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Longo B, D'Orsi G, La Padula S, Atzeni M, Vanni G, Buonomo CO, Cervelli V. Narrow inferior-central septum-based pedicle: A safe technique to improve aesthetic outcomes in breast reduction. J Plast Reconstr Aesthet Surg 2023; 85:226-234. [PMID: 37524035 DOI: 10.1016/j.bjps.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Inferior-central pedicle has some aesthetic drawbacks, including hypertrophic scar along the inframammary fold (IMF), squaring of the breast contours, and propensity to develop long-term 'bottoming-out.' This study aimed to verify if the narrow inferior-central (NIC) septum-based pedicle can allow the surgeon to improve aesthetic outcomes compared with the traditional inferior-central pedicle approach. METHODS Forty breasts underwent NIC-based breast reduction (group A), and 37 underwent traditional inferior-central pedicles (group B). The NIC pedicle was drawn with a width of 3.5-4.5 cm. The recorded measurements were sternal notch to nipple distance (S-N) and nipple to IMF distance (N-IMF) at the time of preoperative markings and follow-up 1, 6, and 18 months after the procedure. RESULTS The two groups were homogeneous regarding demographics, operative data, and preoperative S-N and N-IMF distances. Both groups showed no total or partial nipple-areola necrosis. At the 18-month follow-up, S-N (p < 0.00001) and N-IMF (p = 0.00039) distances were statistically different between the two groups, in favour of NIC group A. Changes in N-IMF distances between the 1- and 18-month visits were statistically different among groups (p < 0.0001), with a length variation of + 17.51% and + 28.46%, respectively. Patient satisfaction rate regarding "breast shape" (p = 0.021), "lower pole appearance" (p = 0.00017), and "scar" (p = 0.047) were higher in group A. CONCLUSION NIC-based pedicle proved to be a safe procedure and allowed us to overcome limitations that typically characterise the inferior pedicle, i.e., 'bottoming-out' deformity, hypertrophic scar of the lower pole, and squaring of the breast contours. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Benedetto Longo
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy.
| | - Gennaro D'Orsi
- Department of Surgical Sciences, School of Medicine and Surgery, Ph.D. Program in Medical-Surgical Applied Sciences, Tor Vergata University of Rome, Italy
| | - Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Matteo Atzeni
- Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit, University of Cagliari, University Hospital Duilio Casula, Cagliari, Italy
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
| | - Claudio Oreste Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
| | - Valerio Cervelli
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
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Zelko I, DeLeonibus A, Haidar J, Bahat D, Bishop SN. Nipple-Sparing Gigantomastia Breast Reduction: A Systematic Review. Ann Plast Surg 2023; 90:267-272. [PMID: 36796050 DOI: 10.1097/sap.0000000000003415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION There remains an unclear definition of the term "gigantomastia," with many studies using different parameters and measurements. Currently, the operative management and patient education for gigantomastia are outdated. The historical teaching that a free nipple graft is necessary in elongated pedicles to avoid nipple necrosis may not be factual. The principal goal of our review aims to determine the safety of nipple-sparing breast reductions on large ptotic breasts via complication rate analysis. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of conduct for systematic review and meta-analysis. In October 2021, PubMed was used to search the US National Library of Medicine database. Rayyan Intelligent Systematic Review aided in screening studies by title then abstract. If inclusion criteria were met, the entire article was reviewed. RESULTS Twenty-two articles satisfied the inclusion and exclusion criteria. The study was composed of 1689 total patients with a mean body mass index of 32.9 (±3.4). Mean midclavicle-to-nipple distance and resection weight per breast was 39 cm (±3.8) and 1423.8 g (±268.9), respectively. A Wise pattern was preferred in 77.3% of the studies, with an inferior (45.5%) and superomedial (45.5%) pedicle used most commonly. Complete nipple areolar complex necrosis (1.7%) was found in 4 studies, whereas partial (5.9%) was observed in 11. More common complications included delayed wound healing (17.4%), surgical site infection (14.3%), seroma (10.5%), scar hypertrophy (9.9%), and wound dehiscence (9.2%). CONCLUSION Nipple-sparing breast reduction surgery can be safely performed on hypertrophic and severely ptotic breasts with nipple areolar complications, such as partial or complete nipple areolar complex loss, at a rate less than previously believed.
