in using a superolateral pedicle for breast reduction in 726 patients over the past 40 years. Over the past 10 years, the technique has also been adapted for simultaneous augmentation-mastopexy, especially in post-bariatric surgery patients. Benefits include recruitment of lateral breast tissue to fill the upper pole and correct axillary fullness. The technique has the advantages of ease of execution and a low complication rate. RESULTS Complete data were available for 397 patients. Resection weights varied from 380 to 1248 g, and mean sternal notch-nipple distance was 25.3 cm. Mean follow-up was 22 months. Complications were uncommon: four cases of partial nipple-areola complex loss, dehiscence in 14 patients, three hematomas and seven cases of superficial surgical site infection. Nipple sensitivity was decreased in eight patients, and three patients were unable to breastfeed following surgery. Revision surgery was requested by 14 patients. CONCLUSIONS Breast reduction using the superolateral dermoglandular flap is easy to execute, versatile, safe and effective, preserving physiological functions, and is an excellent option when treating patients with medium-to-large breasts. 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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Abstract
BACKGROUND Mammaplasty surgery has been modified in the past few years, as plastic surgeons worked to improve and maintain the breast shape and especially the "bottoming out" of the gland. The classic Pitanguy's technique has been shown to be an anatomically safe technique in the management of the breast. However, as first described, cannot be applied in gigantomastia or in severe breast ptosis cases or in cases of dense breast parenchyma or for a long-lasting breast lift result. Using 2 different modifications, the Pitanguy technique can be applied for breasts of all sizes and for all cases of breast ptosis. METHODS A retrospective study of 140 patients who underwent the Pitanguy method and its 2 modifications was performed. The first modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nac. The medial flap is then advanced superiorly, rotated 90 degrees, and sutured to point A, whereas the lateral flap is placed below the medial one. The second modification describes an inferior chest wall-based flap for achieving a desirable shape that can be maintained over a long period. The inferior flap is based only in the thoracic wall vasculature, completely detached from surrounding structures, maintaining a good volume. The upper flap of the breast covers the inferior flap. RESULTS The follow-up included 140 patients and the follow-up period ranged from 1 to 10 years. Five patients were operated on less than 4 months ago and were not involved in this study. All patients gained natural-shaped breasts, and they were pleased with the results. Serious complications, including flap necrosis, were avoided because caution was used to preserve the internal mammary perforators while performing the Pitanguy's technique and its 2 modifications. CONCLUSIONS The classic Pitanguy technique and its 2 modifications provide a versatile, well-vascularized pedicle that allows elevation of the nipple areola complex at the desired height. Using these 2 modifications, the Pitanguy's technique can be applied for breasts of all sizes and for all cases of breast ptosis.
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Abstract
AIM Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or roundness. We present a technique of breast reduction combined with augmentation termed "reductive augmentation" to solve this problem. The technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis in the patient who has previously undergone breast augmentation with or without mastopexy. METHODS An evolution of techniques has been used to create a breast with more upper pole fullness and anterior projection in those patients desiring a more round, higher-profile appearance. Reductive augmentation is a one-stage procedure in which a breast augmentation is immediately followed by a modified superomedial pedicle breast reduction. Often, the excision of breast tissue is greater than would normally be performed with breast reduction alone. RESULTS Thirty-five patients underwent reductive augmentation, of which 12 were primary surgeries and 23 were revisions. There was an average tissue removal of 255 and 227 g, respectively, per breast for the primary and revision groups. Six of the reductive augmentations were performed for gross asymmetry. Fourteen patients had a previous mastopexy, and 3 patients had a previous breast reduction. The average follow-up was 26 months. CONCLUSIONS Reductive augmentation is an effective one-stage method for achieving a more round-appearing breast with upper pole fullness both in primary breast reduction candidates and in revisionary breast surgery. This technique can also be applied to those patients with significant asymmetry. 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)
- Paul E Chasan
- Ranch and Coast Plastic Surgery, 1431 Camino del Mar, Del Mar, CA, 92014, USA.
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Adams WP, Baxter R, Glicksman C, Mast BA, Tantillo M, Van Natta BW. The Use of Poly-4-Hydroxybutyrate (P4HB) Scaffold in the Ptotic Breast: A Multicenter Clinical Study. Aesthet Surg J 2018; 38:502-518. [PMID: 29401215 DOI: 10.1093/asj/sjy022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mastopexy and reduction mammaplasty are often limited by the patient's poor native soft tissue quality, resulting in ptosis recurrence and loss of rejuvenated surgical results. Surgical scaffolds and acellular dermal matrices are used in these procedures to provide physical and mechanical stabilization of weakened or compromised tissue. GalaFLEX scaffold, made from poly-4-hydroxybutyrate (P4HB), is a next-generation product for soft tissue reinforcement that resorbs gradually while aiding tissue regeneration to achieve excellent outcomes. OBJECTIVES To assess the clinical performance of GalaFLEX scaffold in soft tissue reinforcement during elective mastopexy and reduction mammaplasty. METHODS This multicenter, single-arm, observational study assessed product performance and outcomes of GalaFLEX scaffold when used in breast surgery. Outcomes included ptosis correction and maintenance, associated adverse events, patient and surgeon satisfaction, and mammographic and ultrasound imaging evaluation. RESULTS At 6 centers in the US, 62 of 69 enrolled patients were treated. Of this population, 89.7% had successful ptosis correction and maintenance at 1 year, with high patient and surgeon satisfaction for breast shape, droop/sag of the breast, and maintenance of results at 1 year. There were 5 adverse events deemed related to the device (8.0%), including nerve pain, breast swelling, ptosis, and 2 instances of asymmetry. CONCLUSIONS GalaFLEX scaffold safely and successfully supports and elevates breast tissue in mastopexy and reduction mammaplasty, with maintained support at 1 year. Surgeon and patient satisfaction were high. No mammogram or ultrasound interference was detected. LEVEL OF EVIDENCE 4
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Affiliation(s)
- William P Adams
- Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Richard Baxter
- plastic surgeon in private practice in Mountlake Terrace, WA
| | | | - Bruce A Mast
- Maurice J. Jurkiewicz Professor of Reconstructive Plastic Surgery and Chief of the Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL
| | | | - Bruce W Van Natta
- Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
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14
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Qureshi AA, Myckatyn TM, Tenenbaum MM. Mastopexy and Mastopexy-Augmentation. Aesthet Surg J 2018; 38:374-384. [PMID: 29365038 DOI: 10.1093/asj/sjx181] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mastopexy and mastopexy-augmentation are aesthetic breast surgeries that seek to create youthful, beautiful appearing breasts. Age, hormonal changes, or weight loss can lead to alterations that require addressing the skin envelope and breast parenchyma. Many surgical approaches have been described including periareolar, vertical, and Wise pattern techniques, but most modern mastopexies include manipulation of the breast parenchyma to improve the longevity of breast ptosis correction. Mesh support of the ptotic breast is an extension of this paradigm shift and seeks to restore the lost strength of the support structures of the breast. Despite initial controversy, single stage mastopexy-augmentation has been demonstrated to be a safe option for appropriately selected and informed patients who desire both correction of shape and volume. Revisions may still be necessary based on patient and surgeon goals for correction. Evolving technologies will likely continue to enhance the ability of aesthetic plastic surgeons to provide pleasing, durable correction of breast ptosis.
