1
|
Shih L, Doval A, Burns HR, Kaplan J, Ellsworth WA, Chevray PM, Spiegel AJ, Friedman JD. Staged breast reconstruction utilizing primary nipple repositioning surgery prior to nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg 2024; 91:249-257. [PMID: 38428233 DOI: 10.1016/j.bjps.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/27/2023] [Accepted: 02/04/2024] [Indexed: 03/03/2024]
Abstract
Staged nipple-sparing mastectomy (NSM) following mastopexy or breast reduction has become increasingly utilized in patients with large or ptotic breasts. The safety and efficacy of this approach has been demonstrated in recent years. However, the optimal timing between stages has not been established. The authors provide their experience with this staged approach with emphasis on timing between stages. An institutional review board approved this retrospective study. Data of all patients at a single institution who underwent staged NSM following mastopexy or reduction mammaplasty for therapeutic or prophylactic oncologic surgical management from 2016 to 2020 were reviewed. Timing between stages as well as surgical, oncologic, aesthetic, and patient-reported outcomes were evaluated. Nineteen patients (38 breasts) underwent staged NSM following planned mastopexy/breast reduction. The mean time interval between stages was 25 weeks. No patients developed nipple areolar complex necrosis. Infection and hematoma were seen in one breast (2.6%) and seroma in two (5.3%) after NSM. Delayed wound healing was seen in eight breasts (21.1%) after first stage mastopexy/reduction and in 12 breasts (31.6%) after NSM. Skin flap necrosis was noted in two breasts (5.3%) after NSM. No patients developed oncological recurrence. Mean patient-reported post-operative satisfaction and well-being scores were 63 and 67 out of 100, respectively. The authors describe their experience with staged NSM following nipple repositioning procedures. Their results suggest that this procedure can be performed safely with cosmetically favorable results if surgeons wait an average of 25 weeks between first and second stage procedures.
Collapse
Affiliation(s)
- Linden Shih
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Andres Doval
- Division of Plastic Surgery, Institute for Reconstructive Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Heather R Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jordan Kaplan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Warren A Ellsworth
- Division of Plastic Surgery, Institute for Reconstructive Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Pierre M Chevray
- Division of Plastic Surgery, Institute for Reconstructive Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Aldona J Spiegel
- Division of Plastic Surgery, Institute for Reconstructive Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Jeffrey D Friedman
- Division of Plastic Surgery, Institute for Reconstructive Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
2
|
Williams S, Menon A, Shauly O, Van Natta B, Gould D, Losken A. Reviewing Outcomes and Complications with the Use of Mesh in Breast Reduction Surgery. Aesthetic Plast Surg 2024:10.1007/s00266-024-03896-4. [PMID: 38448602 DOI: 10.1007/s00266-024-03896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Reduction mammoplasty is a common reconstructive and esthetic procedure with variable long-term outcomes regarding breast shape, projection, and nipple-areolar complex. One common complaint is recurrent breast ptosis, which may be mitigated by sufficient support of the inferior pole. This review will look at the effects of mesh in mitigating postoperative ptosis following reduction mammoplasty. METHODS A comprehensive review of the literature was performed using the PubMed database. Manuscripts that provided data with respect to the effects of mesh on cosmetic outcomes, patient-reported outcomes, complications, and surveillance were utilized. RESULTS Six studies with a total of 634 patients were included in this review. There is limited evidence to support a cosmetic benefit with the use of mesh in reduction mammoplasty patients. While subjective satisfaction was demonstrated in one paper, few others had objective measurements of the impact of mesh. Complications included infection, skin necrosis, and loss of nipple sensation. Mammography was found to not be affected by mesh placement. DISCUSSION The use of mesh during reduction mammoplasty is a relatively modern innovation that does not appear to have a significantly different risk profile than that of traditional reduction procedures. There is limited cosmetic value based on currently available data. More objective future analysis is necessary in order to justify the use of mesh in reduction mammoplasty for its claimed cosmetic benefits. 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.
Collapse
Affiliation(s)
| | | | - Orr Shauly
- Emory Division of Plastic and Reconstructive Surgery, 3200 Downwood Circle Northwest, Atlanta, GA, 30327, USA.
| | | | | | - Albert Losken
- Emory Division of Plastic and Reconstructive Surgery, 3200 Downwood Circle Northwest, Atlanta, GA, 30327, USA
| |
Collapse
|
3
|
Mortada H, Ibrahim EA, Alhumsi TR. Modified McKissock's Breast Reduction Technique: A Case Series and Description of Our Technique Modification. JPRAS Open 2024; 39:81-88. [PMID: 38186384 PMCID: PMC10770475 DOI: 10.1016/j.jpra.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background The modified McKissock breast reduction technique uses upper and lower vascular pedicles to reduce breast size and reshape the breasts. This technique has gained significant interest in recent years because of its potential to minimize surgical complications. The current study aims to report our experience and results with our refined version of the McKissock technique. Methods We conducted a prospective cohort study on patients with breast hypertrophy between 2022 and 2023 to evaluate the modified McKissock breast reduction technique. Two main alterations were made to the original McKissock technique. First, the superior pedicle was modified to create a superomedial pedicle. Second, the inferior pedicle was thinned to form a dermoseptal pedicle with a 4 cm wide base. Results A total of 13 patients underwent surgery using the modified McKissock breast reduction technique. The average age of the patients was 37.2 years. For the right breast, the weight of tissue resected during reduction ranged from 189 g to 695 g (average 379 g). For the left breast, the resection weight range was 160 g to 608 g (average 370 g). There were no complications except one patient who developed partial nipple necrosis on the left side. All patients expressed satisfaction with the outcomes. Conclusion Our modified McKissock breast reduction technique shows promise as a method for reducing breast size. It offers several potential advantages, including improved preservation of the nipple and areola complex, more precise breast shaping, contouring capabilities, and reduced risk of complications. Although the early results of this technique are encouraging, further research is required to evaluate its long-term benefits and risks fully.
Collapse
Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
4
|
Koussayer B, Taylor J, Warner J, Alkaelani MT, Blount T, Wainwright D, Threet A, Le NK, Whalen K, Coughlin E, Mhaskar R, Kuykendall L. Breastfeeding Ability After Breast Reductions: What does the Literature Tell us in 2023? Aesthetic Plast Surg 2024; 48:1142-1155. [PMID: 37845550 DOI: 10.1007/s00266-023-03690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Reduction mammaplasties are routinely performed on women of child-bearing age, yet there still exists some uncertainty regarding a patient's ability to breastfeed following the procedure. This is due to inconsistent definitions of "successful" breastfeeding, a variety of pedicles implemented, and inadequate follow-up in the published literature. Our aim was to summarize the current data and provide clear recommendations for counseling patients on expected breastfeeding outcomes following reduction mammaplasty. METHODS A systematic review and meta-analysis in accordance with the PRISMA guidelines was conducted. We included papers that reported proportion of breastfeeding ability following reduction mammaplasty. RESULTS We identified 33 papers that met our inclusion criteria. We found that women who undergo reduction mammaplasty are at a 3.5 times increased odds of not being able to breastfeed compared to controls. Overall, reduction mammaplasty patients have a breastfeeding success rate of 62%. The breastfeeding success rate for patients with inferior pedicles was 64%, superior pedicles was 59%, and lateral pedicles was 55%. No conclusions could be drawn regarding medial, central, vertical, and horizontal pedicles on breastfeeding ability. CONCLUSION Current data suggest that women undergoing reduction mammaplasty have an increased odds of unsuccessful breastfeeding when compared to similar women who have not undergone the procedure. Based on the current literature, pedicle type does play a role in rate of breastfeeding success, although there is a need for further research on the aforementioned pedicles. Physicians should be aware of the likelihood of successful breastfeeding following reduction mammaplasty so that patients can be more thoroughly counseled prior to a decision for surgery. LEVEL OF EVIDENCE I 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 .
Collapse
Affiliation(s)
- Bilal Koussayer
- University of South Florida Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Justin Taylor
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Jamie Warner
- University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL, 32610, USA
| | | | - Taylor Blount
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - D'Arcy Wainwright
- Department of Plastic Surgery, University of South Florida,, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Abby Threet
- Department of Plastic Surgery, University of South Florida,, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Nicole K Le
- Department of Plastic Surgery, University of South Florida,, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Kristen Whalen
- Department of Plastic Surgery, University of South Florida,, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Emily Coughlin
- University of South Florida Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Rahul Mhaskar
- University of South Florida Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Lauren Kuykendall
- Department of Plastic Surgery, University of South Florida,, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| |
Collapse
|
5
|
Sağır M, Güven E. Expanding Usage of Superior Pedicled Techniques with Reducing Resistance in the Pedicle by Lipoaspiration. Aesthetic Plast Surg 2024; 48:905-913. [PMID: 36595037 DOI: 10.1007/s00266-022-03241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite the advantages of the superior pedicles in breast reduction, there are some limitations with this technique. The mobility of the pedicle may be augmented by liposuction in the pedicle area which may relieve tissue resistance and decrease pedicle compression in order to overcome circulation problems. In fact, the indications of breast reduction using superior pedicles may be expanded by liposuction in the pedicle area. METHODS The patients who underwent breast reduction with superior pedicle techniques between March 2014 and November 2020 and whose pedicle resistances were decreased by liposuction were included in this study. Internal breast morphology was classified into three groups based on the morphology of the periareolar tissues. Group 1 breasts were lipomatous, Group 2 breasts were lipo-glandular and Group 3 breasts were fibroglandular. During the short-term follow-up, the circulation of the nipple-areola complex (NAC) was evaluated both clinically and with an hand held Doppler device. The long-term aesthetic results were evaluated at the postoperative twelfth month with a visual analogue scale. RESULTS One hundred eighty-nine patients with either Group 1 or Group 2 breasts were included in this study. The mean age of the patients was 38.3 years. The mean follow-up period was 31.7 months. Neither partial nor total NAC loss was observed and none of the patients had bottoming-out deformity. CONCLUSION Liposuction to the pedicle area is an effective and reliable method that both reduces the resistance in the pedicle and overcomes the circulation problems in certain patient groups (groups 1 and 2), increases the mobilization of the pedicle, reduces the breast to the desired size and prevents bottoming-out in the long term and increases the use of superior pedicle techniques. According to our clinical results, it was demonstrated that pedicle vascular mapping with preoperative Doppler sonography was not necessary in these patients. 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 .
Collapse
Affiliation(s)
- Mehmet Sağır
- Department of Plastic Reconstructive and Aesthetic Surgery, Private Acıbadem Maslak Hospital, 34457, Sarıyer, İstanbul, Turkey.
| | - Erdem Güven
- Department of Plastic Reconstructive and Aesthetic Surgery, Private Acıbadem Maslak Hospital, 34457, Sarıyer, İstanbul, Turkey
| |
Collapse
|
6
|
Yücel AF, Kozanoğlu E, Emekli U, Arıncı RA. Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients. Aesthetic Plast Surg 2024:10.1007/s00266-024-03855-z. [PMID: 38355743 DOI: 10.1007/s00266-024-03855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients. MATERIALS AND METHODS Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department. RESULTS This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores. CONCLUSION Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty. 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 .