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Affiliation(s)
- Ian Zelko
- From the Cleveland Clinic, Dermatology and Plastic Surgery Institute, Cleveland, OH
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Prasidha I, Boyages J, Lam TC. Safety of Reduction Mammaplasty and Mastopexy After Breast Conservation Therapy and Radiation Therapy: A Case Series. Ann Plast Surg 2023; 90:27-32. [PMID: 36534097 DOI: 10.1097/sap.0000000000003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Conservative surgery and radiotherapy (CS + RT) have become the standard of care for early-stage breast cancer as an alternative to mastectomy. With the increasing rate of obesity and incidence of macromastia, surgeons increasingly encounter patients with a history of breast radiation desiring breast reduction. However, elective breast surgery after irradiation remains to be controversial due to known adverse effects of radiation, especially on wound healing, and unknown effects of lumpectomy on traditional pedicle choices. Herein, we present our experiences and outcomes of reduction mammaplasties and mastopexies in patients with breast cancer previously treated with CS + RT. METHODS Between 2009 and 2020, 13 patients undergoing reduction mammaplasty or mastopexy, who have previously underwent CS + RT with or without axillary surgery, were included in this study. Surgical techniques and complications, including delayed wound healing, infection, fat necrosis, and nipple-areolar necrosis, were recorded and analyzed based on the irradiated versus nonirradiated sides. RESULTS Of the 13 patients, delayed wound healing occurred in 7% on the irradiated side and 15% on the nonirradiated sides (P > 0.05). No significant correlation was observed between the number of complications and time of elective breast surgery from the last radiation therapy. Complications between irradiated and nonirradiated breasts did not significantly differ in both the reduction mammaplasty and mastopexy groups. CONCLUSIONS Reduction mammaplasty and mastopexy in patients with a history of lumpectomy and breast irradiation can be safely performed and should be considered in those experiencing macromastia or asymmetry post-CS + RT.
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Affiliation(s)
- Ines Prasidha
- From the Department of Plastic and Reconstructive Surgery, Westmead Hospital
| | - John Boyages
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Simplifying Free Nipple Graft Mammoplasty in Postmenopausal Obese Patients using Inferior Dermaglandular Flap. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02992-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jørgensen MG, Albertsdottir E, Dalaei F, Hesselfeldt-Nielsen J, Schmidt VJ, Sørensen JA, Toyserkani NM. Age and Body Mass Index Affect Patient Satisfaction Following Reduction Mammoplasty: A Multicenter Study Using BREAST-Q. Aesthet Surg J 2021; 41:NP336-NP345. [PMID: 33561191 DOI: 10.1093/asj/sjaa395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Reduction mammoplasty effectively improves quality of life for women with macromastia. However, little is known whether surgical- or patient-related factors affect satisfaction. OBJECTIVE The authors sought to investigate factors associated with altered patient satisfaction following reduction mammoplasty. METHODS A cross-section study was performed by sending the BREAST-Q Reduction module to all patients who had undergone reduction mammoplasty between January 2009 and December 2018 at 2 tertiary Danish hospitals. Demographics and pre-, peri-, and postoperative details were gathered from electronic medical records. RESULTS A total of 393 patients returned the questionnaire and were eligible for the study. Increasing age at the time of surgery was associated with higher satisfaction with breasts nipples, headache, psychosocial well-being, and outcome. Increased body mass index at the time of surgery negatively affected satisfaction with breasts and psychosocial well-being. Increase in body mass index after surgery was further associated with lower satisfaction with breasts, nipples, sexual well-being, and more pain in the breast area. Postoperative scar revision and wound infection was more common following inferior pedicle technique than superomedial technique and negatively affected satisfaction with outcome and pain in the breast area. CONCLUSIONS Patients should be motivated to optimize their weight prior to reduction mammoplasty to achieve optimal satisfaction. Age was associated with improved patient satisfaction, which should considered when operating on younger patients. Postoperative complications affect patient satisfaction, and the superomedial technique seems to be a better choice than the inferior pedicle technique in medium-large breasts. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - Farima Dalaei