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Affiliation(s)
- Ali A Qureshi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Use of Poly-4-Hydroxybutyrate Mesh to Optimize Soft-Tissue Support in Mastopexy: A Single-Site Study. Plast Reconstr Surg 2017; 139:67-75. [PMID: 28027230 DOI: 10.1097/prs.0000000000002922] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ptotic breast is surgically rejuvenated through a mastopexy procedure. Recurrent ptosis or other negative changes to the breast shape are not uncommon following mastopexy, as the tissue laxity and skin quality that contributed to ptosis are not surgically corrected. The purpose of this study was to assess the postsurgical changes in the breasts of patients who underwent a primary mastopexy procedure with soft-tissue reinforcement using a long-term poly-4-hydroxybutyrate resorbable scaffold (i.e., GalaFLEX). METHODS From July of 2012 to January of 2014, 11 consecutive patients underwent a central mound mastopexy with soft-tissue reinforcement in the lower pole using a poly-4-hydroxybutyrate resorbable scaffold. Patients returned for postoperative follow-up visits that included three-dimensional scans of their breasts at months 1, 3, 6, and 12. RESULTS There were no major complications in the study. Changes in the breast shape defined by distances between predefined landmarks between months 1 and 12 ranged from 1.5 to 9.6 percent. Some postoperative breast settlement occurred between months 1 and 3. The mean change in the nipple-to-inframammary fold distance from months 1 to 12 was 8 mm. Lower pole stretch was 5 percent. CONCLUSIONS Initial findings suggest that central mound mastopexy with soft-tissue reinforcement in the lower pole performed on difficult larger breasts yields a relatively stable result for 1 year after surgery. There was no statistically significant change between months 3 and 12 from the sternal notch to lowest point on the breast as determined by established three-dimensional imaging techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Lee J, Jung JH, Kim WW, Yang JD, Lee JW, Li J, Park HY. Comparison of two different types of oxidized regenerated cellulose for partial breast defects. J Surg Res 2017. [PMID: 28624048 DOI: 10.1016/j.jss.2017.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A defect after partial mastectomy, sometimes, is hard to be filled with patient's own breast tissue. Two different types of oxidized regenerated cellulose (ORC) for filling of partial defects in small-sized breasts were compared with respect to clinicopathologic factors and outcomes. METHODS A total of 45 patients with breast cancer underwent conventional partial mastectomy with insertion of an ORC filling material. The two filling materials used were a hemostasis-purposed ORC and adhesion barrier-purposed ORC. Clinical factors were compared between these two ORC materials. Both the surgeon and patient assessed the cosmetic outcomes using the Harvard/NSABP/RTOG Breast Cosmesis Grading Scale. RESULTS Partial mastectomy with filling material insertion technique was not inferior to partial mastectomy-only technique in many clinical aspects. And most of the clinicopathologic factors showed no significant difference between the two groups. However, the mean operation time was significantly shorter in the hemostasis-purposed ORC group (P = 0.027). In addition, the infection rate was significantly higher in the adhesion barrier-purposed ORC group (P = 0.040). CONCLUSIONS Reconstructive surgery using a hemostasis-purposed ORC was associated with a shorter operation time and lower incidence of postoperative infection than that using an adhesion barrier-purposed ORC. However, both types of ORC were feasible as filling compounds for partial defects of the breast.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jeong Woo Lee
- Department of Plastic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Junjie Li
- Department of Surgery, Sichuan Province Cancer Hospital, Chengdu, China
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
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Adams WP, Toriumi DM, Van Natta BW. Clinical Use of GalaFLEX in Facial and Breast Cosmetic Plastic Surgery. Aesthet Surg J 2016; 36:S23-S32. [PMID: 27697886 DOI: 10.1093/asj/sjw142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 12/16/2022] Open
Abstract
Resolution of ptosis is a key step to the success of many plastic surgery procedures. Ptosis is a manifestation of tissue stretch. Tissue stretch can occur as a result of the natural aging process or health of the patient, or tissue may stretch under added weight or volume, such as when implants are placed. Surgical rejuvenation of ptotic tissues is very effective and results in marked changes in the patient profile yet the tissue that resulted in the need for the procedure first place has not improved and ptosis can recur. Recent developments in long-term resorbable porous materials have provided surgeons with the opportunity to experiment with tissue reinforcement in plastic surgery procedures. These new materials have a low profile, rapid tissue integration, and a long-term strength retention profile. Long-term resorbable scaffolds such as poly-4-hydroxybutyrate (P4HB) natural scaffold (GalaFLEX scaffold, Galatea Surgical, Inc., Lexington, MA) have shown promise for a host of plastic surgery indications. This article presents clinical experience with GalaFLEX for soft tissue reinforcement in three different clinical applications; including the reinforcement of the superficial muscular aponeurotic system (SMAS) in minimally invasive facelift, reinforcement of the skin envelope in mastopexy, and reinforcement of the breast capsule (pocket) in revisional breast surgery. Soft tissue reinforcement has been shown to provide increased mechanical strength as well as improved maintenance of postoperative results. LEVEL OF EVIDENCE 5 Therapeutic.
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Affiliation(s)
- William P Adams
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Dean M Toriumi
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Bruce W Van Natta
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
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Abstract
The GalaFLEX Scaffold (Galatea Surgical, Inc., Lexington, MA) for plastic and reconstructive surgery belongs to a new generation of products for soft tissue reinforcement made from poly-4-hydroxybutyrate (P4HB). Other members of this new family of products include MonoMax Suture (Aesculap AG, Tuttlingen, Germany) for soft tissue approximation, BioFiber Scaffold (Tornier, Inc., Edina, MN) for tendon repair, and Phasix Mesh (C.R. Bard, Inc., Murray Hill, NJ) for hernia repair. Each of these fully resorbable products provides prolonged strength retention, typically 50% to 70% strength retention at 12 weeks, and facilitates remodeling in vivo to provide a strong, lasting repair. P4HB belongs to a naturally occurring class of biopolymers and fibers made from it are uniquely strong, flexible, and biocompatible. GalaFLEX Scaffold is comprised of high-strength, resorbable P4HB monofilament fibers. It is a knitted macroporous scaffold intended to elevate, reinforce, and repair soft tissue. The scaffold acts as a lattice for new tissue growth, which is rapidly vascularized and becomes fully integrated with adjacent tissue as the fibers resorb. In this review, we describe the development of P4HB, its production, properties, safety, and biocompatibility of devices made from P4HB. Early clinical results and current clinical applications of products made from P4HB are also discussed. The results of post-market clinical studies evaluating the GalaFLEX Scaffold in rhytidectomy and cosmetic breast surgery demonstrate that the scaffold can reinforce lifted soft tissue, resulting in persistent surgical results in the face and neck at one year, and provide lower pole stability after breast lift at one year.
