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Vertical Mammaplasty and Liposuction

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... The ideal result of any breast reductive surgery is to produce a long lasting conically shaped breast with preservation of nipple and areola viability and sensation [1]. Liposuction is a relatively new adjunctive procedure for breast reduction [2,3]. As large amounts of fat can be found in hypertrophic breasts [4,5]. ...
... The cannula can be introduced between the sutures and additional fat aspirated from the larger breast. This maneuver is much easier and faster than undoing the sutures and reshaping the breast [3]. ...
Article
The ideal result of any breast reductive surgery is to produce a long lasting conically shaped breast with pres-ervation of nipple and areola viability and sensation. Liposuction is a relatively new adjunct procedure for breast reduction. It offers significant benefits when used in com-bination of reduction techniques and contributes to a better breast contouring. The amount of fat in breast tissue and its impact on the applicability of liposuction in the breast has not been studied till recently. In this study all patients with breast hypertrophy were managed by superior pedicle vertical mammaplasty with liposuction. The amount of fat suctioned was calculated as well as the amount of fat content in the surgical specimen. Results denote that the amount of fat content of the breast in Egyptians, even in young patients with large breasts is more than previously estimated, liposuction is feasible in all old patients and about 86.9% of young patients with large breasts. Although fat content increases with age and with body weight with great individual variation. Neither clinical examination nor mammography can predict best candidates for breast lipo-suction and the best policy is to routinely try liposuction at the beginning of breast reductive surgery.
... Used in the breast area, this technique enables the surgeon to obtain a more pliable, easy-to-shape gland and short scars, while preserving important structures, such as vessels and nerves, and achieving improved symmetry. [18][19][20][21][22][23] Applied in the surrounding breast area, ancillary lipoplasty helps to enhance the inframammary fold, defat the lateral chest wall (both axillary and subaxillary regions), and correct synmastia deformity ( Figure 1). 17,24 For these reasons, it has been used increasingly in recent years. ...
... All patients underwent a vertical mammaplasty as described by Lejour,22 under general anesthesia and one preoperative antibiotic prophylaxis dose. All the surgeries were performed by the senior author (A.P.). ...
Article
Suction-assisted lipoplasty (SAL) may be used in breast reduction either alone or as an adjunct to standard reduction mammaplasty procedures. Although adequate results have been attained through breast reduction with ancillary lipoplasty, the safety of this procedure has not been evaluated. The purpose of this study was to evaluate outcomes in breast reduction surgery complemented with lipoplasty of the breast area. A prospective, randomized double-blinded trial with 2 study groups was designed. A total of 25 patients were included in the control group (without SAL) and 25 in the active group (with SAL). Lipoplasty of the breast area was performed using the tumescent technique. Neither lipoplasty of the surrounding breast area nor other surgical procedures were performed. The primary outcome measure was the complication rate; the secondary outcomes were the clinical data from the patient and the surgical and aesthetic results. For comparison of paired variables, linear or logistic regression models were used with an alpha level of 5% for statistical significance. The 2 groups were comparable with respect to sex, body mass index, comorbidities and smoking habits, but the active group (with SAL) was younger (P = .351). The overall complication rate was higher in the group that underwent reduction mammaplasty with SAL (18% vs. 6%, P = .0324), in which a higher incidence of dehiscence and tissue necrosis was observed. There were no differences with respect to aesthetic outcome. In this study, breast reduction with ancillary lipoplasty resulted in a higher rate of complications when compared to reduction mammaplasty with no lipoplasty. Caution must be used when applying SAL in the pedicle, under the nipple-areola complex, or in the pillars during a standard reduction mammaplasty.
... In the 90 s, Lejour developed further modifications of the vertical scar technique by adaption of the superior pedicle to the final size of the new breast, and placement of additional sutures into the re-joined vertical breast pillars 3 . Skin surplus around the areola as well as from the lower part of the areola to the inframammary fold was plicated. ...