Collapse
Affiliation(s)
| | - Erol Kozanoğlu
- Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ufuk Emekli
- Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | | |
Collapse
|
7
|
Tekdogan B, Martineau J, Scampa M, Kalbermatten DF, Oranges CM. Oncoplastic reduction mammoplasty: Systematic review and proportional meta-analysis of surgical outcomes. J Plast Reconstr Aesthet Surg 2024; 89:86-96. [PMID: 38159475 DOI: 10.1016/j.bjps.2023.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Breast-conserving surgery is the standard of care for early-stage breast cancer but can often result in unsatisfactory cosmetic outcomes. Oncoplastic surgery aims to address these issues by combining local excision with plastic surgery techniques to improve oncologic and esthetic outcomes. By incorporating breast reduction techniques into cancer surgery, wider margins of excision can be achieved, leading to enhanced oncological safety and reduced recurrence rates without causing significant asymmetry. This systematic review and meta-analysis aims to provide an updated understanding of the surgical outcomes associated with oncoplastic reduction mammoplasty. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. Articles reporting post-operative outcomes following the oncoplastic reduction mammoplasty were included. A proportional meta-analysis of post-operative complications was performed to obtain their proportions and 95% Confidence Intervals (CIs). RESULTS Eighteen studies met the inclusion criteria, representing a total of 2711 oncoplastic reduction mammoplasty procedures in 2680 patients. The overall complication rate was 20% (95% CI: 15-25%). The positive margin rate following oncoplastic reduction mammoplasty was 11% (95% CI: 6-17%). The re-excision rate was 6% (95% CI: 3-12%). The completion mastectomy rate was 3% (95% CI: 2-6%). CONCLUSIONS Oncoplastic reduction mammoplasty is a safe and effective alternative to mastectomy and traditional breast-conserving surgery in the treatment of early-stage breast cancers.
Collapse
Affiliation(s)
- Boran Tekdogan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Jérôme Martineau
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Matteo Scampa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.
| |
Collapse
|
8
|
Wallace L, Wokes JET. Internal Bra: A literature Review and Sub-Classification of Definitions. Aesthetic Plast Surg 2024:10.1007/s00266-023-03802-4. [PMID: 38189817 DOI: 10.1007/s00266-023-03802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The term 'internal bra' refers to a range of techniques that aim to stabilise the position of the breast and improve longevity of surgical results. It is increasingly being used to describe techniques in surgical literature and on patient information platforms, including social media. However a lack of consistency in the use of the term is a potential source of confusion and conflicting information. OBJECTIVES This narrative review aims to improve understanding of what is meant by the term 'internal bra', by providing an overview of the different techniques it refers to and suggesting more specific terminology for use going forward. METHODS A literature search of the Medline, Embase, and Google Scholar databases was conducted to identify papers in which a surgical technique was described using the term 'internal bra'. RESULTS 'Internal bra' techniques can be categorised into 5 groups: mesh techniques, acellular dermal matrix techniques, suture techniques, dermal flap techniques, and muscle techniques. Promising results exist for techniques in each group; however, research is generally limited by small studies with short follow up periods, and significant inconsistencies exist in use of the term 'internal bra'. CONCLUSIONS The titles of the five groups identified in this paper should be used going forward when discussing 'internal bra' techniques, in order to bring greater clarity to both surgical literature and patient information. Further research is also required to establish if 'internal bra' techniques truly improve longevity of surgical results and if one technique, or group of techniques, is superior. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
Affiliation(s)
- Lauren Wallace
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | - James E T Wokes
- Department of Plastic and Reconstructive Surgery, University Hospital of North Durham, Durham, UK
| |
Collapse
|
9
|
Ou Y, Wu M, Liu D, Luo L, Xu X, Panayi AC, He J, Long Y, Feng J, Nian M, Cui Y. Efficacy and Safety of Nerve Block for Postoperative Analgesia in Patients Undergoing Breast Cosmetic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2024; 48:71-83. [PMID: 36939869 DOI: 10.1007/s00266-023-03320-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/04/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND To evaluate the postoperative analgesic efficacy and safety of nerve block (NB) in patients undergoing breast surgery for cosmetic purposes. METHODS PubMed, Web of Science, Embase and Cochrane Libraries were searched from inception to September 2022, to identify all eligible randomized controlled trials (RCTs). Continuous data are presented as mean difference (MD) with 95% confidence intervals (CI), whereas dichotomous data are provided as odds ratios (OR) with 95% CI. This meta-analysis was performed in RevMan 5.4. RESULTS A total of 10 RCTs with 565 patients were meta-analyzed. Compared to the control group, the pain score of the NB group was significantly lower at postoperative 2, 3-4, 6-8, 12-16 and 24 h. Opioid consumption in the first postoperative 24 h was significantly lower in the NB group (MD = - 9.02, 95% CI - 14.29 to - 3.75, P < 0.05), I2 = 95%). In addition, the NB group showed a prolonged time to first postoperative analgesic requirement (MD = 43.15, 95% CI 4.74-81.56, P < 0.05, I2 = 96%), decreased incidence of additional postoperative analgesia (OR 0.14, 95% CI 0.07-0.28, P < 0.05, I2 = 0%) and reduced incidence of postoperative nausea or vomiting (OR 0.33; 95% CI 0.22-0.48; P < 0.05; I2 = 0%). There was no significant difference in operation duration between the two groups. CONCLUSIONS Nerve block is an effective and safe option for postoperative analgesia after breast cosmetic surgery. LEVEL OF EVIDENCE II 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 .
Collapse
Affiliation(s)
- Yanting Ou
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Mengfan Wu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Dandan Liu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Lin Luo
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Xiangwen Xu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Junjun He
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yun Long
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Jun Feng
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Mingxuan Nian
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yongyan Cui
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
| |
Collapse
|
10
|
Kammien AJ, Zhao KL, Wride AM, Butler PD, Ayyala HS. Visual representation of diversity in online patient education materials for reduction mammaplasty. J Plast Reconstr Aesthet Surg 2023; 87:284-286. [PMID: 37925916 DOI: 10.1016/j.bjps.2023.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
Online patient education materials play an important role in plastic surgery, and surgeons should ensure that materials accurately reflect their patient population. This study compared the skin tone of images in online materials from the American Society of Plastic Surgeons (ASPS), academic plastic surgery programs, and private groups to the demographics of the United States (US) reduction mammaplasty population. Images within patient education materials and embedded photo galleries were assessed and skin tones were categorized using the Fitzpatrick Skin Scale (FSS). Two reviewers evaluated 616 images. Scores of 1-3 were categorized as White, while scores of 4-6 were classified as non-White. The proportion of images categorized as White and non-White were compared to the demographics of the reduction mammaplasty population in the US. Of 616 images, 82% were classified as White, while 18% were non-White. This distribution differed significantly from the racial demographic distribution of patients undergoing reduction mammaplasty in the US in 2020, where 48% identified as White and 52% as non-White (p < 0.001). There was also a statistically significant difference in the distribution of FSS scores between the materials from the ASPS, academic programs, and private surgeon groups, with private groups having a lower percentage of non-White images (p = 0.028). These findings suggest that implicit bias may impact the creation of patient education materials for reduction mammaplasty and highlights the need for improvement in distributing patient education materials that accurately represent the diverse reduction mammaplasty population.
Collapse
Affiliation(s)
- Alexander J Kammien
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, Suite BB330, New Haven, CT 06511, USA
| | - K Lynn Zhao
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, Suite BB330, New Haven, CT 06511, USA
| | - A Mitchel Wride
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, Suite BB330, New Haven, CT 06511, USA
| | - Paris D Butler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, Suite BB330, New Haven, CT 06511, USA
| | - Haripriya S Ayyala
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, Suite BB330, New Haven, CT 06511, USA.
| |
Collapse
|
11
|
Akyurek M, Hafiz G. Horizontal pillar technique: A single pedicle septum-based approach in reduction mammaplasty with a twist. J Plast Reconstr Aesthet Surg 2023; 87:33-40. [PMID: 37804645 DOI: 10.1016/j.bjps.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
Breast reduction surgery has proven to be a successful treatment for various conditions such as postural disorders, anxiety, dermatological problems, and body image disorders, and is tailored to accommodate each patient's needs and anatomical variations. The author presents a modified approach for reduction mammaplasty using a septum-based superomedial pedicled nipple-areola complex (NAC) flap combined with horizontal dermoglandular pillars. This adjustment enhances desired breast projection, potentially eliminating the need for alternative pedicles in most cases. The limitations and disadvantages of this new technique are discussed. Between July 2015 and July 2021, 85 patients underwent surgery using the horizontal pillar reduction mammaplasty. Clinical data obtained during follow-up visits were recorded. Patients were asked to answer the local version of the Breast-Q, version 2.0, reduction module postoperative scale questionnaire to evaluate breast shape contentment and patient satisfaction at the 1-year follow-up. Necrosis of the NAC was not observed in any patient. The most common complaints in the early postoperative period were pain along the inframammary fold and swelling that extended into the axillary region. The mean values and standard deviations of the postoperative Breast-Q scores were calculated. The postoperative satisfaction with breasts scale mean value was 84.11 ± 12.86, and the postoperative satisfaction with outcomes scale mean value was 81.08 ± 9.97. The horizontal pillar reduction mammaplasty technique is safe, reliable, and easy to perform in breast reduction. Although the initial findings are encouraging, future anatomical and clinical studies are necessary to fully explore this modified technique's functional limitations and long-term outcomes.
Collapse
Affiliation(s)
- Mustafa Akyurek
- Canakkale Onsekiz Mart University, Department of Plastic Reconstructive and Aesthetic Surgery, Canakkale, Turkey.
| | - Gunes Hafiz
- Canakkale Onsekiz Mart University, Department of Plastic Reconstructive and Aesthetic Surgery, Canakkale, Turkey.
| |
Collapse
|
12
|
Jasionowska S, Murugesan L, Pasha T, King ICC, Cavale N. Refinement of the Superomedial Pedicle Technique: A New Approach to Breast Reshaping Following Reduction. Aesthetic Plast Surg 2023; 47:2234-2239. [PMID: 37202483 PMCID: PMC10784394 DOI: 10.1007/s00266-023-03363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/08/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION We present an alteration of the superomedial pedicle technique in breast reduction to control lateral fullness and create a more natural and contoured breast during reshaping. This approach has been adopted by the senior author (NC) in 79 patients over the past 4 years. METHODS A wise pattern skin incision is used, and the nipple-areola complex (NAC) is maintained on a de-epithelialized superomedial pedicle. Instead of fully releasing the pedicle from the lateral parenchyma for rotation and inset, a bridge of tissue between the pedicle on its most posterior aspect and the lateral pillar is maintained. Key holding sutures are subsequently placed in Scarpa's fascia for reshaping. RESULTS We find that with this refinement, the connection with the lateral pillar pulls the lateral parenchyma medially and superiorly when the pedicle is rotated into its new position, adding a natural curve to the side. The superior medial pedicle is still attached in its postero-lateral aspect to the lateral pillar and theoretically, will provide an even more robust vascular supply to the NAC. In our series, three patients developed minor skin healing issues amenable to treatment with dressings. No one suffered from nipple loss or other serious complications, and no dog ear revisions were required. CONCLUSIONS We present a simple alteration of the superomedial pedicle technique that we believe results in improved breast contouring. Our experience suggests that this simple adaptation is safe, effective, and reproducible. 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 .