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Affiliation(s)
- Simon F Williams
- Dr Williams is a Consultant to Tepha, Inc. and a member of the Tepha Board of Directors. Dr Martin is the Chief Scientific Officer of Tepha, Inc. Dr Moses is a Consultant to Tepha, Inc. and is the Founder of Galatea Surgical, Inc. Galatea Surgical, Inc. is a wholly owned subsidiary of Tepha, Inc
| | - David P Martin
- Dr Williams is a Consultant to Tepha, Inc. and a member of the Tepha Board of Directors. Dr Martin is the Chief Scientific Officer of Tepha, Inc. Dr Moses is a Consultant to Tepha, Inc. and is the Founder of Galatea Surgical, Inc. Galatea Surgical, Inc. is a wholly owned subsidiary of Tepha, Inc
| | - Arikha C Moses
- Dr Williams is a Consultant to Tepha, Inc. and a member of the Tepha Board of Directors. Dr Martin is the Chief Scientific Officer of Tepha, Inc. Dr Moses is a Consultant to Tepha, Inc. and is the Founder of Galatea Surgical, Inc. Galatea Surgical, Inc. is a wholly owned subsidiary of Tepha, Inc
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Ors S. Autoaugmentation Mastopexy Modification Prevents Bottoming-Out Deformity and Areola Distortion: A Preliminary Report. Aesthetic Plast Surg 2016; 40:497-506. [PMID: 27234524 DOI: 10.1007/s00266-016-0652-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/05/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ptotic breast deformity results from involution of breast parenchyma and leads to a loss of volume, along with a converse laxity of the skin envelope. As the breast tissue descends inferiorly with gravity, there is an apparent volume loss in the upper pole and the central breast, and the lower pole becomes fuller and often wider. This study presents modifications for a well-known mastopexy technique which provides not only autoaugmentation for the breast but also suspension for the breast parenchyma and reduces bottoming-out deformity, and also obtains a regular areola shape in all types of breasts. PATIENTS AND METHODS The modifications involve 2-4 cm subareolar crescentic incisions for regular areolas and cylindrical excision of the recipient area in the superior medial and lateral pillars for wide flaps in medium and large-size breasts. RESULTS The present study included 63 female patients, with an average body mass index of 25.5 ± 2.0 kg/m(2), aged 26-47 years (average 35 years). The author performed vertical scar mastopexy and augmented the breasts with a distal-based flap of deepithelialized dermoglandular tissue inserted beneath the breast parenchyma of a superior-based nipple-areolar complex pedicle. CONCLUSIONS In this study, modifications included subareolar crescentic incisions and cylindrical excisions in the superior medial and lateral pillar regions. This technique produced satisfactory results for all types of breasts in terms of good breast shape, natural image at the upper pole of the breast, good projection, and reduced bottoming-out deformity. This simple modified technique maintained the size of the breasts and avoided augmentation by breast implants. LEVEL OF EVIDENCE V 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)
- Safvet Ors
- SO-EP Aesthetic & Plastic Surgery Clinic, Seyitgazi Mah. Seyyid Burhaneddin Bulv. No: 51/A, 38050, Kayseri, Turkey.
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Kankaya Y, Oruç M, Sungur N, Aslan ÖÇ, Gürsoy K, Özer K, Koçer U. Four flap suspension technique for prevention of bottoming out after breast reduction. Ann Surg Treat Res 2015; 90:10-5. [PMID: 26793687 PMCID: PMC4717603 DOI: 10.4174/astr.2016.90.1.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/06/2015] [Accepted: 08/18/2015] [Indexed: 12/02/2022] Open
Abstract
Purpose Bottoming-out deformity is accepted as the most important disadvantage of inferior pedicle breast reduction. For prevention of this deformity, different techniques are used in combination with inferior pedicle. In this study, we aimed to prevent bottoming-out deformity by producing an internal bra effect through combination of inferior pedicle technique with 2 superior and 2 inferior dermal flaps that were raised from each side of the pedicle. Methods Thirteen patients whose medical records became available during the follow-up period at Ankara Training and Research Hospital from January 2010 to January 2015 were included in this study. We retrospectively obtained patient medical records including demographic characteristics and clinical data. Superior dermal flaps were planned on both sides of the pedicle 2 cm inferior to the lower border of areola and inferior dermal flaps were planned 6 cm inferior to the superior dermal flaps. The superior and inferior dermal flaps were secured to the periosteum of the 2nd and 4th ribs respectively with permanent sutures. Results Preoperatively, the average distance between the inframammary fold and areola was 13.9 cm (range, 11-18 cm). The average amount of breast parenchymal resection was 745 g (range, 612-1,496 g). The average distance between the inframammary fold and the lower border of the areola was 7.9 cm (range, 7.5-9 cm) on the postoperative first-year measurements. Conclusion In conclusion, according to our study, suspension technique to prevent bottoming-out deformity is associated with an easier technique without the need for alloplastic or allogenic materials. Since fixation is performed to the ribs instead of soft tissues like the pectoral fascia or muscle, we believe that this fixation is more long lasting and can be an effective alternative to other suspension techniques.
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Affiliation(s)
- Yüksel Kankaya
- Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Melike Oruç
- Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Nezih Sungur
- Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Özlem Çolak Aslan
- Okmeydani Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Istanbul, Turkey
| | - Koray Gürsoy
- Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Kadri Özer
- Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Uğur Koçer
- Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
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Abstract
Numerous combinations of pedicle design and incision patterns have been described for mastopexy, but upper pole volume deficiency, suboptimal shape, or recurrent ptosis are still undesired postoperative findings. The challenges of preventing such outcomes are amplified in the massive weight loss (MWL) patient population, where both the extent of morphologic deformation and alterations in tissue characteristics (ie, a materials failure) can be severe. To correct this problem, we propose a technique that combines breast circumference-reduction with maximal glandular rotation and superomedial repositioning: the circumrotational technique. The technique reduces the circumference of the breast base, enhances anterior projection, and defines the lateral breast border by maximal glandular rotation and elevation, reorienting and engaging lax structural elements within the parenchyma. It also recruits ptotic lateral breast tissue into the upper pole, maximizing volume. This technique proposes an initial glandular hyperelevation, upper pole tissue "stacking," and broad peripheral fixation of the breast-to-chest wall to support the breast during the healing period and combat the propensity for recurrence. The circumrotational technique has been mostly used for mastopexy after MWL, but can also be used for typical mastopexies in non-MWL patients with grade 2 or 3 breast ptosis.