... There is a debate regarding how to maintain attractive breast shape and projection. The use of sutures for glandular suspension and re-shaping was described in techniques involving wide undermining of the breast base [5,27,28]. This is not applicable to the central pedicle technique which is based on keeping maximal attachment of the pedicle to the chest wall for maximal preservation of the vascularity. ...
Article
Breast reduction is a common plastic surgical procedure. The indication of surgery is either functional, aesthetic or both. In this study, we describe our modification and clinical experience with the central pedicle technique for breast reduction. The surgical technique was applied to 20 cases of macromastia (breast enlargement) of various degrees of severity. The technique entails separate handling of the skin and parenchyma. The skin is partially excised, using the conventional keyhole pattern. The breast parenchyma is widely separated from the 2-3 cm-thick skin flaps. Dissection stops 2 cm from the chest wall to assure vascular contribution from the lateral thoracic artery, the internal mammary perforators, the intercostal perforators and the thoracoacromial artery. The central pedicle is reduced by excising slices of the breast tissue in a slanting manner. The skin is re-draped around the reduced pedicle, leaving an inverted T-shaped scar. The technique is simple, reliable and versatile. It is applicable to all degrees of macromastia.
... Many of the authors refer to minor or moderate breast reductions and mastopexies, 7-9 but few allude to large reduction mastoplasty. [10][11][12][13][14][15] This article presents the basic concepts that have served as my guides for planning reduction surgery. 10 The first principle is that the glandular resection shapes and defines the breast form. ...
Article
Background: Circumvertical reduction mastoplasty combines periareolar and vertical techniques for the treatment of large breast hypertrophies. Objective: The advantage of circumvertical reduction mastoplasty over the periareolar technique is the occurrence of fewer wrinkles. Its advantage over the vertical technique is a shorter scar that does not extend beyond the new inframammary crease. Methods: In this technique, the areola is transposed attached to the gland and glandular removal is performed as a wedge excision in the lower quadrant and inferior portions of the lateral and medial quadrants. Liposuction is rarely required but may be useful at the end of the procedure and in cases with small asymmetries. Results: Once the surgery is complete, a uniform and harmonious distribution of wrinkles is observed. Postoperative follow-up of 62 patients, ranging from 1 to 6 years, revealed resections of up to 1000 g per breast. All results were satisfactory. Conclusions: Circumvertical reduction mastoplasty offers a reliable and easily performed approach to breast reduction, which is appropriate for removal of between 400 and 1000 g per breast.
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Article
Zusammenfassung Im Rahmen der Mammahyperplasie stellt sich ein vielfältiges Beschwerdebild dar, neben den körperlichen Beschwerden leiden Patientinnen häufig unter psychischen Beschwerden. Die Mammareduktionsplastik ist nach wie vor eine der am häufigsten durchgeführten plastischen Operationen an der weiblichen Brust, sie wird von den Krankenkassen aber in vielen Fällen nicht bezahlt. Ziel dieser monozentrischen retrospektiven Studie war die Evaluation des Einflusses der Mammareduktionsplastik auf die Beschwerden der Patientinnen. Es zeigte sich postoperativ eine signifikante Reduktion der Rückenschmerzen, 50 % der Patientinnen waren postoperativ beschwerdefrei. Einhergehend hiermit kam es ebenfalls zu einer signifikanten Reduktion von Kopf- und Nackenschmerzen, muskulären Verspannungen sowie Schulterschmerzen, und es kam zu einer signifikanten Verbesserung von Haltungsfehlern. Cutisveränderungen und Entzündungen traten signifikant weniger postoperativ auf. Positiv wurde der Effekt durch die Operation auf den psychischen Leidensdruck bewertet, es zeigte sich eine signifikante Verbesserung von Selbstbewusstsein, Körperbild und Wohlbefinden und es resultierte ebenfalls eine Verbesserung der Situation im Berufsleben. Zusammenfassend zeigt sich eine signifikante Verbesserung der körperlichen und psychischen Beschwerden.
