Scar wars: Optimizing outcomes with reduction mammaplasty

Plastic and Reconstructive Surgery (Impact Factor: 2.99). 01/2006; 116(7):2026-9. DOI: 10.1097/01.prs.0000191197.21528.26
Source: PubMed
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    ABSTRACT: The purpose of this study was to analyse the geometrical principles of breast reduction, to propose a classification of reduction mammaplasty techniques and to show a simplified approach based on the authors experience. A thorough analysis of the geometrical differences between the normal and enlarged breast was performed. As a result of this analysis, the concept of separate management of the skin and gland for breast reduction was used as a method to classify the different techniques. Some aspects of technique selection and the authors' preferences are also discussed. The four geometric differences between the normal and enlarged breast are: vertical excess, broadened base, horizontal excess and a descended nipple-areola complex. All breast reduction techniques use a specific pedicle and a separate skin incision pattern, so they should be named after the scar and pedicle used. Technique selection must consider the degree of hypertrophy and ptosis, the skin and gland quality, the patient's requirements, and the surgeon's experience and preferences. Some clinical examples are provided. The comprehension of basic breast geometry, a universal language for communication and a simple algorithm to approach the breast reduction patient are valuable tools, particularly for the surgeon who is becoming acquainted with reduction mammaplasty procedures.
    Journal of Plastic Reconstructive & Aesthetic Surgery 06/2008; 61(11):1284-93. DOI:10.1016/j.bjps.2007.11.060 · 1.42 Impact Factor
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    ABSTRACT: Combined cosmetic procedures have become increasingly popular. One of the most common combinations of cosmetic procedures includes abdominoplasty and cosmetic breast surgery. The shortened recovery and financial savings associated with combined surgery contribute to the increased demand for these combined surgeries. The goal of this study was to evaluate the safety and efficacy of combined abdominoplasty and breast surgery at a single plastic surgery practice that performs a large volume of these cases. This is an update to a study published in 2006. A retrospective review was performed for patients who underwent combined abdominoplasty and cosmetic breast surgery during the last 10 years at a single outpatient surgery center. Abdominoplasty inclusion criteria were defined as lower, mini, full, reverse, or circumferential abdominoplasty. Cosmetic breast surgery inclusion criteria were defined as augmentation, mastopexy, augmentation-mastopexy, reduction, or removal and replacement of implants. Pertinent preoperative and intraoperative data were recorded along with complications and revisions. There were 268 patients during the 10-year period between 1997 and 2007. There were no cases of death, pulmonary embolism, deep venous thrombosis, or other life-threatening complications. The overall complication rate was 34%. Abdominoplasty seroma and scars requiring revision comprised 68% (n = 74) of the complications. The total revision rate was 13%. Combined abdominoplasty and cosmetic breast surgery was safe and effective in this large series of cases performed at a single plastic surgery practice. The complication and revision rates of the combined surgery were similar to those reported for individually staged procedures.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 03/2009; 29(2):129-34. DOI:10.1016/j.asj.2008.12.002 · 1.84 Impact Factor
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    ABSTRACT: Purpose: We evaluated the long-term results and patient's satisfaction in reduction mammaplasties for symptomatic mammary hypertrophy. Methods: From 2002 to 2008 a total of 92 women underwent bilateral mammaplasty for a symptomatic macromastia at our department. Three different surgical techniques for reduction mammaplasty were used (Bostwick, Stroembeck, Ribeiro). Patients were re-contacted in 2009 and asked to complete a self-assessment survey in order to asses their satisfaction with the post-operative symptom-relief and the overall outcome. Results: 90.5 % of all patients stated, that they would retrospectively re-opt for a reduction mammaplasty. Preoperative patients' age, BMI and severity of macromasty-related symptoms were found to be factors positively correlated with a high post-interventional satisfaction with the achieved symptom-relief and the overall outcome. No correlation was found between the amount of intra-operatively resected breast tissue and the post-operative patients' assessment. Patients' assessment regarding the achieved post-operative symptom relief was comparable for all three surgical techniques, however the overall outcome rating for both bi-pedicled approaches (Stroembeck and Ribeiro) was higher compared to the mono-pedicled Bostwick technique. Conclusions: Reduction mammaplasty for patients with a mammary hypertrophy and somatic symptoms could offer a causal and effective treatment. The predictive factors for a high patients' satisfaction identified in this study could become a valuable tool in the pre-operative patients counceling and their role should be further evaluated prospectively. The use of bi-pedicled surgical techniques seems to favor a high post-operative patients' assessment.
    Archives of Gynecology 11/2012; 287(4). DOI:10.1007/s00404-012-2620-z · 1.36 Impact Factor
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