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Affiliation(s)
- Gabriele Cáceres Miotto
- Dr Miotto is a Post-Doctoral Fellow, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. Dr Eaves is a Professor of Surgery, Division of Plastic Surgery, Emory University; Medical Director of the Emory Aesthetic Center and Emory Ambulatory Surgery Center, Atlanta, Georgia, USA; and Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| | - Felmont F Eaves
- Dr Miotto is a Post-Doctoral Fellow, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. Dr Eaves is a Professor of Surgery, Division of Plastic Surgery, Emory University; Medical Director of the Emory Aesthetic Center and Emory Ambulatory Surgery Center, Atlanta, Georgia, USA; and Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
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22
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Ibrahim AM, Sinno HH, Izadpanah A, Vorstenbosch J, Dionisopoulos T, Markarian MK, Lee BT, Lin SJ. Mastopexy for breast ptosis: Utility outcomes of population preferences. Plast Surg (Oakv) 2015; 23:103-7. [PMID: 26090352 DOI: 10.4172/plastic-surgery.1000916] [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 Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states. OBJECTIVE To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics. METHODS Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant. RESULTS Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance. DISCUSSION For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to 'perfect health' than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema. CONCLUSIONS Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
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Affiliation(s)
- Ahmed Ms Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hani H Sinno
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; ; Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Ali Izadpanah
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Joshua Vorstenbosch
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tassos Dionisopoulos
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Mark K Markarian
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ibrahim AMS, Sinno HH, Lzadpanah A, Vorstenbosch J, Dionisopoulos T, Markarian MK, Lee BT, Lin SJ. Mastopexy for breast ptosis: Utility outcomes of population preferences. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states. Objective To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics. Methods Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant. Results Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance. Discussion For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to ‘perfect health’ than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema. Conclusions Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
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Affiliation(s)
- Ahmed MS Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hani H Sinno
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Ali Lzadpanah
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Joshua Vorstenbosch
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tassos Dionisopoulos
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Mark K Markarian
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Risks and Benefits of Using an Absorbable Mesh in One-Stage Immediate Breast Reconstruction. Plast Reconstr Surg 2015; 135:498e-507e. [DOI: 10.1097/prs.0000000000001027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Domergue S, Ziade M, Lefevre M, Prud'homme A, Yachouh J. Dermal flaps in breast reduction: Prospective study in 100 breasts. J Plast Reconstr Aesthet Surg 2014; 67:e147-50. [DOI: 10.1016/j.bjps.2014.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 12/02/2013] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
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Golas AR, Hernandez KA, Spector JA. Tissue engineering for plastic surgeons: a primer. Aesthetic Plast Surg 2014; 38:207-221. [PMID: 24378377 DOI: 10.1007/s00266-013-0255-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/17/2013] [Indexed: 01/12/2023]
Abstract
A central tenet of reconstructive surgery is the principle of "replacing like with like." However, due to limitations in the availability of autologous tissue or because of the complications that may ensue from harvesting it, autologous reconstruction may be impractical to perform or too costly in terms of patient donor-site morbidity. The field of tissue engineering has long held promise to alleviate these shortcomings. Scaffolds are the structural building blocks of tissue-engineered constructs, akin to the extracellular matrix within native tissues. Commonly used scaffolds include allogenic or xenogenic decellularized tissue, synthetic or naturally derived hydrogels, and synthetic biodegradable nonhydrogel polymeric scaffolds. Embryonic, induced pluripotent, and mesenchymal stem cells also hold immense potential for regenerative purposes. Chemical signals including growth factors and cytokines may be harnessed to augment wound healing and tissue regeneration. Tissue engineering is already clinically prevalent in the fields of breast augmentation and reconstruction, skin substitutes, wound healing, auricular reconstruction, and bone, cartilage, and nerve grafting. Future directions for tissue engineering in plastic surgery include the development of prevascularized constructs and rationally designed scaffolds, the use of stem cells to regenerate organs and tissues, and gene therapy.
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Affiliation(s)
- Alyssa Reiffel Golas
- Division of Plastic Surgery, Weill Cornell Medical College, 525 E 68th Street, Payson 709A, New York, NY, 10065, USA.
| | - Karina A Hernandez
- Division of Plastic Surgery, Weill Cornell Medical College, 525 E 68th Street, Payson 709A, New York, NY, 10065, USA
| | - Jason A Spector
- Division of Plastic Surgery, Weill Cornell Medical College, 525 E 68th Street, Payson 709A, New York, NY, 10065, USA
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Zic R, Vlajcic Z, Dewing D, Zambelli M, Stanec Z. The "dermal cage": a modification of the inferior pedicle breast reduction. Aesthetic Plast Surg 2013; 37:364-71. [PMID: 23358579 DOI: 10.1007/s00266-012-0030-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 11/09/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED In spite of more recent techniques for breast reduction, the inferior pedicle technique has proven to be enduring and still a very popular option in the plastic surgeon's armamentarium despite certain shortcomings. This technique is especially important for treating large breasts with a long sternal notch-to-nipple distance. The modifications we describe in this article overcome some of the main drawbacks of the standard inferior pedicle technique and make the procedure particularly effective when used on appropriately selected patients. This is achieved principally by the creation of a strong, durable, and internalized "dermal cage" that remains fixed to the chest wall in the upper part, as well as on both sides, to support the majority of the remaining breast tissue. This serves several purposes, including narrowing the breast thereby giving good projection and reduction of the N-IMF length of the inferior pedicle. Through suspension and fixation of the inferior pedicle to the chest wall, one can mitigate the effects of gravity on the inferior pedicle. The benefits of this include reduced tension on the T junction, thereby reducing the incidence of wound dehiscence in the immediate postoperative period, while reduction of tension on the nipple-areola complex reduces "bottoming" out over the long term. This process has been the main shortcoming of the inferior pedicle technique to date. The technique was used on 26 patients over a 7-year period with a mean long-term follow-up of 41 months. The results demonstrate the short- and long-term effectiveness of our own particular combination of modifications to previously described techniques and modifications of the inferior pedicle breast reduction. LEVEL OF EVIDENCE V 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)
- Rado Zic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
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Kim T, Cho H. The suitability of absorbable mesh insertion for oncoplastic breast surgery in patients with breast cancer scheduled to be irradiated. J Breast Cancer 2013; 16:84-9. [PMID: 23593087 PMCID: PMC3625775 DOI: 10.4048/jbc.2013.16.1.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 03/03/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective of this study was to investigate the influence of radiotherapy on the cosmetic outcome after immediate breast reconstruction using an absorbable mesh in breast cancer. Methods From July 2008 to July 2009, 35 breast cancer patients who received immediate breast reconstruction with absorbable mesh insertion at the time of breast conserving surgery followed by radiotherapy were retrospectively studied. Results In 91% of cases there was an excellent or good cosmetic outcome before the initiation of radiotherapy, and in 8.6% the outcome was fair at this point. However, 6 months after surgery and irradiation, the rate of excellent to good cosmetic outcomes had decreased to 60% and fair outcomes had increased to 25.7%. Contrary to the decreased rate of good cosmetic outcomes from 65.7% to 42.9% at 1 year after operation, the rate of fair to poor outcomes considerably increased from 8.6% to 57.1%. The significant factors affecting cosmetic outcomes were pathology, specimen volume, and the estimated percentage of breast volume excised (EPBVE). Chemotherapy affected the cosmetic outcome at borderline significance level. Age, breast volume tumor site, insertion of drain, radiation dose, and time elapsed between surgery and radiotherapy were not significantly associated with the cosmetic outcome. Conclusion Applying an absorbable mesh for the immediate reconstruction of the breast should be carefully considered in patients with an EPBVE of over 30% who are scheduled to be irradiated.