Chapter
The concept of oncoplastic surgery (OP) is not so complicated. If the surgeon can manage three “basic” reduction mammaplasty techniques such as techniques derived from the upper nipple and areola blood supply (superior pedicle) [1–3], techniques derived from the lower/posterior nipple and areola blood supply (inferior pedicle) [4–7], and techniques derived from glandular nipple and areola blood supply (periareolar) [8, 9], it is possible to solve around 90% of the cases. In this chapter, the goal is to show you possible solutions in special cases that seem initially too much complicated due to anatomical variations, tumor locations, or patient’s wishes.
Chapter
Immediate breast reconstruction with anatomic form-stable implants, associated with skin and nipple-sparing mastectomies, represented one of the greatest advances in oncoplastic and reconstructive breast surgery. It has a low level of complications and decreases both the time spent in reconstructive surgeries and the number of surgeries for most patients. Surgical revisions of the reconstruction are still needed in some cases and are one of the biggest limitations. However, these are surgical procedures that present minor risks, and many of the procedures can be performed under local anesthesia. Currently, this is our most commonly used technique due to its practicality, low level of long-term complications, and satisfactory aesthetic outcomes.
Chapter
The authors describe a mammoplasty reduction technique that they believe is safe owing to modern cutaneous resection and adequate areolar nourishment. It is made possible by maintaining a large pedicle that is also versatile as it can be used on all kinds of breasts. Good results can be reproduced by other surgeons.
Chapter
The goal of breast reduction is the correction of the volume, shape and symmetry of the breasts while preserving nipple sensitivity.
Chapter
Nipple-areolar complex (NAC) necrosis is a dreaded complication of reduction mammaplasty and mastopexy that can lead to prolonged morbidity and permanent cosmetic deformity. Preventing ischemic complications is greatly preferable to treating a necrotic nipple and areola. The guiding principle in surgical management of ischemic complications of the nipple-areolar complex is to avoid aggressive treatment until the tissues have “declared” themselves. With properly timed and well-executed reconstructive procedures, it is possible in most cases to restore a very natural-appearing nipple-areolar complex.
Chapter
Malposition of the nipple-areola complex (NAC) is a commonly encountered problem in aesthetic and reconstructive breast surgery, which has a significant impact on the overall appearance of the breast. It can be associated with the natural aging process of the breast producing a low-sitting NAC, and multiple techniques have been described to address this. Cranial or lateral malposition is less frequently seen, but poses a significant challenge to the surgeon to correct while minimizing the concurrent alternation to the shape and function of the breast and additional scarring. The authors describe the double U-plasty to correct the malpositioned nipple. This is a simple, safe, and reproducible technique that allows the NAC to be moved in any direction with minimal scarring. With careful planning and technique, the sensation to the nipple and the function of the ductal system can also be preserved.
Article
Introduction: Preoperative planning is an essential prerequisite for the success of plastic surgery. In procedures such as breast reduction, freehand drawings may be associated with a number of challenges during the determination of axes vertical and parallel to the surgical site. Furthermore, many procedures involve subjective maneuvers, such as attempts aimed at positioning both nipples on the same line and transferring nipple-areola complexes in a well-matched manner. Our newly designed instrument, that is, the goniometer (TG), aims to ensure metric measurements appropriate for the axes, and it may also be used in circumstances that require angle measurements. Moreover, it incorporates a canal system to facilitate surgical designing of the area, to which the nipple-areola complex will be transferred. Method: From April 2013 to September 2015, TG device was used in superior pedicle breast reduction operation of 96 patients and 50 of them were randomly selected for the purpose of study analyses. An additional randomly selected 50 patients, in whom surgical planning was based on conventional techniques were served as controls. At postoperative 1 year, symmetry analysis was carried out on patient photographs. Results: No partial or total necrosis occurred at the nipple-areola complex, and symmetrical volume and shape could be achieved in all cases. TG device exhibited superiority in all criteria used for postoperative symmetry analyses (P < .05). Conclusion: We believe that this device may effectively accelerate the planning process in various types of plastic and aesthetic operations and may help ensure symmetry, especially in reduction mammoplasty and mastopexy.