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Volker-Jürgen Schmidt
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Singolda R, Bracha G, Zoabi T, Zaretski A, Inbal A, Gur E, Barnea Y, Arad E. Superiomedial Pedicle Breast Reduction for Gigantic Breast Hypertrophy: Experience in 341 Breasts and Suggested Safety Modifications. Aesthetic Plast Surg 2021; 45:375-385. [PMID: 32964280 DOI: 10.1007/s00266-020-01973-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Reduction mammoplasty in patients with gigantic breast hypertrophy runs a high risk of complication. Traditionally, inferior pedicle reductions or free nipple grafting techniques have been recommended for gigantic breasts on the basis of measurements and expected resection weights. The superiomedial pedicle (SMP) technique has been less commonly used, due to concerns of vascular inadequacy. This study examines the outcomes of SMP in large reductions and outlines suggested modifications for enhanced safety. METHODS This is a retrospective review of all patients who underwent SMP breast reduction in our institution between 2005 and 2016. Included are cases with resection weights greater than 800 g. RESULTS A total of 173 patients with 341 breasts were included. Mean sternal notch to nipple (SNN) distance was mean 35.0 ± 6.6 cm (range 23-44.5) on the left and 34.9 ± 6.6 cm (range 18-46) on the right. Mean resection weight was 1152.2 ± 368.6 g (range 810-2926) on the left and 1159.4 ± 326.6 g (range 800-2528) on the right. The total complication rate was 22.7%. Minor complications occurred in 63 (18.6%) breasts. Major complications occurred in 12 (4.1%) breasts. NAC congestion and partial necrosis occurred in 1.8% and total NAC necrosis in 0.9%. CONCLUSION The SMP reduction technique is a safe option for gigantic breast reduction with comparable complication rates to other techniques. Preoperative measurements or resection weights are not reliable risk factors alone. High tissue density may be a significant risk factor. High-risk breasts mandate surgical planning and should be tailored to include technical modifications as described. 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)
- Roei Singolda
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel-Aviv, Israel.
| | - Gal Bracha
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Tariq Zoabi
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Arik Zaretski
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Inbal
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Gur
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Barnea
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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7
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Bustos SS, Molinar V, Kuruoglu D, Cespedes-Gomez O, Sharaf BA, Martinez-Jorge J, Manrique OJ, Tran NV, Nguyen MDT. Inferior pedicle breast reduction and long nipple-to-inframammary fold distance: How long is safe? J Plast Reconstr Aesthet Surg 2020; 74:495-503. [PMID: 33127349 DOI: 10.1016/j.bjps.2020.08.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle. METHODS A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis. RESULTS Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16-48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5-27). The mean resection weight was 699.6 g (SD:310.4; r:125-2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8-9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88-1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001-1.005), adjusting for N-IMF and SNN distances. CONCLUSION Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.