Collapse
Affiliation(s)
- Sara Jasionowska
- REAL Plastic Surgery Clinic, 25 Patcham Terrace, London, SW8 4EX, UK
- Plastic Surgery Department, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Log Murugesan
- REAL Plastic Surgery Clinic, 25 Patcham Terrace, London, SW8 4EX, UK
| | - Terouz Pasha
- REAL Plastic Surgery Clinic, 25 Patcham Terrace, London, SW8 4EX, UK
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, SE1 7EH, UK
| | - Ian C C King
- REAL Plastic Surgery Clinic, 25 Patcham Terrace, London, SW8 4EX, UK
| | - Naveen Cavale
- REAL Plastic Surgery Clinic, 25 Patcham Terrace, London, SW8 4EX, UK.
| |
Collapse
|
13
|
Sonmez M, Saglam ME. Preserving the Nipple Projection in Breast Reduction with the Free Nipple-Areolar Graft Technique: Purse-String Suture. Aesthetic Plast Surg 2023; 47:2255-2260. [PMID: 37322327 DOI: 10.1007/s00266-023-03429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Breast reduction with the free nipple-areolar graft (FNG) technique has disadvantages such as loss of nipple projection, loss of nipple sensation, and depigmentation of the nipple-areolar complex. In this study, patients in whom a purse-string (PS) suture was used in the center of the de-epithelialized area to prevent loss of nipple projection were compared with patients who underwent the conventional method. METHODS A retrospective analysis of the patients who underwent breast reduction with the FNG was conducted in our department. Patients were divided into two groups according to the FNG placement. In the PS suture method group, a 1-cm-diameter circumferential suture was placed with a 5-0 Monocryl® (poliglecaprone 25) suture to gain a 6-mm-nipple projection. In the conventional method group, the FNG was placed directly over the de-epithelized area. Graft viability was evaluated after 3 weeks postoperatively. The final nipple projection and depigmentation were evaluated after 6 months postoperatively. The results were evaluated with statistical tests. RESULTS The number of patients with the conventional method was 10, and the PS suture method was 12. There was no statistically significant difference between two groups regarding graft loss and depigmentation (p > 0.05). Nipple projection was significantly higher in the PS method group (p < 0.05). CONCLUSION We observed that PS circumferential suture made an acceptable nipple projection compared to the conventional method in breast reduction with the FNG technique. Since the method is easy to apply and has relatively low risk, it would contribute to clinical practice. 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 .
Collapse
Affiliation(s)
- Mehmet Sonmez
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara City Hospital, Yildirim Beyazit University, Universiteler Mah. 1604. Cad. No: 9, Cankaya, 06800, Ankara, Turkey.
| | - Murat Enes Saglam
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara City Hospital, University of Health Sciences, Universiteler Mah. 1604. Cad. No: 9, Cankaya, 06800, Ankara, Turkey
| |
Collapse
|
14
|
Hudson DA. The Role of the Inframammary Fold (IMF) in Aesthetic and Reconstructive Surgery: A Critical Analysis and Surgical Solution. Aesthetic Plast Surg 2023:10.1007/s00266-023-03729-w. [PMID: 37957392 DOI: 10.1007/s00266-023-03729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The inframammary fold (IMF) is a critical structure in breast aesthetics and is affected by various types of breast surgery. The ideal IMF has a semi-elliptical shape, which may become attenuated with age and descends in macromastia. The aim of this study was to analyse the IMF and retain/restore its shape with sutures. METHODS A retrospective study was conducted on breast surgeries performed over a four-year period (2019-2022). The morphometry of the IMF was evaluated preoperatively while the patients were standing. In cases where the IMF was symmetrical, sutures were used to reinforce it during surgery. When the loss of the semi-elliptical shape was clinically indicated, the IMF was mobilized, repositioned, and then sutured into place. RESULTS The study included 56 patients: 43 undergoing immediate breast reconstruction, and 13 undergoing bilateral breast reductions. In over two thirds of the patients, the lateral IMF was inferiorly displaced compared to the medial IMF. CONCLUSION It is recommended to reinforce the IMF in all patients undergoing breast surgery. Where the IMF has an elliptical shape preoperatively, it is reinforced. Where IMF is inferiorly displaced, mobilization and superior advancement of the IMF, followed by suture reinforcement, are necessary. This approach results in a well-defined IMF with improved breast aesthetics. 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 .
Collapse
Affiliation(s)
- Donald A Hudson
- UCT Private Academic Hospital, Rondebosch, Cape Town, South Africa.
| |
Collapse
|
15
|
Simsek Turan EH, Uslu A, Turan MI, Vardar Gok O, Parlak AE, Akgul N. The effects of breast reduction with superomedial and inferior pedicle techniques on radiological breast imaging. J Plast Reconstr Aesthet Surg 2023; 86:79-87. [PMID: 37716253 DOI: 10.1016/j.bjps.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 07/26/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Several breast reduction techniques have been introduced, and the reliability of these techniques has been demonstrated in clinical practice. However, it is still controversial how patients should be evaluated radiologically both preoperative and postoperative. This study aims to compare the radiological findings seen following reduction mammoplasty with two different techniques (inferior pedicle and superomedial pedicle), in connection with the surgical steps. METHODS Medical records of 141 patients and a total of 278 breasts who underwent breast reduction with the diagnosis of macromastia were retrospectively analyzed. Demographic and operative data such as age, type of pedicle, preoperative and postoperative nipple-areola complex (NAC) position, and NAC transfer distance were recorded. Radiological evaluation was performed by two radiologists experienced in breast imaging by reinterpreting preoperative and postoperative mammography images. RESULTS The rate of postoperative structural distortion (p < 0.001), thickened areola (p = 0.011), and retroareolar fibrotic band (p < 0.001) were observed to be significantly higher in the superomedial group. The risk of fat necrosis increases as the NAC transfer distance increases and a value of >9.5 cm in the NAC transfer distance can be considered as the cutoff value in terms of fat necrosis development, especially in those using superomedial pedicle technique. CONCLUSION Surgical technique-specific benign radiological changes occur following reduction mammoplasty. However, these changes do not significantly affect the Breast imaging, reporting, and data system category. The localization of fat necrosis differs depending on the surgical technique, and the risk of fat necrosis increases as the NAC transfer distance increases, especially in those who have undergone superomedial pedicle breast reduction surgery.
Collapse
Affiliation(s)
- Emine Handan Simsek Turan
- University of Health Sciences, Antalya Training and Research Hospital, Department of Plastic and Reconstructive Surgery, Antalya, Turkey.
| | - Asım Uslu
- University of Health Sciences, Antalya Training and Research Hospital, Department of Plastic and Reconstructive Surgery, Antalya, Turkey
| | | | - Ozlem Vardar Gok
- University of Health Sciences, Antalya Training and Research Hospital, Department of Radiology, Antalya, Turkey
| | - Ayse Eda Parlak
- University of Health Sciences, Antalya Training and Research Hospital, Department of Radiology, Antalya, Turkey
| | - Nedim Akgul
- University of Health Sciences, Antalya Training and Research Hospital, Department of General Surgery, Antalya, Turkey
| |
Collapse
|
16
|
Estler A, Zanderigo E, Wessling D, Grözinger G, Steinmacher S, Daigeler A, Jorge C, Santos Stahl A, Feng YS, Schipperges V, Nikolaou K, Stahl S. Quantification of Breast Volume According to age and BMI: A Three-Dimensional MRI Analysis of 400 Women. Aesthetic Plast Surg 2023; 47:1713-1724. [PMID: 36418548 DOI: 10.1007/s00266-022-03167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Breast size alteration is the most common aesthetic surgical procedure worldwide. This study aimed to assess the correlation between breast volume and BMI or age. MATERIALS AND METHODS The analyses were conducted utilizing 400 patients selected by a retrospective review of the archives at our institution. Epidemiological data and medical history were assessed. Adjusting for the age and BMI of patient from previously described cohorts, we calculated mean breast volumes per side and differences from the upper and lower percentiles to the mean volumes. RESULTS The patients had a median BMI of 23.5 (range: 14.7-45.6) and a median age of 51 (range: 24-82). The average total breast volume increased strongly with BMI (r=0.834, p<0.01) and moderately with age (r=0.305, p<0.01). Within a BMI range of 18-24, breast volumes in the 8th and 18th percentile differ on average by about 50 ml. One BMI unit increase in women with breast sizes in the 10th percentile accounts for a breast volume difference of about 30 ml. CONCLUSION BMI strongly correlates with breast size. To achieve natural results, preoperative consultation and planning of aesthetic and reconstructive breast surgery must recognize BMI as a major determinant of average breast size. 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 .
Collapse
Affiliation(s)
- Arne Estler
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany.
| | - Eloisa Zanderigo
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Daniel Wessling
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Sahra Steinmacher
- Department of Women´s Health, University Hospital of Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Plastic Hand and Reconstructive Surgery BG Trauma Centre Tübingen, Schnarrenbergstr 95, 72076, Tübingen, Germany
| | - Cristina Jorge
- Department of General-, Visceral-, Vascular-, and Paediatric Surgery, Saarland University Medical Centre, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | | | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Vincent Schipperges
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), University Hospital Freiburg, Freiburg, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstr. 36, 66111, Saarbrücken, Germany
| |
Collapse
|
17
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
18
|
Yiltok SJ, Akintayo AJ, Karago CY, Choji JD, Sankey B, Agada E, Dafong AA, Ezekiel AS, Orkar KS. Reduction Mammoplasty for Macromastia: Our Experience Using the Inferior Pedicle with Inverted-T Skin Resection. J West Afr Coll Surg 2023; 13:77-83. [PMID: 37538218 PMCID: PMC10395857 DOI: 10.4103/jwas.jwas_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 08/05/2023]
Abstract
Introduction Macromastia is a major reason why women seek for breast reduction especially when there are symptoms. Breast reduction is an uncommon procedure in our environment and this is a report of our experience with inferior pedicle with an inverted-T skin resection. Materials and Methods This is a report of breast reductions using the inferior pedicle with an inverted-T skin resection approach that were carried out between 2004 and 2022. The information that was retrieved from the case notes were age, marital status, parity, last child birth, family history of breast enlargement, presenting features, height, weight, the weight of tissue excised, and complications. The data obtained were then entered into the SPSS version 25 (IBM Corp.) software and analysed. Results Seventeen women were managed with an age range of 16-50 years and a mean of 31.06 ± 9.66 years. The most common features at presentation were heavy weight around the chest, backache, shoulder pain, no appropriate brassiere with low self-esteem and self-confidence. Ten had skin changes and recurrent rashes over the breast, whereas four complained of grooves with skin changes. The weight of excised breast tissue ranged from 0.2 to 5.5 kg with an average of 2.18 ± 1.28 kg for the right and 2.05 ± 1.00 kg for the left breast. All except one patient had blood transfusion. The common complications were delayed wound healing (47%) followed by partial wound dehiscence (17.6%), and flap necrosis (11.8%). Except for those with flap necrosis the wounds healed with some having broad scars. Conclusions Patients for breast reduction are mainly due to the symptoms and signs with the associated large breast. The inferior pedicle with inverted-T skin resection is a valuable technique with a very good outcome. To improve access to breast reduction, there is the need to enhance awareness through advocacy using women groups and health education.