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Affiliation(s)
- Taehyun Kim
- Department of Surgery, Inje University Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Abstract
Plastic surgeons have been performing operations to improve the aesthetic aspect of the breast for centuries. Throughout ancient times, great controversy produced many theories of how breast cancer occurred and the best treatment. Because of beliefs that closure of mastectomy sites could conceal tumor recurrence, breast reconstruction did not gain wide acceptance until the mid-1900s. Today, plastic surgeons have a variety of techniques to reconstruct the breast. The first autologous muscle flap for breast reconstruction was the latissimus dorsi myocutaneous flap, described in 1896 by Iginio Tansini. The introduction of Carl Hartrampf's transverse rectus abdominis myocutaneous flap and Robert J. Allen's deep inferior epigastric perforator flap have also provided excellent reconstructive options. With regard to augmentation, Vincenz Czerny attempted to enhance a woman's breast in 1895 with implantation of a lumbar lipoma. Soon after, surgeons used paraffin injections and polyvinylic alcohol sponge implantation, which yielded disastrous results. In 1961, Thomas Cronin and Frank Gerow promoted the first silicone implant, paving the way for today's silicone and saline prototypes. Although reduction mammaplasty techniques had originated centuries earlier than mastopexy methods, the advancements of both have largely paralleled one another. In 1949, the Wise pattern was introduced to preoperatively plan safer and predictable outcomes in breast reductions. Efforts to minimize scars were achieved with Claude Lassus' introduction and Madeleine Lejour's subsequent modification of the vertical scar mammaplasty. In hopes of fostering an understanding of current post-mastectomy procedures and instilling passion for innovating future techniques, we provide a near-complete, surgically focused historical account of the primary contributors to breast reconstruction.
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van Deventer PV, Graewe FR, Würinger E. Improving the longevity and results of mastopexy and breast reduction procedures: reconstructing an internal breast support system with biocompatible mesh to replace the supporting function of the ligamentous suspension. Aesthetic Plast Surg 2012; 36:578-89. [PMID: 22101986 PMCID: PMC3356514 DOI: 10.1007/s00266-011-9845-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/16/2011] [Indexed: 12/01/2022]
Abstract
Background The reasons for recurrent ptosis in mastopexy and breast reduction procedures are twofold. First, available surgical techniques do not reconstruct the normal breast anatomy responsible for maintaining breast shape. Second, in many instances the techniques rely on atrophied tissue to provide long-term support. The discovery in 1997 of the ligamentous suspension (the supporting system of the breast) gave rise to the concept that reconstruction of this anatomical structure was needed to ensure a sustained postoperative result. Applying the latest knowledge regarding the structural and vascular anatomy of the breast in the surgical technique and utilizing material other than atrophied breast tissue enabled us to prevent the recurrence of breast ptosis. Methods A surgical technique was developed to replace the supportive function of a failed ligamentous suspension in 112 patients with ptotic breasts. This was done by reconstructing an internal breast-supporting system (IBSS) with biocompatible mesh. Results Satisfactory breast shape, nipple projection, and upper breast fullness was obtained with this technique in mastopexy patients with moderate-sized ptotic breasts. In patients with larger breasts good results were obtained with a simultaneous breast reduction. The longest follow-up is 6 years 3 months. Conclusions With this technique recurrent breast ptosis can be prevented in mastopexy and breast reduction procedures. The results are such that it eliminates the need for silicone prostheses to obtain satisfactory upper-breast fullness. The surgical technique is especially indicated in patients with skin of poor quality or patients with high expectations.
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Affiliation(s)
- Petrus V van Deventer
- Division of Plastic and Reconstructive Surgery, Faculty of Health Sciences, University of Stellenbosch, Tygerberg Campus, Bellville, Western Cape, South Africa.
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Koo MY, Lee SK, Hur SM, Bae SY, Choi MY, Cho DH, Kim S, Choe JH, Kim JH, Kim JS, Lee JE, Nam SJ, Yang JH. Results from over one year of follow-up for absorbable mesh insertion in partial mastectomy. Yonsei Med J 2011; 52:803-8. [PMID: 21786446 PMCID: PMC3159934 DOI: 10.3349/ymj.2011.52.5.803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Recently, several clinicians have reported the advantages of simplicity and cosmetic satisfaction of absorbable mesh insertion. However, there is insufficient evidence regarding its long-term outcomes. We have investigated the surgical complications and postoperative examination from the oncologic viewpoint. MATERIALS AND METHODS From February 2008 to March 2009, 34 breast cancer patients underwent curative surgery with absorbable mesh insertion in Samsung Medical Center. Patient characteristics and follow up results including complications, clinical and radiological findings were retrospectively investigated. RESULTS The mean age of the study population was 50.1±8.9 years old (range 31-82) with a mean tumor size of 3±1.8 cm (range 0.8-10.5), and the excised breast tissue showed a mean volume of 156.1±99.8 mL (range 27-550). Over the median follow-up period of 18±4.6 months (range 3-25), mesh associated complications, including severe pain or discomfort, edema, and recurrent fluid collection, occurred in nine patients (26.5%). In three cases (8.8%), recurrent mastitis resulted in mesh removal or surgical intervention. In the postoperative radiologic survey, the most common finding was fluid collection, which occurred in five patients (16.1%), including one case with organizing hematoma. Fat necrosis and microcalcifications were found in three patients (9.7%). CONCLUSION Absorbable mesh insertion has been established as a technically feasible, time-saving procedure after breast excision. However, the follow-up results showed some noticeable side effects and the oncologic safety of the procedure is unconfirmed. Therefore, we suggest that mesh insertion should be considered only in select cases and should be followed-up carefully.