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Affiliation(s)
- Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Center for Regenerative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Vanessa Molinar
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Doga Kuruoglu
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Omar Cespedes-Gomez
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Basel A Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jorys Martinez-Jorge
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Nho V Tran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Minh-Doan T Nguyen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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Waltho D, Gallo L, Gallo M, Murphy J, Copeland A, Mowakket S, Moltaji S, Baxter C, Karpinski M, Thoma A. Outcomes and Outcome Measures in Breast Reduction Mammaplasty: A Systematic Review. Aesthet Surg J 2020; 40:383-391. [PMID: 31679031 DOI: 10.1093/asj/sjz308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is difficult due to variation in outcome reporting. OBJECTIVES The authors sought to identify a comprehensive list of outcomes and outcome measures in reduction mammaplasty. METHODS A comprehensive computerized search was performed. Included studies were randomized or nonrandomized controlled trials involving at least 100 cases of female breast hypertrophy and patients of all ages who underwent 1 or more defined reduction mammaplasty technique. Outcomes and outcome measures were extracted and tabulated. RESULTS A total 106 articles were eligible for inclusion; 57 unique outcomes and 16 outcome measures were identified. Frequency of patient-reported and author-reported outcomes were 44% and 88%, respectively. Postoperative complications were the most frequently reported outcome (82.2%). Quality-of-life outcomes were accounted for in 37.7% of studies. Outcome measures were either condition-specific or generic; frequencies were as low as 1% and as high as 5.6%. Five scales were formally assessed in the breast reduction populations. Clinical measures were defined in 15.1% of studies. CONCLUSIONS There is marked heterogeneity in reporting of outcomes and outcome measures in the literature. A standardized outcome set is needed to compare outcomes of various reduction mammaplasty techniques. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Daniel Waltho
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Lucas Gallo
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Matteo Gallo
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jessica Murphy
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Andrea Copeland
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Sadek Mowakket
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Syena Moltaji
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Charmaine Baxter
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Achilleas Thoma
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Bauermeister AJ, Gill K, Zuriarrain A, Earle SA, Newman MI. “Reduction mammaplasty with superomedial pedicle technique: A literature review and retrospective analysis of 938 consecutive breast reductions”. J Plast Reconstr Aesthet Surg 2019; 72:410-418. [DOI: 10.1016/j.bjps.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 11/17/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
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Ashour T, Khachaba Y, El Naggar A. Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis. Electron Physician 2018; 10:7230-7234. [PMID: 30214706 PMCID: PMC6122870 DOI: 10.19082/7230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/28/2018] [Indexed: 11/20/2022] Open
Abstract
Reduction mammaplasty in huge breasts poses a great challenge for plastic surgeons. The classic technique is free nipple and areola grafting after breast amputation. This paper is a short technical report of reduction mammoplasty on 40 patients with severe breast ptosis (suprasternal notch to nipple >35 cm) and giganticomastia (anticipated resection of more than 1 kg per breast) were operated upon using superomedial pedicle technique for reduction mammaplasty. All patients were satisfied with their results aesthetically, and showed relief in their neck pain. There were no cases of total nipple-areola loss. In one breast, the nipple-areolar complex (NAC) was congested intra-operatively and free nipple grafting was done. The NAC sensation was preserved in 36 cases, and all other complications were minimal and self-limiting. The superomedial pedicle technique has proven to be a safe and reliable method for reduction mammaplasty in huge breasts. Compared to the classic free nipple and areola technique, this method showed promising results in preserving the nipple sensation and giving more pleasant natural projecting breasts.