Collapse
Affiliation(s)
- Simon Jekat Yiltok
- Department of Surgery, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | | | - Christopher Y. Karago
- Department of Plastic Surgery, Prince Mishari bin Saud Hospital, Baljurashi, Bahah Region, Kingdom of Saudi Arabia
| | - Joshua D. Choji
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Babangida Sankey
- Department of Plastic Surgery, Skin 101 Hospital, Maitama, Abuja, Nigeria
| | - Enye Agada
- Department of Surgery, Federal Medical Centre, Makurdi, Nigeria
| | - Atarang A. Dafong
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Anthony S. Ezekiel
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Kusu Samuel Orkar
- Department of Plastic Surgery, Queen Victoria Hospital, West Sussex, UK
| |
Collapse
|
19
|
Mughal M, Berner JE, Ho-Asjoe M, See M, Roblin P, Rose V, Mohanna PN. One-stop autologous breast reconstruction: A safe and effective cost-saving pathway. J Plast Reconstr Aesthet Surg 2023; 92:276-281. [PMID: 38582053 DOI: 10.1016/j.bjps.2023.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Patients undergoing autologous breast reconstruction usually require further operations as part of their reconstructive journey. This involves contralateral breast symmetrization and nipple-areola complex (NAC) reconstruction. Restrained access to elective operating space led us to implement a one-stop breast reconstruction pathway. METHODS Patients undergoing contemporaneous contralateral breast symmetrization and immediate NAC reconstruction with free nipple grafts between July 2020 and June 2021 were identified. A retrospective review of our prospectively maintained database was conducted, to retrieve surgical notes, postoperative complications, and length of inpatient stay. A cost analysis was performed considering savings from contralateral symmetrization. RESULTS A total of 50 eligible cases were identified, which had unilateral one-stop breast reconstructions. Complication rates and length of stay were not affected by this approach, with only one free flap being lost for this cohort. This approach resulted in £181,000 being saved for our service over a calendar year. DISCUSSION A one-stop breast reconstruction pathway has proven to be safe and effective in our unit. During these uncertain times, it has streamlined the management of eligible patients, while releasing capacity for other elective operations. Patients avoid having to wait for secondary procedures, finishing their reconstructive pathway earlier. We plan to continue providing this service which has shown to be beneficial clinically and financially.
Collapse
Affiliation(s)
- Maleeha Mughal
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom.
| | - Juan Enrique Berner
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mark Ho-Asjoe
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Marlene See
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Paul Roblin
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Victoria Rose
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Pari-Naz Mohanna
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| |
Collapse
|
20
|
Seretis K, Bounas N, Papaspyrou F. Antibiotic Prophylaxis in Reduction Mammaplasty: A Network Meta-Analysis. Aesthetic Plast Surg 2023. [PMID: 36928312 DOI: 10.1007/s00266-023-03313-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Mounting evidence suggests that breast reduction surgery displays higher rates of surgical site infections (SSI) than initially presumed. Objective of this network meta-analysis is to evaluate the effectiveness of different antibiotic regimens in the prophylaxis from surgical site infections and delayed wound healing (DWH) following breast reduction. METHODS A network meta-analysis was conducted using a predetermined protocol after searching the electronic databases MEDLINE, Scopus, the Cochrane Library and US National Institutes of Health Ongoing Trials Register from inception to July 2022. The included studies had to examine breast reduction in females with at least 1-month follow-up, receiving antibiotics in an intervention arm compared to a control arm. The quality of studies was assessed using the Cochrane risk of bias tool. A frequentist Mantel-Haenszel approach was adopted for the reported SSI rates while an inverse variance random effects model was used for the DWH rates. RESULTS A total of 10 studies was included in the analysis involving 1331 patients. All but one study controlled for major risk factors, and no differences were observed in patients' baseline characteristics. Antibiotic administration significantly reduced the SSI rate after breast reduction, with the prolonged antibiotic regimen being the most efficacious (odds ratio [OR]: 0.36 [95%CI: 0.15-0.85]). No statistically significant reduction in delayed wound healing rate was revealed among the regimens. CONCLUSIONS Antibiotics mitigate the SSI rate after breast reduction. This meta-analysis provides an evidence-based strategy to optimize antibiotic administration. Further research is needed though to examine antibiotic prophylaxis on delayed wound healing. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
21
|
Dow T, Selman T, Williams J, Bezuhly M. The Role of ACE-Inhibitors and ARBs in reducing hypertrophic scarring following bilateral breast reduction. J Plast Reconstr Aesthet Surg 2023; 78:1-3. [PMID: 36669236 DOI: 10.1016/j.bjps.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/20/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The angiotensin-renin system (ARS) has been shown to play a role in the promotion of tissue fibrosis through angiotensin II activation of the angiotensin-receptor 1 and subsequently transforming growth factor beta-1 (TGF- β1). Breast reduction surgery is known to have a potential complication of hypertrophic scarring. The primary objective of this study is to assess whether the use of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARBs) by patients undergoing bilateral reduction mammoplasty is correlated with a reduction in hypertrophic scarring complications post-operatively. METHODS A retrospective chart review of all patients who received bilateral breast reduction surgery in our province over a 10-year period was performed. Patient charts were reviewed for post-operative hypertrophic scarring as well as medications being used around the time of surgery. The rate of hypertrophic scarring within patients treated with an ACEi or ARB for existing hypertension were compared with the rest of the population. RESULTS A total of 981 patients met the inclusion criteria of the study. The overall incidence of hypertrophic scarring was 6%. Within the population, 132 (14%) of patients had a clinical diagnosis of hypertension. Of the patients who were managed with an ACEi or ARB, one (2%) patient developed hypertrophic scarring post-operatively. This was significantly less than the total population and the remainder of the population with hypertension treated with a medication other than an ACEi or ARB. CONCLUSIONS This study investigated the impact of routine ACEi or ARB use by patients undergoing bilateral reduction mammoplasty and demonstrated a statistically significant reduction in the incidence of hypertrophic scarring. This study is one of the first to investigate ACEi or ARB use in humans to reduce rates of unsightly scarring. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Todd Dow
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Tamara Selman
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason Williams
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
22
|
Xia TY, Scomacao I, Duraes E, Cakmakoglu C, Schwarz G. Aesthetic, Quality-of-Life, and Clinical Outcomes after Inferior Pedicle Oncoplastic Reduction Mammoplasty. Aesthetic Plast Surg 2023. [PMID: 36735002 DOI: 10.1007/s00266-023-03257-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Oncoplastic breast surgery is more likely to achieve superior aesthetic outcomes compared to lumpectomy alone. Oncoplastic reduction mammoplasty (ORM) is a volume displacement oncoplastic technique that combines lumpectomy and reduction mammoplasty. Data on aesthetic and quality-of-life (QoL) outcomes after ORM are scarce in the literature. Based on a literature review, this present study reports outcomes on the largest group of ORM patients to date. METHODS A retrospective review was conducted of all patients who underwent ORM between 2011 and 2018 at a tertiary care centre. Patients were excluded if no pedicle information was available or did not undergo post-operative radiotherapy. All patients with available post-operative photographs were aesthetically evaluated by four blinded, independent investigators blinded based on breast symmetry, nipple symmetry, and overall appearance. The BREAST-Q (breast conserving module) was used to assess QoL outcomes. RESULTS Two-hundred-and-sixteen consecutive patients (223 breasts) were included. Macromastia (cup size D or higher) was present in 173 patients (80.1%). Inferior pedicle ORM was utilized in 179 (80.3%) breasts. Eighty-eight patients (40.7%) were aesthetically evaluated, of whom 69 patients (78.4%) had "good", "very good", or "excellent" grades in all aesthetic categories. Seventy-five patients (85.2%) had "good" or better grades in overall appearance. Preoperative ptosis grade, cup size, presence of post-operative complications, and breast specimen weight had no significant correlations with aesthetic grades. Inferior pedicle ORM was associated with a higher "satisfaction with breast" Q-score (p=0.017) compared to other pedicle approaches. CONCLUSION Inferior pedicle ORM achieves objectively excellent aesthetic outcomes and high patient satisfaction with the reconstruction. 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 .
Collapse
|
23
|
Holzbach T, Linder S, Leitsch S, Loucas R, Loucas M, Giunta RE, Mayer J. Improving symmetry of nipple-areola complex (NAC) position in reduction mammoplasty using laser level projection. J Plast Reconstr Aesthet Surg 2023; 77:284-290. [PMID: 36608397 DOI: 10.1016/j.bjps.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Symmetrical height of the nipple-areola complex (NAC) is a key factor in the perception of breast symmetry. For preoperative markings, we mainly rely on conventional anthropometric measurements of distances in correlation to anatomical landmarks. In this study, we evaluated whether the use of a class 2 laser projection water level would lead to better symmetry of nipple height in reduction mammoplasty procedures when used for preoperative planning. METHODS We analysed 100 patients undergoing reduction mammoplasty with a supero-medial pedicle and wise-pattern skin resection. We compared the bilateral differences in nipple height of the last 50 reduction mammoplasty procedures before using the laser projection water level (group A; no laser) with the first 50 reduction mammoplasties after implementation of this device (group B; laser). The follow-up period was 12 months. RESULTS A total of 48 patients were included in group A and 44 patients in group B. Patient demographics, mean resection weight and complications did not differ statistically significantly. Nipple height differences were significantly lower in group B (laser), measuring 0.22 ± 0.20 cm (0-0.9; n = 44), than those in group A (no laser; p < 0.001), measuring 0.61 ± 0.28 cm (0.2-1.2; n = 49). CONCLUSION Using laser level projection helped improve nipple height symmetry in reduction mammoplasty. We consider a difference of more than 1 cm in nipple height to be unacceptable in aesthetic reduction mammoplasty. This simple tool facilitates preoperative markings, and we find it to be safe, quick to install and very helpful in daily practice.