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Affiliation(s)
- Min Young Koo
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mo Hur
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Youn Bae
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Young Choi
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hui Cho
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Righi B, Robotti E. Successfully exploiting two opposing forces: a rational explanation for the "interlocking suture". Aesthetic Plast Surg 2011; 35:177-83. [PMID: 20871997 DOI: 10.1007/s00266-010-9580-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 08/06/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Issues of poor circumareolar scars and asymmetry or malposition of the nipple-areola complex (NAC) are frequently associated with those breast reduction or pexy techniques that rely on an ample excision of skin around the areola, either alone or associated with a vertical scar in a circumvertical approach. To prevent such problems, in 2007 Hammond et al. introduced the "interlocking suture." The objective of this study was to demonstrate the true ability of this suture to reduce the common complications of periareolar surgery simply by managing the existing contrast between NAC centripetal and outer breast tegument centrifugal forces. METHODS By using finite element method (FEM) software, the NAC traditional interrupted stitches were compared with both round-block and interlocking sutures, and the skin strain in all three procedures was qualified. RESULTS The contribution of circuitous stitches in the interlocking suture leads to a more advantageous distribution of forces. FEM analysis shows that the interlocking suture reduces skin stress on peripheral breast teguments by 14% compared to the round-block suture and by 15% compared to the traditional (radial) suture. When evaluating the areolar edge, the interlocking suture leads to a reduction in skin stress of 9.9% compared with traditional interrupted stitches. CONCLUSIONS The efficient, long-lasting results of the interlocking suture are directly due to its unique design, which effectively reduces the tension between the NAC and breast tegument edges in periareolar surgery, thus improving the quality of the scar.
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Affiliation(s)
- Bernardo Righi
- Department of Plastic and Reconstructive Surgery, Ospedali Riuniti, Bergamo, Italy.
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Oncoplastic surgery in Japanese patients with breast cancer close to the areola: partial mastectomy using periareolar mammoplasty: a case report. Case Rep Surg 2011; 2011:121985. [PMID: 22606571 PMCID: PMC3350227 DOI: 10.1155/2011/121985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/13/2011] [Indexed: 11/21/2022] Open
Abstract
We report the results of oncoplastic surgery in two Japanese patients with early breast cancer. Their breasts were large and ptotic, and their lesions, which were close to the areola, were considered to be suitable for breast conservative surgery. Oncoplastic surgery involving partial resection of the gland and a periareolar mammoplasty were performed. The technique was easy to perform, and the cosmetic outcome was excellent.
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Brown RH, Izaddoost S, Bullocks JM. Preventing the "bottoming out" and "star-gazing" phenomena in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere. Aesthetic Plast Surg 2010; 34:760-7. [PMID: 20602099 DOI: 10.1007/s00266-010-9538-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/18/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND The phenomena of "bottoming out" (pseudoptosis) and "star-gazing" (the upward rotation of the nipple-areola complex) is a common postoperative problem when using the inferior pedicle breast reduction technique. Multiple techniques have been described to help prevent this problem, including internal suspension techniques and the use of mesh to support the pedicle. We describe our technique and present a case series in which acellular dermal matrix (AlloDerm(®)) is used as an internal brassiere or sling to support the inferior pedicle and prevent postoperative "bottoming out" and "star-gazing." METHODS Twenty-seven patients underwent inferior pedicle reduction mammaplasty through a Wise pattern performed by a single surgeon. In each case, acellular dermal matrix (0.79-2.03 mm thick) was sutured to the chest wall as a sling or internal brassiere to support the inferior pedicle. The pedicle was also plicated in a horizontal fashion to increase the projection of the breast and to improve the position of the nipple-areola complex. RESULTS The mean weight of reduction per breast was 850 g. The mean distance from the nipple to the inframammary fold was 16.4 cm. The mean distance from the sternal notch to the nipple was 32.2 cm. Only one patient developed cellulitis and one patient had partial skin flap necrosis. There was no nipple loss. At routine follow-up it was found that the aesthetic breast shape has been retained and pseudoptosis or "bottoming out" was not significant in any patient. The longest follow-up is 29 months. CONCLUSION The use of an acellular dermal matrix internal brassiere is a safe and effective technique for preventing the "bottoming out" and "star-gazing" phenomena that occurs after inferior pedicle breast reduction. Longer-term follow-up will be required to assess the longevity of these results.
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Goes JCS, Bates D. Periareolar mastopexy with FortaPerm. Aesthetic Plast Surg 2010; 34:350-8. [PMID: 20336456 DOI: 10.1007/s00266-009-9462-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 11/16/2009] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recurrent ptosis is a common sequel of mastopexy. The use of mesh as an adjunct to the double-skin technique was developed to reduce the incidence of recurrent ptosis. The optimal mesh needs to strike the right balance between persistence, inflammation, biocompatibility, and incorporation without interfering with mammography or presenting a long-term infection risk. This study investigated the ability of a biologic tissue matrix, FortaPerm, to achieve these goals. METHODS Women undergoing mastopexy were enrolled in this prospective observational study. The study participants were evaluated at multiple time points for 5 years. Efficacy was assessed primarily by photographic evaluation and secondarily by mammography, patient and physician global assessments, and patient pain assessments. RESULTS Five women ages 17-41 years were enrolled in this study. At 12 months, 80% of the patients (4/5), and at 5 years, 66% of the patients (2/3) had no asymmetry or ptosis. Mammographic evaluation of the breasts was not affected by the presence of the FortaPerm, and there were no abnormal findings. In two patients, FortaPerm was associated with bilateral seromas associated with extrusion of small amounts of the FortaPerm material in the absence of surrounding inflammation. CONCLUSIONS FortaPerm achieved excellent initial aesthetic outcomes and long-term maintenance of the breast position with no evidence of ptosis 5 years postoperatively for a majority of the patients. FortaPerm did not interfere with mammography, presented no long-term safety concerns, and produced satisfactory results for all patients relative to appearance of the scar as well as shape and firmness of the breasts.
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Simultaneous augmentation and periareolar mastopexy: selecting the correct implant. Aesthetic Plast Surg 2010; 34:33-9; discussion 40-1. [PMID: 20043160 DOI: 10.1007/s00266-009-9440-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 10/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Periareolar mastopexy is a well-described technique for cosmetic improvement of breasts classified as Regnault ptosis grades 1 and 2. However, this technique is used less frequently for cases of grade 3 ptosis. METHODS Grades 2 and 3 ptosis were corrected for selected patients using a combination of augmentation with Style 410 shaped, form-stable, highly cohesive, silicone gel implants and periareolar mastopexy. RESULTS In this study, 17 patients were treated. The Style 410 implants used included four different devices: FX (full height, extra-full projection, n = 4), MX (medium height, extra-full projection, n = 1), MF (medium height, full projection, n = 8), and FF (full height, full projection, n = 4). No complications occurred immediately after surgery, and only two cases of capsular contracture Baker grade 2 cases with implant palpability occurred during a mean follow-up period of 18 months. All 17 women were very satisfied with the improvement in their clothed appearance, and 16 were very satisfied overall with their surgery and body image improvements. CONCLUSIONS With proper selection of patients and Style 410 breast implants, cases of grade 3 breast ptosis can be managed successfully by the periareolar approach, thus extending the range of cases suitable for this technique. The different shapes of the Style 410 form-stable, silicone gel implants help to recreate the desired natural-looking breast, achieving stable results with minimal complications.