Chapter
A 27-year-old patient with scoliosis and pseudoptosis had breast augmentation with 370 mL smooth, high-profile, silicone implants placed in the subpectoral pockets. Six months postoperatively, she had Baker 2 capsule contracture. The Breast Group discussed the use of mastopexy with the implants, mastopexy with the implants removed, and later augmentation, vertical mastopexy, and prepectoral dissection with scoring of breast base and suturing to pectoralis.
Chapter
A 21-year-old patient with pectus carinatum and scoliosis desires higher breasts. She has pseudoptosis on examination. There was a discussion on the type of mastopexy, vertical versus traditional, possible augmentation, and possible treatment of the pectus excavatum.
Chapter
Breast asymmetry since puberty was the problem with this 27-year-old patient. Grade 3 ptosis on right and grade 1/2 on left. The Group considered Lejour-type mastopexy followed in 3 months with augmentation (subpectoral, subglandular), liposuction, lift the left breast and reduce the right, and bilateral breast reduction with standard T scar. She finally had Lejour-type mastopexy bilaterally with tissue removed from the right side to match the left. Results were very good.
Chapter
This patient had gained weight to 80 kg and then reduced her weight to 53 kg. There were empty pendulous breasts as a result. A vertical mastopexy was performed and she developed a hematoma postoperatively that had to be evacuated. She ultimately “bottomed out” and requested implants. It was decided to perhaps do an augmentation but the surgeon wanted to know of any tips or traps in this type of case. Ultimately an augmentation was performed but the implants remained too high. Another procedure was performed to lower the implants.
Chapter
This 29-year-old patient with tuberous breasts requested larger breasts. Subglandular augmentation through a periareolar incision and PIP round, high-profile, smooth implants was suggested. The Group discussed inframammary incision, dividing the fibrous bands of the tuberous breasts, low-profile anatomical implants, excising part of the gland, and periareolar incision. Breast augmentation was performed using lower intra-areolar incisions and using 290 mL smooth, round, high-profile, titanium-coated, silicone gel implants in subglandular pockets. A small amount of breast tissue is excised from behind each areola, with diathermy and the breast tissue scored radially in four quadrants by direct vision.
Article
Purpose Conventional breast reduction is technically difficult, produces scarring, and may result in loss of nipple sensation, possible necrosis of the areolar complex, or both. Our objective was to develop tumescent liposuction as an alternative. Materials and Methods Patient selection was important. Patients should have large breasts but not severe ptosis. After volumetric measurement, the breasts were infused with tumescent solution. Approximately one half of the breast volume was removed with suction lipectomy by using the Giorgio Fisher cannulas. More tissue was removed from the lateral quadrants than from the medial quadrants. During the removal of the last JOO mL, the underdermis was abraded with the 2.5-mm Giorgio Fisher cannula. This loosened the dermal plexus throughout the breast area up to the clavicle. The breasts were supported during the postoperative period with Reston foam and binders. With this technique, the breasts were reduced and elevated during the postoperative period. Results A 2.5- to 5-cm elevation of the areolar complex followed this liposculpting. No cases of loss of sensation or nipple necrosis developed. Breast reduction and areolar complex elevation were possible with superficial and deep liposculpting of the adult breast in cases of grades I and II ptosis. Conclusion Breast reduction by liposuction provides a scarless alternative to conventional methods. It is especially useful in adolescent gigantomastia before there is significant breast ptosis.