Collapse
Affiliation(s)
- Thomas Holzbach
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Frauenfeld, Switzerland.
| | - Sora Linder
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Frauenfeld, Switzerland
| | - Sebastian Leitsch
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Frauenfeld, Switzerland
| | - Rafael Loucas
- Department of Hand and Plastic Surgery, Thurgau Hospital Group, Frauenfeld, Switzerland
| | - Marios Loucas
- Division of Plastic, Aesthetic and Reconstructive Surgery Medical University Graz, Graz, Austria
| | - Riccardo Enzo Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Julius Mayer
- Department of Plastic Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
24
|
Alhindi N, Mortada H, Alzaid W, Al Qurashi AA, Awan B. A Systematic Literature Review of the Clinical Presentation, Management, and Outcome of Gestational Gigantomastia in the 21st Century. Aesthetic Plast Surg 2023; 47:10-29. [PMID: 35941388 DOI: 10.1007/s00266-022-03003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two treatment options for GG, and breast reduction or mastectomy with delayed reconstruction is the only available surgical option. We have conducted this systematic review to summarize and critically analyze all the GG data in the literature. METHODS The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were adhered to in reporting this article. A systematic search was conducted in February 2022 for published case reports and case series on GG using the PubMed, MEDLINE, and Cochrane databases. The following keywords were used: macromastia, gestational gigantomastia, and gestational. RESULTS A total of 639 articles were searched, and only 66 case reports published between 1962 and 2022 were included. The mean patient's age at presentation was 28.79 years old. The majority of the patients were in their first trimester (n = 23, 47%). The main complaint was rapid bilateral breast enlargement (n = 54, 80.59%). Bromocriptine was the most common medical management used (n = 19/35, 54.28%). Bilateral breast reduction was the most common surgery (n = 24/48, 50%). Most patients had uneventful recovery (n = 40/54, 74.07%). CONCLUSION Gigantomastia is a difficult condition, in terms of its management. We have found that surgery is the gold-standard among all the cases reported; while Bromocriptine was the most commonly administered medical therapy. This systematic review provides a guideline for plastic surgeons to better facilitate their care of these patients. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Nawaf Alhindi
- Faculty of Medicine, King Abdulaziz University, P.O. BOX: 23456, Rabigh, Saudi Arabia.
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Wasan Alzaid
- Faculty of Medicine, Jouf University, Al-Jawf, Saudi Arabia
| | - Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Basim Awan
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
25
|
Hernanz F, Martínez P, Jimeno J, Paz L, Muñoz P. Long-term outcomes of bilateral breast reduction in women with obesity and symptomatic macromastia. A cohort study. J Plast Reconstr Aesthet Surg 2023; 76:133-135. [PMID: 36516503 DOI: 10.1016/j.bjps.2022.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Affiliation(s)
- F Hernanz
- Breast Unit. Hospital Valdecilla, University of Cantabria, Avd. Valdecilla sn, Santander 39008, Spain.
| | - P Martínez
- Breast Unit. Hospital Valdecilla, University of Cantabria, Avd. Valdecilla sn, Santander 39008, Spain
| | - J Jimeno
- Breast Unit. Hospital Valdecilla, University of Cantabria, Avd. Valdecilla sn, Santander 39008, Spain
| | - L Paz
- Breast Unit. Hospital Valdecilla, University of Cantabria, Avd. Valdecilla sn, Santander 39008, Spain
| | - P Muñoz
- Servicio Cántabro de Salud (SCS), Cantabria, Spain
| |
Collapse
|
26
|
Tunå Butt S, Widmark-Jensen E, Meyer S, Hansson E. Swedish Normative Scores for the BREAST-Q Reduction/Mastopexy Module. Aesthetic Plast Surg 2023; 47:73-80. [PMID: 35920862 DOI: 10.1007/s00266-022-03025-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Norm values for patient reported outcomes, that is knowledge about how the general population of women rate their breast-related satisfaction and quality of life, are necessary to interpret the meaning of scores. The aims of this study were to create Swedish normative values for the BREAST-Q reduction/mastopexy module and to describe what healthy women are most satisfied/dissatisfied with regarding their breasts. METHODS A random sample of 400 women aged 18-80, currently living in Region Västra Götaland, were sent BREAST-Q reduction/mastopexy. Descriptive data are presented. RESULTS One hundred and forty-six women answered the questionnaire (36.5%). Mean total scores ranged from 48 to 78. No clear changes in scores could be seen with age and women with a high BMI seem to be less satisfied with their breasts. The participants were most satisfied with the appearance of the breasts when dressed, the appearance in the mirror dressed, the shape of the breasts with bra, and symmetry of size and most dissatisfied with appearance in the mirror naked and the shape of the breasts without a bra. Thirty to forty-five per cent of healthy women never or almost never feel sexually attractive. Among physical symptoms often described in breast hypertrophy, the most common among healthy women were lack of energy, pain in the neck, arms and shoulders, headache and difficulty performing intense physical activity. CONCLUSION The norms for BREAST-Q reduction/mastopexy add another piece to the puzzle to what constitutes normal breast satisfaction and how surgical outcomes can be evaluated. 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 .
Collapse
|
27
|
Friedman R, Garvey SR, Nanda A, Boustany AN, Tobias AM, Cauley RP. Breast reduction as gender-affirming chest surgery in non-binary patients: Addressing the needs of a growing population. J Plast Reconstr Aesthet Surg 2023; 76:12-4. [PMID: 36512995 DOI: 10.1016/j.bjps.2022.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
|
28
|
Torresetti M, Zuccatosta L, Di Benedetto G. The effects of breast reduction on pulmonary functions: A systematic review. J Plast Reconstr Aesthet Surg 2022; 75:4335-4346. [PMID: 36229312 DOI: 10.1016/j.bjps.2022.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
Breast reduction is one of the most commonly requested and performed plastic surgery procedures, and its psychological, esthetic, and analgesic benefits are well known. Several studies dealing with the effects of reduction mammoplasty on the physiology of respiration have been published in the past decades. This systematic review aims to assess whether bilateral breast reduction is associated with measurable improvement in lung function in women with macromastia. This review was performed in accordance with the PRISMA guidelines. PubMed, SCOPUS, and Web of Science databases were queried in search of clinical studies that investigated lung function in women undergoing breast reduction for macromastia and reported any type of parameter or outcome measure relevant to pulmonary function. The search yielded 394 articles of which 15 articles met our specific inclusion criteria. The primary outcome measures of the studies and their respective results were tabulated, contrasted, and compared. The 15 studies included in this review cover the period from 1974 to 2018. According to most included studies, reduction mammaplasty produces a change of objective respiratory parameters, such as spirometric tests or arterial blood gas (ABG) measurements; nevertheless, the clinical and functional relevance of the observed changes is debatable.
Collapse
Affiliation(s)
- Matteo Torresetti
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy.
| | - Lina Zuccatosta
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Giovanni Di Benedetto
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| |
Collapse
|
29
|
Yao A, Yi J, Greige N, Chemakin K, Weichman KE, Ricci JA. Effect of intraoperative blood pressure on incidence of hematoma in breast reduction mammoplasty. J Plast Reconstr Aesthet Surg 2022:S1748-6815(22)00199-1. [PMID: 35568688 DOI: 10.1016/j.bjps.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Postoperative hematomas are among the most frequent complications following breast reduction mammoplasty (BRM). Intraoperative hypotension has been implicated in the development of postoperative hematomas following breast reduction. In this study, we performed a retrospective, propensity-matched analysis of patients undergoing primary breast reduction to determine the relationship between intraoperative blood pressure and the development of a postoperative hematoma. METHODS A retrospective review of all patients that underwent BRM at a single institution from 2017 to 2019 (n = 563) was conducted. Patients who developed a postoperative hematoma were propensity matched to two controls based on body mass index (BMI) and age. The mean systolic blood pressure (SBP) and average mean arterial pressure (MAP) were recorded for each third of the operation. Data were analyzed using conditional logistic regression. RESULTS Thirty-two patients that developed postoperative hematomas were propensity matched to 64 controls. There was no difference in baseline SBP, diastolic blood pressures, or prevalence of hypertension between groups. There was no significant difference in average SBP or MAP between groups. The average MAP during the first third of the procedure was found to be lower in patients who developed a hematoma (69 vs. 72 mmHg), which approached significance at p = 0.08. Closed suction drains were used in 53% of the hematoma group and 78% of the control group (p = 0.02). CONCLUSION There does not appear to be an association between intraoperative blood pressure and the incidence of hematoma when comparing patients who developed hematomas after BRM to propensity-matched controls.
Collapse
|
30
|
Davis MJ, Roy MG, Monson LA. Analysis of adolescent patient satisfaction and well-being following reduction mammaplasty using the BREAST-Q survey. J Pediatr Surg 2022; 57:538-43. [PMID: 34289933 DOI: 10.1016/j.jpedsurg.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND While functional breast reduction surgery has been shown to lead to increased quality of life in adult patients, the effects of this operation has not been investigated as thoroughly in adolescent patients. This study uses the BREAST-Q, a validated, surgery-specific questionnaire, to measure changes in adolescent patient well-being and satisfaction following reduction mammaplasty. METHODS All patients presenting for breast reduction consultation between February and December 2016 were asked to complete the BREAST-Q. Post-operative surveys were completed at three-month follow up. A matched control cohort was established using patients who completed a pre-operative survey and were deemed appropriate surgical candidates, but then were denied by insurance and did not undergo surgery. RESULTS Of the 28 adolescent patients who presented for breast reduction consultation, 15 met inclusion criteria; 11 patients underwent reduction mammaplasty, and 4 patients were included in the control cohort. When these groups were compared, statistically significant improvements were observed in all BREAST-Q categories except for sexual well-being. Overall patient satisfaction correlated most highly to satisfaction with information. CONCLUSIONS This study examines quality of life outcomes in adolescent breast reduction patients using the BREAST-Q survey. Our findings indicate that adolescent patients have an improved quality of life following breast reduction, but that their satisfaction stems from different sources from those of adult patients. Further characterization of outcomes specific to young patients with surgically managed symptomatic macromastia will increase the practice of tailored, evidence-based medicine for adolescent patients. LEVEL OF EVIDENCE Treatment Study, Level III.
Collapse
|
31
|
Nergiz D, Süren D, Alikanoğlu AS, Yıldırım HT, Altun ZA, Uslu A. Rate of Incidental Pathological Lesions ın Reduction Mammoplasty Specimens and Incidence of Invasive Breast Carcinoma Following Breast Reduction Operation. Aesthetic Plast Surg 2022; 46:83-90. [PMID: 34476567 DOI: 10.1007/s00266-021-02558-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Reduction mammoplasty (RM) is one of the most frequently performed surgical procedures. The incidental determination of significant pathologic lesions (SPL), that is precursor and malignant lesions, in RM specimens is rare. The aim of this study was to determine the frequency of SPL in RM specimens, to evaluate the relationship between SPL and clinicopathological factors, and to examine the incidence of invasive breast carcinoma forming in the remaining breast tissue during the postoperative follow-up period developing in patients after RM operation. MATERIAL AND METHOD This retrospective study included 874 females who underwent RM operation between January 2012 and January 2021. Demographic, clinicopathological findings, and preoperative radiological findings were recorded. The patients were followed up after the RM operation in respect of the first occurrence of breast cancer. RESULTS Invasive carcinoma was determined in 0.2% and SPL in 3.5% in RM. The probability of SPL determination was greater in patients aged ≥ 40 years and with ≥ 4 paraffin blocks (p=0.038, p=0.01, respectively). No statistically significant difference was found between patients with and without SPL in respect of radiological findings (p=0.35). The mean postoperative follow-up period was 53.6 months, and invasive carcinoma was diagnosed during follow-up in 0.2% of all patients (6.9% of the patients with SPL). CONCLUSION Age over 40 years and an increased number of sampled blocks were found to be factors increasing the possibility of the determination of precursor and malignant lesions in RM specimens. RM could decrease the risk of the development of breast cancer. 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 .