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Affiliation(s)
- Tarek Ashour
- M.D., MRCS, Lecturer of Plastic Surgery, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - Youssif Khachaba
- M.D., MRCS, Lecturer of Plastic Surgery, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - Ahmed El Naggar
- M.D., MRCS, Lecturer of Plastic Surgery, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
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The Safety, Cosmetic Outcome, and Patient Satisfaction after Inferior Pedicle Reduction Mammaplasty for Significant Macromastia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1798. [PMID: 30276047 PMCID: PMC6157945 DOI: 10.1097/gox.0000000000001798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Abstract
Background: Significant macromastia is socially and physically debilitating. Reduction mammaplasty in these cases carries significant morbidity. Methods: Cases of inferior pedicle reduction mammaplasty performed at the breast unit, King Fahd Hospital, Jeddah, Saudi Arabia, over the last 10 years were reviewed. Inclusion criteria were cases with significant macromastia in which the distance from the supra-sternal notch to the nipple was ≥ 40 cm. Results: There were 26 cases of inferior pedicle reduction mammaplasty done for significant macromastia. The average age was 34.56 years (range, 16–56 years). The average sternal notch to the nipple distance was 43.08 cm (range, 40–49 cm). The average amount of breast tissue removed from the right breast was 1,057.6 g (range, 495–2,450) and from the left breast was 959.4 g (range, 445–2,100). Postoperatively, 4/26 (15.4%) had ecchymosis, 9/26 (34.6%) developed T-junction sloughing, 2/26 (7.7%) had wound infection, and 1/26 (3.8%) had unilateral partial nipple-areola complex ischemia. In 7/26 (26.9%), scars were evident and revision was performed in 4/26 (15.4%) cases. Variable degrees of upper breast flattening and bottoming were seen in most cases; however, these variations were more profound in fatty breasts and longer pedicles. The average follow-up period was 26.04 months (range, 3–68 months). All patients were satisfied with the reduced breast heaviness, but only 19/26 (73.1%) were highly satisfied with the breast shape and scars. Conclusions: In cases of significant macromastia, inferior pedicle reduction mammaplasty is a safe procedure. Evident scars, upper breast flattening, and bottoming adversely affect the level of satisfaction.
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Kelahmetoglu O, Firinciogullari R, Yagmur C, Yildiz K, Guneren E. Combination of Würinger's Horizontal Septum and Inferior Pedicle Techniques to Increase Nipple-Areolar Complex Viability During Breast Reduction Surgery. Aesthetic Plast Surg 2017; 41:1311-1317. [PMID: 28698934 DOI: 10.1007/s00266-017-0933-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger's horizontal septum and inferior pedicle techniques. METHODS This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger's horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm. RESULTS The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g). CONCLUSIONS This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction. 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)
- Osman Kelahmetoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey.
| | - Remzi Firinciogullari
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ozel Ege Şehir Hastanesi, Izmir, Turkey
| | - Caglayan Yagmur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Kemalettin Yildiz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey
| | - Ethem Guneren
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey
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The free-nipple breast-reduction technique performed with transfer of the nipple-areola complex over the superior or superomedial pedicles. Aesthetic Plast Surg 2014; 38:718-26. [PMID: 24902916 DOI: 10.1007/s00266-014-0343-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although the free-nipple breast-reduction technique is essentially an amputation, achieving aesthetic results still is important. The authors present their technique for free nipple-areola complex (NAC) transfer over the superomedial or superior pedicle full-thickness flaps in patients for whom a free-nipple technique is inevitable due to certain risk factors. METHODS The study included 25 patients who underwent surgery with the aforementioned method for addressing severe gigantomastia. The patients had a mean age of 43 years (range 34-59 years) and a mean body mass index (BMI) of 35.8 kg/m(2) (range 28-42 kg/m(2)). During the operation, the NAC was elevated as a full-thickness skin graft, then transposed to the superior or superomedial pedicles, which had been planned previously. The subsequent stages of the operation thus became a Wise-pattern breast reduction. RESULTS The mean resection per breast was 1,815 g (range 1,620-2,410 g). Breast projection, shape, and areolar pigmentation were assessed during the follow-up visit. One patient experienced a partial loss of the NAC graft, which healed secondarily, and three patients experienced a patchy hypopigmentation of the NAC. Breast projection and conical structure were observed to be preserved during the follow-up period. CONCLUSIONS The modified free-nipple technique aimed to convert the reduction procedure to a technique similar to pedicle methods, yielding successful results during the early phases. The full-thickness flap constructed in this way provides more fullness and a maximum contribution to projection in patients who will inevitably undergo breast reduction with the free-nipple method. 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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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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Wettstein R, Christofides E, Pittet B, Psaras G, Harder Y. Superior pedicle breast reduction for hypertrophy with massive ptosis. J Plast Reconstr Aesthet Surg 2011; 64:500-7. [DOI: 10.1016/j.bjps.2010.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 05/17/2010] [Accepted: 05/19/2010] [Indexed: 11/29/2022]
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Letertre P, Lasserre G, Ricbourg B. [Large breast hypertrophy and gigantomastia management by postero-inferior pedicle reduction technique. About 20 cases]. ANN CHIR PLAST ESTH 2009; 54:331-9. [PMID: 19223105 DOI: 10.1016/j.anplas.2008.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 10/14/2008] [Indexed: 11/17/2022]
Abstract
The authors present a retrospective study about 20 patients operated for important breast hypertrophy and gigantomastia by the postero-inferior reduction technique. They compare the results obtained by this technique on the breast (projection, breast-feeding) and on the nipple-areola complex (sensibility, pigmentation, nipple projection), with those obtained by the Thorek technique (free nipple grafting). The authors show that this technique is reliable for such breasts hypertrophies, with good esthetics results, and avoid free nipple grafting.