Article
Background Vertical techniques have become more popular and versatile in breast reduction and mastopexy procedures. The authors introduce a combination of vertical mammoplasty with vertical bipedicle technique, presenting some innovations concerning pedicle design, glandular dissection pattern, and the role of liposuction. Methods In this article, we describe a personal surgical technique and analyze the results on 73 mastopexy and breast reduction patients, operated on between 2012 and 2014 by the senior author. The most important aspects of this technique are as follows: 1. the concept of lipotunnelization, where parenchymal tunnels are made with cannulas without suction; 2. the systematic use of liposuction/lipotunnelization to recreate the inframammary fold and decrease pillars height; 3. the use of a thick and narrow vertical pedicle (bipedicled); 4. no skin undermining. ResultsTwenty-five patients underwent mastopexy and 48 breast reduction. Results were evaluated by clinical examination and patient photographs. Good shape and projection of the breast and correct nipple elevation were achieved, correlating with a high level of patient satisfaction. No major complications occurred. Conclusion This lipomammoplasty technique is a reliable and effective option, suitable for a wide range of symptomatic macromastia/ptosis. Adjunctive use of liposuction/lipotunnelization in vertical breast reduction accomplishes effective contouring of the breast with low associated complications and significantly reduces the revision rates. Level of Evidence IVThis 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.
Article
Many reduction mammaplasty procedures have been proposed of late. Many rely on intraoperative refinements that demand an advanced level of experience with the technique and invoke a steep learning curve fraught with problems for the novice. The central pedicle reduction mammaplasty technique was introduced by Hester et al in 1985. This technique has been shown to be a safe, reliable, and versatile approach to breast reduction that is applicable to the majority of breast sizes and shapes. Its particular advantages are in the predictability in tailoring the skin envelope and glandular component from preoperative judgement, in the flexibility in the intraoperative execution of the procedure, and in the maintenance of a generous neurovascular supply. These advantages allow for a low complication rate. This technique can easily be taught with a high degree of predictability in planning and execution. A series of approximately 50 consecutive cases is presented with an analysis of the results.
Article
An analysis of 105 consecutive breast reduction cases carried out by means of either the superior- or inferior-pedicle technique was undertaken in an effort to compare the two techniques and evaluate patient satisfaction. The two techniques were compared on the basis of weight of tissue excised from each breast, upward nipple displacement required, patient age, complications, operating time, and histopathology. A patient questionnaire sent to each subject in the study evaluated satisfaction with the surgery. It is concluded from this study that both the superior- and inferior-pedicle techniques are safe, versatile, and workable surgical options which can be incorporated within a cosmetic surgical practice. Both procedures, when utilized for appropriate indications, serve as means to address all degrees of breast hypertrophy. There was a high degree of patient satisfaction for both surgical techniques, with evidence of significant reduction in the symptoms that often led patients to consider the operation.
Article
Background Ptotic breast deformity results from involution of breast parenchyma and leads to a loss of volume, along with a converse laxity of the skin envelope. As the breast tissue descends inferiorly with gravity, there is an apparent volume loss in the upper pole and the central breast, and the lower pole becomes fuller and often wider. This study presents modifications for a well-known mastopexy technique which provides not only autoaugmentation for the breast but also suspension for the breast parenchyma and reduces bottoming-out deformity, and also obtains a regular areola shape in all types of breasts. Patients and Methods The modifications involve 2–4 cm subareolar crescentic incisions for regular areolas and cylindrical excision of the recipient area in the superior medial and lateral pillars for wide flaps in medium and large-size breasts. Results The present study included 63 female patients, with an average body mass index of 25.5 ± 2.0 kg/m2, aged 26–47 years (average 35 years). The author performed vertical scar mastopexy and augmented the breasts with a distal-based flap of deepithelialized dermoglandular tissue inserted beneath the breast parenchyma of a superior-based nipple-areolar complex pedicle. Conclusions In this study, modifications included subareolar crescentic incisions and cylindrical excisions in the superior medial and lateral pillar regions. This technique produced satisfactory results for all types of breasts in terms of good breast shape, natural image at the upper pole of the breast, good projection, and reduced bottoming-out deformity. This simple modified technique maintained the size of the breasts and avoided augmentation by breast implants. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www. springer. com/ 00266.