Collapse
|
32
|
Engel R, Greenberg Y, Siddiqui A. Negative Pressure Wound Therapy for Improved Nipple Survival in Large Volume Reduction Mammaplasty. Aesthetic Plast Surg 2022; 46:108-112. [PMID: 34355263 DOI: 10.1007/s00266-021-02492-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Large volume breast reductions are at increased risk of nipple ischemia and necrosis due to tenuous blood supply of long pedicles. We adapted incisional negative pressure wound therapy to augment nipple survival in such patients undergoing mammaplasty by inferior pedicle technique. METHODS Patients with nipple-to-inframammary fold distance >14 cm were informed of increased risk of requiring free nipple graft. All patients underwent inferior pedicle technique with Wise pattern skin incision. Once incisions were closed and the nipple-areolar complex was inset, the complex was assessed for vascularity. In 12 cases there was evidence of compromised arterial inflow or venous outflow. For these patients, incisional negative pressure wound therapy was applied to the bilateral nipple-areolar complexes for 5-7 days. RESULTS None of the 12 patients (24 breasts) in this series experienced nipple-areolar complex ischemia or necrosis. Only 2 patients experienced delayed wound healing which was successfully managed by local wound care. CONCLUSIONS This study demonstrates the utility of negative pressure wound therapy in nipple survival for at-risk patients. We believe it augments healing by allowing improved micro-circulation. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.
Collapse
Affiliation(s)
- Ricardo Engel
- Wayne State University School of Medicine, 540 E Canfield, Detroit, MI, 48201, USA.
| | | | | |
Collapse
|
33
|
Daar DA, Bekisz JM, Chiodo MV, DeMitchell-Rodriguez EM, Saadeh PB. Hematoma After Non-Oncologic Breast Procedures: A Comprehensive Review of the Evidence. Aesthetic Plast Surg 2021; 45:2602-2617. [PMID: 33864116 DOI: 10.1007/s00266-021-02276-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hematoma after non-oncologic breast surgery is a common concern requiring expeditious treatment. The purpose of this study is to perform an evidence-based review of perioperative factors that may contribute to hematoma in non-oncologic breast procedures. METHODS A comprehensive literature review was performed of non-oncologic breast procedures: breast augmentation, single-stage augmentation-mastopexy, mastopexy, and reduction. In total, 28 studies highlighting incidence and potential risk factors for hematoma were included; overall level of evidence was established regarding each perioperative factor examined and hematoma rate. RESULTS The hematoma rate in breast augmentation ranges from 0.2 to 5.7%. There is inconclusive evidence to support an association between pocket choice or incision location and hematoma rate (Level III) and no evidence of an association between implant type and hematoma (Level V). Single-stage augmentation-mastopexy may have a lower hematoma rate than augmentation alone (Level II). Hematoma may increase the risk of capsular contracture (Level III). In breast reduction, the hematoma rate ranges from 1.0 to 9.3%. Evidence of an association between incision choice and hematoma rate is inconclusive (Level III). Use of epinephrine-containing solution, pedicle choice, and resection weight do not appear to affect hematoma rate (Level V, II, and II, respectively). The use of postoperative drains and ketorolac do not affect the incidence of hematoma (Level I and III, respectively). Intraoperative hypotension may increase the risk of hematoma after breast reduction (Level III). CONCLUSIONS Breast hematomas are not uncommon complications. Current literature lacks ample evidence for risk factors for hematoma after non-oncologic breast procedures, warranting further, high-powered investigations. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- David A Daar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Michael V Chiodo
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Evellyn M DeMitchell-Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Pierre B Saadeh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| |
Collapse
|
34
|
Ozbey R, Cansel N, Firat C, Baydemir MB. Factors Affecting Patient Satisfaction in Breast Reduction Surgeries: A Retrospective Clinical Study. Aesthetic Plast Surg 2021; 45:2658-2664. [PMID: 34075461 DOI: 10.1007/s00266-021-02354-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire. METHODS Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant. RESULTS Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m2. Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001). CONCLUSIONS In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. 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 .
Collapse
Affiliation(s)
- Rafet Ozbey
- Department of Plastic Surgery, Inonu University Turgut Ozal Medical Center Training and Research Hospital, Malatya, Turkey.
| | - Neslihan Cansel
- Department of Psychiatry, Inonu University Turgut Ozal Medical Center Training and Research Hospital, Malatya, Turkey
| | - Cemal Firat
- Department of Plastic Surgery, Inonu University Turgut Ozal Medical Center Training and Research Hospital, Malatya, Turkey
| | | |
Collapse
|
35
|
Broer PN, Moellhoff N, Aung T, Forte AJ, Topka C, Richter DF, Colombo M, Sinno S, Kehrer A, Zeman F, Rohrich RJ, Prantl L, Heidekrueger PI. How to Approach Secondary Breast Reduction: International Trends and a Systematic Review of the Literature. Aesthetic Plast Surg 2021; 45:2555-2567. [PMID: 33821309 PMCID: PMC8677686 DOI: 10.1007/s00266-021-02243-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
Background Secondary breast reduction is complex and poses significant challenges to surgeons. Complication rates exceed those of primary reduction, commonly caused by impaired vascular supply of the nipple-areolar complex (NAC). Literature on the topic is scare and provides contradicting recommendations, especially with regard to pedicle choice in cases with unknown primary reduction technique. Aim of this study was to investigate international trends and to compare findings with literature. Methods A large-scale web-based questionnaire on international trends in mammaplasty (mastopexy and breast reduction) was designed and distributed to over five thousand surgeons in eight geographic regions. The presented manuscript evaluated information regarding pedicle choice in secondary breast reduction and compared data to literature identified in a systematic review. Results The survey was completed by 1431 participants. Overall, secondary procedures were performed in less than 5% or in 5 to 10% of cases. The preferred pedicle for secondary reductions differed significantly between geographic regions (p<0.001). The majority of respondents reported to use a superior or supero-medial pedicle (34.8% and 32.2%, respectively). Residual analysis revealed a strong association between the use of an inferior pedicle and procedures performed in North America. Conclusions Secondary breast reduction is challenging and there remains international disparity with regard to pedicle choice for secondary procedures. Studies investigating outcome when the primary pedicle is unknown are scarce and provide incoherent recommendations. High-quality data is needed to provide evidence-based practice guidelines.
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 the Table of Contents or the online Instructions to Authors www.springer.com/00266
Collapse
Affiliation(s)
- P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Muenchen Klinik Bogenhausen, Technical University Academic Teaching Hospital, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Thiha Aung
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Charlotte Topka
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Muenchen Klinik Bogenhausen, Technical University Academic Teaching Hospital, Munich, Germany
| | - Dirk F Richter
- Department of Plastic and Reconstructive Surgery, Dreifaltigkeitskrankenhaus, Wesseling, Germany
| | - Martin Colombo
- Private practice in Buenos Aires, Buenos Aires, Argentina
| | | | - Andreas Kehrer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Lukas Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Paul I Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| |
Collapse
|
36
|
LaFontaine SN, Yao A, Hwang LK, Draper L, Benacquista T, Garfein ES, Weichman KE. Postoperative pain and opioid use after breast reduction with or without preoperative nerve block. J Plast Reconstr Aesthet Surg 2021; 75:1735-1743. [PMID: 34961696 DOI: 10.1016/j.bjps.2021.11.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physician-prescribed opioids have been implicated as key contributing factors in the current opioid epidemic in the United States. Breast reduction mammoplasty is one of the most commonly performed procedures in plastic surgery and patients are often prescribed large amounts of postoperative opioids. Here we investigate the effects of erector spinae nerve blocks on postoperative pain, opioid consumption, and quality of life after breast reduction. METHODS Following the institutional review board (IRB) approval, a prospective cohort study of some patients undergoing breast reduction mammoplasty at Montefiore Medical Center between June and September 2019 was undertaken. The patients were stratified into two cohorts for further analysis: those who received preoperative erector spinae nerve block and those who did not. Primary outcomes measures analyzed included Likert pain scores, patient-reported outcome measures, and opioid consumption for the first five postoperative days. RESULTS Forty-seven patients were enrolled in the analysis. Thirteen patients (28%) received nerve blocks, 34 (72%) did not. On average, the patients were prescribed 114.3 (±34.6) morphine equivalents postoperatively and they consumed 45% (±35.3) by the end of the first five days post-surgery. There were no significant differences between cohorts in morphine equivalents prescribed or consumed, postoperative pain scores, or patient-reported outcome measures. CONCLUSIONS Following breast reduction mammoplasty, patients on average consumed < 50% of prescribed opioids, suggesting over-prescription of postoperative opioids for breast reduction recovery. Preoperative nerve block did not improve pain scores or decrease opioid consumption for the first five days after surgery.
Collapse
Affiliation(s)
- Samantha N LaFontaine
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Amy Yao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Lyahn K Hwang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Lawrence Draper
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Teresa Benacquista
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Evan S Garfein
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Katie E Weichman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States.
| |
Collapse
|
37
|
Watfa W, Martineau J, Giordano S, Sapino G, Bramhall RJ, di Summa PG. Long-term evaluation of Nipple-Areolar complex changes in inferior versus superomedial pedicle reduction mammoplasty: A comparative study. J Plast Reconstr Aesthet Surg 2021; 75:1179-1186. [PMID: 34887222 DOI: 10.1016/j.bjps.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/27/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In breast reduction, traditionally the inferior pedicle (IFP) technique is considered the most performed by plastic surgeons. A growing interest for the superomedial pedicle (SMP) mammoplasty technique has been documented in literature and clinical practice. Sensory recovery of the nipple-areolar complex (NAC), final areolar shape and scarring may also have a significant impact on patient satisfaction. OBJECTIVE This study represents a retrospective multimodal analysis comparing NAC sensation and appearance outcomes in IFP and SMP wise pattern breast reductions with 2-year follow-up. METHODS From 2013 to 2017, all performed reduction mammoplasty were included and divided in two groups (IFP or SMP technique). Testing included pressure perception (Semmes-Weinstein monofilaments), NAC measurement (diameters ratio and circumference) and circumareolar scar hypertrophy assessment. Measurements were repeated at 2 weeks, 6 and 24 months postoperatively. RESULTS amongst the 73 patients, 42 (58%) had SMP technique and 31 (42%) had IFP technique. Values at 6-months showed better sensory return in the SMP (p < 0.01**). NAC enlargement, showed no difference between groups. However, there was a statistically significant increase in both the SMP (p < 0.001***) and the IFP (p < 0.01**) groups when comparing the 2-week and 24-month follow-up visits measured ratios confirming a more oval appearance over time with both techniques. Scar hypertrophy showed statistically significant reduction in both the SMP (p < 0.001***) and the IFP (p < 0.01**) groups over time. CONCLUSION This 2-year follow-up study showed little difference in outcomes between the two techniques, but some advantages in NAC sensory recovery with the SMP.