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Dixon JM, Arnott I, Schaverien M. Chronic abscess formation following mesh mastopexy: case report. J Plast Reconstr Aesthet Surg 2009; 63:1220-2. [PMID: 20036205 DOI: 10.1016/j.bjps.2009.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
Mastopexy is a challenging procedure that relies on the redistribution of breast parenchyma and tightening of the skin envelope to provide long-lasting correction of ptosis. Recurrent ptosis, however, is an inevitable complication of many techniques and internal parenchymal supports using autologous or non-autologous material have been tried in an attempt to counteract the effects of gravity. Several studies have reported good long-term outcomes using synthetic mesh with a low rate of complications, however concerns remain including foreign body reaction, infection, and oncological surveillance. This article reports a case of chronic breast abscess formation following the use of polypropylene mesh in mastopexy and the radiological and operative findings.
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Affiliation(s)
- J M Dixon
- Edinburgh Breast Unit and Breakthrough Research Unit, Western General Hospital, Edinburgh EH4 2XU, UK
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Mastopexy with mesh reinforcement: the mechanical characteristics of polyester mesh in the female breast. Plast Reconstr Surg 2009; 124:364-371. [PMID: 19644249 DOI: 10.1097/prs.0b013e3181af0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mastopexy is generally regarded as having only a temporary effect. To prevent recurrent ptosis, mesh has been inserted successfully and safely, without oncological drawbacks, for almost three decades. Recently, preshaped three-dimensional knitted polyester mesh in different sizes was introduced to reinforce the breast during mastopexy. Until now, however, the physical and mechanical characteristics of mesh inserted in the female breast were unknown. METHODS Polyester mesh removed from breasts in which it had been implanted was subjected to mechanical tests (two implants) and histological examination (five pieces of implant). RESULTS Mesh induces only a thin layer of collagenous tissue together acting as a composite material. The collagen increases the in-plane stiffness of the mesh and enhances the overall strength. The composite is so strong that rupture or failure is extremely unlikely. The mesh composite shows high pliability, is therefore very supple and not palpable under the skin. CONCLUSION Three-dimensional knitted polyester mesh appears to possess the proper mechanical characteristics to reinforce a ptotic breast during mastopexy.
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Copcu E. A versatile breast reduction technique: conical plicated central U shaped (COPCUs) mammaplasty. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2009; 3:7. [PMID: 19575809 PMCID: PMC2714313 DOI: 10.1186/1750-1164-3-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 07/03/2009] [Indexed: 11/27/2022]
Abstract
Background There have been numerous studies on reduction mammaplasty and its modifications in the literature. The multitude of modifications of reduction mammaplasty indicates that the ideal technique has yet to be found. There are four reasons for seeking the ideal technique. One reason is to preserve functional features of the breast: breastfeeding and arousal. Other reasons are to achieve the real geometric and aesthetic shape of the breast with the least scar and are to minimize complications of prior surgical techniques without causing an additional complication. Last reason is the limitation of the techniques described before. To these aims, we developed a new versatile reduction mammaplasty technique, which we called conical plicated central U shaped (COPCUs) mammaplasty. Methods We performed central plication to achieve a juvenile look in the superior pole of the breast and to prevent postoperative pseudoptosis and used central U shaped flap to achieve maximum NAC safety and to preserve lactation and nipple sensation. The central U flap was 6 cm in width and the superior conical plication was performed with 2/0 PDS. Preoperative and postoperative standard measures of the breast including the superior pole fullness were compared. Results Forty six patients were operated with the above mentioned technique. All of the patients were satisfied with functional and aesthetic results and none of them had major complications. There were no changes in the nipple innervation. Six patients becoming pregnant after surgery did not experience any problems with lactation. None of the patients required scar revision. Conclusion Our technique is a versatile, safe, reliable technique which creates the least scar, avoids previously described disadvantages, provides maximum preservation of functions, can be employed in all breasts regardless of their sizes.
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Affiliation(s)
- Eray Copcu
- Department of Plastic Reconstructive and Aesthetic Surgery, Medical Faculty, Adnan Menderes University, 09100, Aydin, Turkey.
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Surgisis Acellular Collagen Matrix in Aesthetic and Reconstructive Plastic Surgery Soft Tissue Applications. Clin Plast Surg 2009; 36:229-40, vii. [DOI: 10.1016/j.cps.2008.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
A personal approach to periareolar breast reduction is presented. The circular demarcation of periareolar skin must be limited to twice the demarcated areolar diameter (2 x 4 = 8 cm). A cylindrical resection of volume is removed, as in Strömbeck's technique, from below the areola to the aponeurosis of the pectoral muscle. Through this space, two to four "keel-like" parenchymal pieces are removed to reduce the breast at the cardinal points. The breast cone is assembled by suturing the raw areas from bottom to top, hyperprojecting it. A "round-block" suture around the areola is made, and the procedure is concluded with skin suture. Indications, limitations, and possibilities for use of the technique are analyzed, and the equation is summarized as follows: residual ptosis versus long scars inside the limits and indications of more or less 300 g of removed volume and small or medium breast ptosis. Only after the first 10 cases was the limit of the technique determined. Therefore, these results were not homogeneous. The results were satisfactory and regular for 68 of the 78 patients subjected to surgery and follow-up evaluation.