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Affiliation(s)
- P Letertre
- Service de chirurgie plastique et maxillofaciale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Dancey A. Letter to the Editor. J Plast Reconstr Aesthet Surg 2009. [DOI: 10.1016/j.bjps.2008.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heine N, Eisenmann-Klein M, Prantl L. Gigantomasty: treatment with a short vertical scar. Aesthetic Plast Surg 2008; 32:41-7. [PMID: 17874160 DOI: 10.1007/s00266-007-9005-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 11/06/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the past 15 years, reduction mammoplasty with a short vertical scar has become increasingly common in the world of plastic surgery. Still, the indication for this technique often is limited to smaller reduction weights, so that the inverted T-scar techniques have yet to be regarded as the gold standard for excessive breast hypertrophy. METHODS In the authors' department, their own modification of vertical scar reduction mammoplasty, based on the techniques of C. Lassus, G. Maillard, and M. Lejour, has been performed since 1990. During the past 10 years, the authors have used it for all breast sizes. To investigate the safety and the results for patients with very large breast volumes (gigantomasty involving at least > or =1,000 g of excised tissue per one side), this study retrospectively evaluated 25 women with a mean age of 43.1 +/- 11.2 years who underwent surgery from January 2002 to June 2003. A protocol was used to record patient satisfaction and complaints and to quantify the final result objectively. RESULTS The average resection weight for the 25 women was 1,227 +/- 300 g (maximum, 2,300 g) on the right side and 1,218 +/- 343 g (maximum, 2,100 g) on the left side. The sternal notch-to-nipple distance was reduced from 37.1 +/- 4 cm to 23.4 +/- 2.1 cm on the right side and from 37.4 +/- 3.5 cm to 24 +/- 2 cm on the left side. The brassiere size was reduced by about three cup sizes on the average. During an average follow-up period of 2 years (n = 15), patient satisfaction was high, with good acceptance of the breast shape and a low rate of major complications (12%). CONCLUSION The results suggest that the authors' modified vertical scar technique can be used successfully for all dimensions of reduction mammoplasty regardless of breast weight.
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Affiliation(s)
- N Heine
- Department of Plastic Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Pennington DG. Improving the results of inferior pedicle breast reduction using pedicle suspension and plication. Aesthetic Plast Surg 2006; 30:390-4. [PMID: 16855886 DOI: 10.1007/s00266-006-0040-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The inferior pedicle technique of breast reduction is a widely-used safe technique. It has been criticised as prone to producing inferior quadrant fullness, called variously "pseudoptosis" or "bottoming out." Described are the results of a technique of inferior pedicle suspension and plication which overcome these problems.
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Affiliation(s)
- David G Pennington
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, 1204/135 Macquarie Street, Sydney, NSW, Australia.
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van Wingerden JJ. Avoiding free nipple grafting in gigantomastia with the inferior pedicle technique. Ann Plast Surg 2006; 56:465-7. [PMID: 16557089 DOI: 10.1097/01.sap.0000200723.77878.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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