Collapse
Affiliation(s)
- William Watfa
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of Plastic and Reconstructive Surgery, Saint George Hospital University Medical Center, Beirut, Lebanon.
| | - Jérôme Martineau
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Salvatore Giordano
- Department of Plastic and Reconstructive Surgery, Turku University Hospital, Finland
| | - Gianluca Sapino
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | | | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| |
Collapse
|
38
|
Wolter A, Fertsch S, Munder B, Stambera P, Schulz T, Hagouan M, Janku D, Staemmler K, Grueter L, Abu-Abdallah N, Becker K, Aufmesser B, Kornetka J, Andree C. Double-Unit Superomedio-Central (DUS) Pedicle Inverted-T Reduction Mammaplasty in Gigantomastia: A 7-year Single-Center Retrospective Study. Aesthetic Plast Surg 2021; 45:2061-74. [PMID: 34145475 DOI: 10.1007/s00266-021-02351-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022]
Abstract
Introduction Reduction mammaplasty in patients with gigantomastia is challenging. The Double-Unit technique with a Superomedio-Central pedicle and inverted-T incision is the standard technique for reduction mammaplasty in our clinic. The aim of this study was to review our approach in cases with gigantomastia in comparison with the current literature. Patients and Methods From 01/2011 to 12/2017, we performed 831 reduction mammaplasties in 630 patients. The Double-Unit Superomedio-Central (DUS) pedicle and inverted-T incision was implemented as a standard procedure for gigantomastia. Patient demographics and the outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensibility, and surgical revision rate were obtained and retrospectively analyzed. Results In 37 patients, 55 reduction mammaplasties were performed with more than 1000 g per breast. Mean resection weight was 1311 g on right side and 1289 g on left side. Mean age was 52.5 years, mean body mass index was 32.8 kg/m2, mean sternal-notch-to-nipple distance was 38.3 cm. A free NAC graft was necessary in four breasts. Overall complication rate was 14.5%; secondary surgical revision rate was 12.7%. 91% of the patients were “very satisfied” and “satisfied” with the aesthetic result. Nipple sensibility was rated “high” and “medium” in 83%. Conclusion The Double-Unit technique with a Superomedio-Central pedicle and inverted-T incision is very effective to achieve volume reduction and aesthetically pleasing reproducible results with a low complication rate in cases with gigantomastia. Level of Evidence Level of Evidence 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. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02351-y.
Collapse
|
39
|
Widmark-Jensen E, Bernhardsson S, Eriksson M, Hallberg H, Jepsen C, Jivegård L, Liljegren A, Petzold M, Svensson M, Wärnberg F, Hansson E. A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research. BMC Surg 2021; 21:343. [PMID: 34511096 PMCID: PMC8436537 DOI: 10.1186/s12893-021-01336-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/28/2021] [Indexed: 11/12/2022] Open
Abstract
Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01336-7.
Collapse
Affiliation(s)
- Emmelie Widmark-Jensen
- Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.,Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, SE-411 19, Gothenburg, Sweden.,Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maud Eriksson
- Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Medical Library, Vita Stråket 12, SE-413 45, Gothenburg, Sweden
| | - Håkan Hallberg
- Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Christian Jepsen
- Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.,Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Lennart Jivegård
- Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden
| | - Ann Liljegren
- Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Medical Library, Vita Stråket 12, SE-413 45, Gothenburg, Sweden
| | - Max Petzold
- Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden.,Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Wärnberg
- Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.,Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Blå Stråket, 413 46, Gothenburg, Sweden
| | - Emma Hansson
- Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden. .,Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.
| |
Collapse
|
40
|
Orak F, Baghaki S. Four-Flap Mammaplasty. Aesthetic Plast Surg 2021; 45:1458-65. [PMID: 34041557 DOI: 10.1007/s00266-021-02326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Any kind of breast shaping aims certain endpoints, and results are expected to be durable. We present a breast shaping technique with an anatomical basis, reproducible and long-lasting results. METHODS A total of 700 patients have been operated on with this technique. The age of the patients ranged between 18 and 62 with a mean of 33. The follow-up period ranged between 6 months and 15 years with a mean of 18 months. Results have been documented as follow-up notes and digital photography. Subjective rate of satisfaction was estimated by each patient at 6th month follow-up visit as a rating of the overall shape, healing period and final scars from 1 (poor) to 5 (very good). RESULTS The amount of resection was between 50 and 300 grams (average 190 g) per each breast for mastopexy and 240-670 grams (average 430 g) per each breast for breast reduction. The average change in NAC position at the 6-month follow-up was 3.4 cm ranging between 2.8 and 6.5 cm. In 10 patients (1.4%), hematoma necessitating nonoperative follow-up was observed. In twelve patients (1.7%), wound dehiscence requiring secondary suturing was observed. In 32 patients (4.5%), minor delays in epithelialization were managed with local wound care. In 15 patients, revision of vertical scar was needed. Patients rated their satisfaction with points ranging between 10 and 15 with an average of 13.33. CONCLUSIONS Four-flap mammaplasty results in good and durable cosmetic results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
41
|
Sozer SO, Phillips PM. Myo-Glandular Flap Breast Reduction: Preventing the Bottoming out Deformity-A Novel Technique. Aesthetic Plast Surg 2021; 45:1419-1428. [PMID: 33660018 DOI: 10.1007/s00266-021-02189-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Large, heavy breasts are a common complaint among women causing various functional and aesthetic concerns. The plastic surgery community has offered a variety of surgical techniques to address this condition. Most of these operations developed during the 1970s-1980s cemented their place in history as fundamentals of breast reduction surgery and are still widely taught today. Despite ongoing plastic surgery advances, long-term complications surrounding breast reduction surgery remain a concern, even to experienced surgeons. Its apparent trends have shifted focus over time; from the basics of developing a patient-safe and easily replicable technique, toward developing more refined maneuvers allowing surgeons to reach desired and long-lasting outcomes while preventing known complications. The bottoming out phenomena, lack of nipple areola complex sensitivity, upper pole emptiness with low setting breasts and high revision rates still plague the breast reduction landscape. We present a novel technique involving a pectoralis major-based myo-glandular flap with breast parenchymal suspension to the upper chest wall to combat bottoming out and upper pole emptiness. These procedural elements allow the breasts to attain not only acceptable results, with smaller, round and well-projected breasts, but also to create an active opposing vector to resist the gravitational forces which otherwise pull breast tissue inferiorly creating the bottoming out deformity.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 .
Collapse
|
42
|
Li Z, Qian B, Wang Z, Liu J, Wang B, Guo K, Sun J. Vertical Scar Versus Inverted-T Scar Reduction Mammaplasty: A Meta-Analysis and Systematic Review. Aesthetic Plast Surg 2021; 45:1385-1396. [PMID: 33649925 DOI: 10.1007/s00266-021-02167-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with macromastia experienced constitutional and psychosocial symptoms which could be improved by vertical scar or Inverted-T scar reduction mammaplasty. The authors conducted the first systematic review and meta-analysis in an attempt to declare the differences of the vertical scar versus the Inverted-T scar reduction technique by comparing the postoperative complications and aesthetic effects. METHODS PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases for clinical studies were searched through June 30, 2019. Cumulative analysis was conducted using the Review Manager Version 5.3 software. The summary odds ratio (OR) was estimated using random effect models at 95% confidence intervals (CIs), statistical heterogeneity was tested using the Chi-square test and risk of bias was assessed using the Cochrane Handbook 5.1.0 and the Newcastle-Ottawa scale (NOS). RESULTS Two randomized controlled trials (RCT) and nine observational comparative studies were included. The vertical scar method was significantly lower than the Inverted-T scar method in overall incidence of complications (OR: 2.06; 95%CI, 1.15 to 3.70; P: 0.002) and wound dehiscence (OR: 4.62; 95%CI, 2.33 to 9.16; P<0.00001). No significant differences in seroma, hematoma, nipple necrosis, fat necrosis and reoperation were noted. CONCLUSIONS Both two breast reduction techniques are equally safe, while the vertical scar approach resulted in a statistically lower rate of overall complications and wound dehiscence. 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 .
Collapse
|
43
|
Putri IL, Bhandari L, Klepetko H. Dog-ear's prevention during Inverted-T breast lift and reduction. Ann Med Surg (Lond) 2021; 67:102462. [PMID: 34178317 PMCID: PMC8213894 DOI: 10.1016/j.amsu.2021.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022] Open
Abstract
There are several techniques for the prevention of dog-ear. All of the techniques have their own disadvantages, since mostly they lengthen the wound. The current technique prevents dog ear during inverted-T breast lift and reduction without lengthening the wound or creating tension while closing the wound. The inverted-T technique commonly forms a dog-ear at the ends of the horizontal part of the inverted-T incision. It would be wiser if we could prevent the occurrence of dog ears than to correct dog ears. A novel technique for preventing dog ears during Inverted-T breast lift and breast reduction.
Collapse
Affiliation(s)
- Indri Lakhsmi Putri
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
| | - Laxminarayan Bhandari
- Department of Plastic Surgery, Govt Medical College Kozhikode, Kerala, 673008, India
| | - Heike Klepetko
- Plastic Reconstructive and Aesthetic Surgeon, The Velthuis Private Clinic Rotterdam, The Radetzky Villa Vienna, Rotterdam, Netherlands
| |
Collapse
|
44
|
Yazar S, Bengur FB, Altinkaya A, Kara H, Uras C. Nipple-Sparing Mastectomy and Immediate Implant-Based Reconstruction with or Without Skin Reduction in Patients with Large Ptotic Breasts: A Case-Matched Analysis. Aesthetic Plast Surg 2021; 45:956-67. [PMID: 33095302 DOI: 10.1007/s00266-020-02000-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) and implant-based immediate breast reconstruction are becoming preferred options with improved outcomes. However, reconstruction in patients with large and ptotic breasts is challenging. When mastectomy and skin reduction are combined in a single-staged procedure, the vasculature of the skin is disturbed leading to increased complication rates. This paper aims to compare complication rates of NSM and immediate implant-based reconstruction with or without reduction to determine the safety of reduction in this patient group. METHODS Breast cancer patients that underwent NSM and implant-based immediate breast reconstruction between November 2010 and 2018 were analyzed. All implants were placed submuscularly. Patients with skin reduction and nipple-areolar complex transposition were matched in a 1:1 fashion with patients without reduction. RESULTS There were 50 patients (72 procedures) in each group. Demographics of the groups were similar as a part of matching process. Mean implant volume in the reduction group was higher (399.93 ± 97.54 vs. 360.21 ± 82.54, p = 0.009). Full thickness skin necrosis rate was higher in the reduction group [12/72 (%17) vs. 2/72 (3%), p = 0.009], and the most common site was over the suture line [6/12 (50%)]. Complications in the reduction group were more common in reconstructions with implant volumes greater than 500 cc (p = 0.008). CONCLUSIONS When compared with no reduction, the skin necrosis rate of NSM and immediate implant-based reconstruction with skin reduction is higher. The described technique can only be considered in patients with moderate breast volumes, grade II-III ptosis, and when the planned implant volume is low (< 500 cc). 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 .