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Eom TI, Kim BS, Koo BY, Kim JW, Lim YA, Lee HH, Lee SJ, Kang HJ, Kim LS. The Use of a Corrective Procedure with Vicryl Mesh for Oncoplastic Surgery of the Breast. J Breast Cancer 2009. [DOI: 10.4048/jbc.2009.12.1.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tae Ik Eom
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Byung Seup Kim
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Bon Young Koo
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Jong Wan Kim
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Young Ah Lim
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Han Hee Lee
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Su Jung Lee
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Hee Joon Kang
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
| | - Lee Su Kim
- Division of Breast and Endocrine Surgery, College of Medicine, Hallym University, Anyang, Korea
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de Bruijn HP, Johannes S. Mastopexy with 3D preshaped mesh for long-term results: development of the internal bra system. Aesthetic Plast Surg 2008; 32:757-65. [PMID: 18493817 DOI: 10.1007/s00266-008-9186-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 04/30/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous techniques for mastopexy and breast reduction have been described, indicating the absence of a generally accepted method that fulfills the essential criteria for obtaining a pleasing, long-lasting result. All techniques using local tissue for reinforcement will eventually face recurrent ptosis because essentially the physical tissue properties are not altered. To overcome this, synthetic mesh has successfully been used to obtain permanent results. This method, however, was not generally accepted because of the fear of complications and of reduced oncologic survey and because no practical system was in place. Meanwhile, research showed that mesh could be safely introduced into the female breast. METHODS An easy-to-use mesh implant was developed. It comes as a system consisting of three-dimensional, preshaped, feather-soft woven mesh in different sizes, and concomitant sizers to facilitate the insertion. It acts as an internal bra and is therefore named "the Internal Bra System." The mesh replaces the attenuated natural suspensory system of the breast, returning what was lost by nature. Indications are breast ptosis, breast hypertrophy with ptosis, and contralateral correction after reconstruction. RESULTS A total of 170 patients (327 breasts) were treated with the longest follow-up of 4.5 years. No serious complications were encountered. Physical and X-ray examinations were still possible. No recurrent ptosis was observed and no scar hypertrophy. CONCLUSION The Internal Bra System seems to have finally become the versatile way to obtain a predictable, pleasing, long-term result in mastopexy and breast reduction.
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Improving Shape and Symmetry in Mastopexy With Autologous or Cadaveric Dermal Slings. Ann Plast Surg 2008; 61:138-42. [DOI: 10.1097/sap.0b013e31815bfe7c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Costa MP, Ching AW, Ferreira MC. Thin superior medial pedicle reduction mammaplasty for severe mammary hypertrophy. Aesthetic Plast Surg 2008; 32:645-52. [PMID: 18443850 DOI: 10.1007/s00266-008-9163-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 04/02/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are multitudes of procedures in plastic surgery used to correct hypertrophic and pendulous breasts in patients with heavy and ptotic breasts who need great resections of breast tissue, where the suprasternal notch-to-nipple distance is long and the use of nipple-areola transposition techniques is a challenge for the plastic surgeon. The purpose of this study is to present a technique of reduction mammaplasty that could solve these problems based on the following principles: mammary reduction utilizing a thin superior medial pedicle (0.8-1.5 cm thick) and the resection performed in two steps: (1) the base excess at a plane perpendicular to the breast (this determines the cone's height) and (2) central half keel (this determines the breast diameter reduction). METHODS Ninety patients with mammary hypertrophy were operated on at the "Hospital das Clínicas," São Paulo University Medical School, between January 2000 and November 2005. Inclusion in this study required a minimum of 12-cm change in nipple position and a 750-g breast resection. RESULTS The mean change in nipple position was 16 cm (range = 12-21 cm). The mean weight of each breast was 1400 (range = 750-3000 g). Considering the great amount of volume removed and the size of the operated breasts, few complications were observed and were similar to those reported following other techniques described in the literature. Patient satisfaction following this procedure was high. CONCLUSION The results of this study clearly demonstrate that thin superior medial pedicle reduction mammaplasty is a safe and reliable technique in cases of severe mammary hypertrophy.
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Andrades P, Prado A. Understanding modern breast reduction techniques with a simplified approach. J Plast Reconstr Aesthet Surg 2008; 61:1284-93. [PMID: 18502712 DOI: 10.1016/j.bjps.2007.11.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 11/08/2007] [Accepted: 11/10/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to analyse the geometrical principles of breast reduction, to propose a classification of reduction mammaplasty techniques and to show a simplified approach based on the authors experience. METHODS A thorough analysis of the geometrical differences between the normal and enlarged breast was performed. As a result of this analysis, the concept of separate management of the skin and gland for breast reduction was used as a method to classify the different techniques. Some aspects of technique selection and the authors' preferences are also discussed. RESULTS The four geometric differences between the normal and enlarged breast are: vertical excess, broadened base, horizontal excess and a descended nipple-areola complex. All breast reduction techniques use a specific pedicle and a separate skin incision pattern, so they should be named after the scar and pedicle used. Technique selection must consider the degree of hypertrophy and ptosis, the skin and gland quality, the patient's requirements, and the surgeon's experience and preferences. Some clinical examples are provided. CONCLUSION The comprehension of basic breast geometry, a universal language for communication and a simple algorithm to approach the breast reduction patient are valuable tools, particularly for the surgeon who is becoming acquainted with reduction mammaplasty procedures.
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Affiliation(s)
- Patricio Andrades
- Division of Plastic Surgery, Department of Surgery, J. J. Aguirre Clinical Hospital, University of Chile School of Medicine, Santiago, Chile.
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Hammond DC, Alfonso D, Khuthaila DK. Mastopexy using the short scar periareolar inferior pedicle reduction technique. Plast Reconstr Surg 2008; 121:1533-1539. [PMID: 18453975 DOI: 10.1097/prs.0b013e31816c3b0b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dennis C Hammond
- Grand Rapids, Mich. From the Center for Breast and Body Contouring
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Cho BC, Yang JD, Baik BS. Periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle. J Plast Reconstr Aesthet Surg 2008; 61:275-81. [DOI: 10.1016/j.bjps.2007.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2006] [Revised: 04/06/2007] [Accepted: 10/10/2007] [Indexed: 11/30/2022]
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Abstract
PURPOSE The author presents imaging findings of patients that underwent partial resection of the breast followed by absorbable mesh implantation. MATERIALS AND METHODS Ultrasonographic (n = 18) and mammographic (n = 11) images of patients that had undergone absorbable mesh implantation after breast partial resection were reviewed retrospectively. Sequential changes of the lesions were analyzed in follow-up ultrasonographic examinations, focusing on the change of the size and pattern of the lesion. The presence of a mass, asymmetry, focal asymmetry, architectural distortion, and calcification were evaluated by mammography. Pathologic findings of the implanted mesh in available cases were analyzed. RESULTS Ultrasonograms revealed a well-encapsulated anechoic lesion with (pattern 1, n = 11) or without (pattern 2, n = 5) internal isoechoic nodular portion, and a hyperechoic mass-like lesion without anechoic portion (pattern 3, n = 2). The mean length of the longest diameter decreased gradually as determined in follow-up examinations (3 months, 6.12 +/- 2.599cm; 6 months, 5.08 +/- 2.105cm; 12 months, 3.26 +/- 2.206cm). In mammograms, a mass (n = 4) was noted at the surgical site and focal asymmetry, overlapping with the postoperative change, was seen in the remaining seven cases. Pathologic findings of two cases revealed foreign body reaction. CONCLUSION Ultrasonography of the patients that underwent breast partial resection followed by absorbable mesh implantation showed a well-encapsulated cyst at the surgical site that gradually decreased in follow-up examinations. Adjunctive ultrasonography combined with mammography would be recommended in postoperative follow-up examinations.
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Affiliation(s)
- Hyon Joo Kwag
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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