Collapse
|
45
|
Uslu AB. Effect of Tumescent Lidocaine and Epinephrine Infiltration on Blood Loss in Inferior Pedicle Wise-Pattern Breast Reduction: A Prospective Randomized Study. Aesthetic Plast Surg 2021; 45:442-450. [PMID: 32671449 DOI: 10.1007/s00266-020-01859-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
The idea of infiltrating epinephrine-containing solution in reduction mammoplasty with the aim of reducing blood loss dates back to 1985. Although its use is fairly common among surgeons, scientific evidence supporting such use has been feeble and inconsistent. Therefore, we aimed to investigate the effects of tumescent infiltration of lidocaine- and epinephrine-containing solution on blood loss in reduction mammoplasty. A prospective, randomized, double-blinded study is planned. Forty patients admitted to our clinic for mammary hypertrophy are randomly assigned to experiment and control groups, each of a size of 20 patients. Control group underwent conventional Wise-pattern, inferior pedicle breast reduction, whereas experiment group received tumescent fluid infiltration 20 min prior to making of the incisions. Data including age, body mass index (BMI), comorbidities, operative time, length of hospitalization along with preoperative, postoperative 2nd and 12th hour complete blood counts are recorded for each patient and compared between groups. Data analysis showed no significant difference between groups in terms of age, BMI, comorbidities or preoperative hematocrit levels. Operative time and hospitalization were significantly shorter in experiment group (p < 0.05*). The drop in hematocrit level in both the 2nd (4.93 ± 2.44% to 15.53 ± 7.17%) and 12th hour (9.4 ± 6.79 compared to 21.28 ± 10.15) was lower in the experiment group (p < 0.01*). A multiple variate analysis incorporating preoperative, postoperative 2nd and 12th hour hematocrit levels demonstrated a significant reduction in blood loss with the use of tumescent infiltration (Wilks' lambda F = 12.84, p < 0.01*). Multiple regression analysis revealed age, BMI, comorbidities, preoperative hematocrit levels and hospitalization did not affect postoperative blood loss (p > 0.05). Duration of operation, however, seemed to affect amount of blood loss postoperatively (p < 0.05*). With outcomes obtained from this study, it is clearly shown that tumescent infiltration significantly reduces blood loss in Wise-pattern, inferior pedicle breast reduction. Furthermore, tumescent infiltration is also shown to decrease operative time and length of hospital stay. EBM LEVEL II: 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 .
Collapse
Affiliation(s)
- Alper Burak Uslu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Karaman State Hospital, Universite Mahallesi 1984 Str. Number 1, 70200, Karaman, Turkey.
| |
Collapse
|
46
|
Toplu G, Altınel D, Serin M. Evaluation of Factors Related to Postoperative Complications in Patients Who Underwent Reduction Mammoplasty. Eur J Breast Health 2021; 17:157-164. [PMID: 33870116 DOI: 10.4274/ejbh.galenos.2021.6336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
Objective This study aimed to investigate whether there was an increase in the number of postoperative complications in patients undergoing reduction mammoplasty depending on the technique used (i.e., pedicle type, skin incision pattern), existence of concomitant diseases, and presence of other risk factors. Materials and Methods A total of 186 patients who underwent breast reduction between 2013 and 2018 (bilateral, n = 170; unilateral, n = 16) were included in the study. A retrospective review of the data of patients who underwent reduction mammoplasty, which was performed by the same surgical team in a single institution over a 6-year period, was carried out. Superomedial, superior, and inferior pedicles were used in 99, 55, and 32 patients, respectively. The median follow-up period was 4 years. Results The median patient age was 45 (range: 16-75) years. The median total reduction weight was 2,194 (range: 80-4,800) grams. The median distance between the sternal notch and nipple was 31 cm (range: 24-45 cm) for the right breast and 30 cm (range: 22-45 cm) for the left breast. The overall complication rate was 6.9%. The complication rates in patients with and without any concomitant diseases were 10.2% and 4.6%, respectively. The overall complication rate was significantly higher in patients with smoking habit, accessory breasts, progesterone use, cerebrovascular disease, morbid obesity (Body Mass Index ≥40 kg/m2), and thalassemia. Conclusion Our analysis shows that the presence of concomitant diseases increases the risk for postoperative complications in patients who underwent reduction mammoplasty. Our findings do not suggest that any of the techniques have significant superiority to each other in terms of pedicle safety and overall complication rate.
Collapse
Affiliation(s)
- Gaye Toplu
- Department of Plastic Surgery, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Dinçer Altınel
- Department of Plastic Surgery, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Merdan Serin
- Department of Plastic Surgery, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
47
|
Bas S, Oner C, Aydin AC, Ucak R, Sirvan SS, Karsidag S. Discussion of Histopathological Findings of 954 Breast Reduction Specimens. Sisli Etfal Hastan Tip Bul 2021; 55:42-8. [PMID: 33935534 DOI: 10.14744/SEMB.2020.33349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/07/2020] [Indexed: 11/20/2022]
Abstract
Objectives Breast reduction is a frequently sought procedure by patients and one of the most commonly performed operations by plastic surgeons. Follow-up of histopathological results after reduction mammoplasty is very important. This study aimed to evaluate the histopathological results of patients undergoing bilateral reduction mammoplasty to determine the incidence of breast lesions and risk factors of high-risk breast lesions. Methods 477 patients who underwent reduction mammoplasty in the plastic surgery department between October 2013 and January 2020 were included in this study. Patients were evaluated according to age, body mass index (BMI), comorbidity factors, tobacco use, family history and histopathological findings. Results The mean age of patients was 42.43±12.05 years. Body mass index ranged from 23 to 34.6. As for comorbidity factors, 12 patients had hypertension, five patients had asthma and six patients had diabetes mellitus. Seventeen patients (3.6%) were smokers, and 25 (5.2%) patients had a family history of breast cancer. Among the patients, 2.3% were 20 years and under, 17.1% were between 21 and 30 years old, 21.5% were between 31 and 40 years old, 33.1% were between 41 and 50 years old, 18.2% were between 51 and 60 years old, and 7.5% were 60 years and above. 85.4% of histopathological findings consisted of normal breast tissue and nonproliferative breast lesion breast lesions. The incidences of proliferative breast lesions, atypical hyperplasia and in situ lesions were calculated as 5.7%, 2% and 0.4%, respectively. The mean follow-up period was 3.8±1.6 years. Conclusion Although preoperative breast cancer screening methods are used before the reduction mammoplasty, high-risk lesions may be encountered afterwards. One of the biggest advantages of reduction mammoplasty in addition to psychophysiological recovery is breast cancer risk reduction.
Collapse
|
48
|
Abstract
BACKGROUND Reduction mammoplasty can be successful but surgical scars may continue to be a most undesirable and unavoidable outcome. Various medical and non-invasive methods are available to minimize scar formation but as yet no methods have been discovered to eliminate them. We hypothesize that immediate fat and nanofat-enriched fat graft transfer may improve the scar quality and optimize results. MATERIALS AND METHODS This prospective study comprised 45 superomedial pedicle wise-pattern breast reduction patients divided into three groups of 15 in a randomized fashion. The control group had no additional injections whereas the other two groups received injections of fat and nanofat-enriched fat grafts immediately under their surgery scars, respectively. Surgical scar formation was evaluated at six months and scars were scored using the Vancouver scar scale and a visual analogue scale. RESULTS Fat and nanofat-enriched fat graft-injected groups scored significantly better on all items of the Vancouver scar scale, except for scar height, compared to the control group (p < 0.05). Visual analogue scores were significantly lower in the fat and nanofat-enriched fat graft-injected groups compared to the control group (p < 0.05). CONCLUSIONS In breast reduction patients, simultaneous fat and nanofat-enriched fat grafting appears to be a safe and promising strategy for scar management.
Collapse
Affiliation(s)
- Cemal Alper Kemaloğlu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - İrfan Özyazgan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | |
Collapse
|
49
|
Seswandhana R, Anzhari S, Dachlan I. A successful breastfeeding after vertical scar reduction mammaplasty with superior pedicle: A case report. Ann Med Surg (Lond) 2020; 60:600-603. [PMID: 33304571 PMCID: PMC7708693 DOI: 10.1016/j.amsu.2020.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Most of patients undergo reduction mammaplasty for aesthetic or therapeutic reasons without consider the effect on breastfeeding function. Vertical scar mammaplasty with superior pedicle is expected to be a breast reduction procedure that can keep maintain the function of breastfeeding. This is the first recorded report of breastfeeding after vertical scar reduction mammaplasty with superior pedicle in Indonesia. Presentation of case A 23 years old woman presented to the outpatient clinic with enlargement of both breast for 3 years. Physical examination showed bilateral breast enlargement. No tenderness, nodules, nor axillary lymph node enlargement were found. The patient was managed with vertical scar mammaplasty with superior pedicle. The patient was followed up with complication of skin excess and scarring on the bilateral submammary folds. We performed excision and resection procedures to eliminate the skin excess and scars without further complications. The patient was married and gave birth to her first and second child after two and five years following mammaplasty. The patient was able to provide exclusive breastfeeding for both of her children. Discussion Vertical scar mammaplasty with superior pedicle surgery is a surgical technique that combines a superior pedicle for the areola and performs a central-inferior quadrant resection for breast reduction. It only takes the tissue and glands that are located in the lower quadrant and still maintains the surrounding tissue and glands. This technique also maintains the integrity of nipple-areola complex (NAC) which also important in the lactation process Conclusion Vertical scar mammaplasty with superior pedicle can be one of the superior techniques in breast reduction which can maintain the breastfeeding function thereby increasing patient satisfaction. Breastfeeding after Vertical Scar Reduction Mammaplasty with Superior Pedicle: This procedure only takes the tissue and glands that are located in the lower quadrant. By preserving the superior pedicle it can maintains the integrity of nipple-areola complex (NAC). Keep the breastfeeding function thereby increasing patient satisfaction.
Collapse
Affiliation(s)
- Rosadi Seswandhana
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sharfan Anzhari
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ishandono Dachlan
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| |
Collapse
|
50
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|