Chapter
The patients seeking our help for breast reduction are often young and probably planning to have children later on in their lives. It is therefore most important to offer them a method that not only leaves few scars but also as much physiology as possible. They need to be able to breast feed and have a normal sensibility. The sagittal reduction the way I perform it fulfils these expectations. You can form a pleasant breast with few scars and preserve sensibility and lactation. Scars can always be lengthened but never shortened. So do them as short as possible from the beginning. The method can be used for all patients from mastopexies to big reductions.
Chapter
Immediate breast reconstruction with anatomic form-stable implants, associated with skin-sparing and nipple-paring mastectomies, is one of the greatest advances in oncoplastic and reconstructive breast cancer surgery. It has a low level of complications and decreases both the time spent in reconstructive surgical procedures and the number of surgical procedures for most patients. Surgical revisions of the reconstruction are still needed in some cases and are one of the greatest limitations. However, these are surgical procedures that have minor risks, and many of the procedures can be performed with the patient under local anesthesia. Currently, this is our most commonly used technique owing to its practicality, low level of long-term complications, and satisfactory aesthetic outcomes.
Chapter
In general, oncoplastic surgery can be performed by mammaplasty techniques. Knowledge and understanding of vascular supply of breast parenchyma and the nipple–areola complex is a very important key to success. When a simple mammaplasty technique cannot be used, there are other options that surgeons and patients can discuss. Prosthesis reconstruction can be performed with a low capsular contraction rate when the proper intraoperative radiotherapy protocol is used. Other fasciocutaneous and myocutaneous flaps can be done with promising results, and the surgeon should keep in mind the oncoplastic principle to achieve the best oncologic and aesthetic benefit.
Chapter
Body contouring has become a new specialty in plastic surgery. The demand for skin resecting and contourimproving procedures grows as bariatric surgery is expanding. New concepts were introduced because of new insights into the anatomy and physiology of the skin and the subcutaneous tissue, such as the description of the superficial aponeurotic system of the body. Each region is adjacent to another and more than one region is addressed in one operation, as introduced in the body lift. Thighs, buttocks, abdomen, and waist/ flanks can be modeled three-dimensionally today. Special attention is paid to other, not less important, areas such as the face, the breasts, and the arms. These skin regions are also more or less overexpanded by excessive fat deposits and require surgical treatment as well. Single techniques such as mastopexy have been extended to the adjacent area, the chest wall. It is usually performed in combination with a chest and arm lift. If a lower body lift is not appropriate, the abdominal region can be treated with conventional abdominoplasty, either with short scars or, in more severe cases, as a belt lipectomy, where the incision reaches to the back. The goal is always to restore a normal body image of the patient in as few operations and with as little risk as possible.
Article
The goal of breast reduction is the correction of the volume, shape, and symmetry of the breast while preserving nipple sensitivity. Since the early days of breast surgery, many surgical techniques have been proposed to reach this goal, but over the two last decades, new techniques have been published that attempt to minimize the scars. The periareolar scar is unavoidable as the nipple-areola complex has to be repositioned, but the vertical scar has proved to be avoidable in mastopexies [6], as has the horizontal submammary scar in the majority of cases, even in large reductions [3].Following the description of Dartigues in 1925 and the publication of Lassus in 1970 [8], in the early 1990s Lejour popularized a technique derived from Lassus [9]. The Lejour vertical mammaplasty is a technique that combines a superior pedicle for the areola and a central resection for the breast reduction associated with liposuction and wide undermining of the skin along the vertical scar. Despite the results reported on large series [12], many surgeons are still reluctant to apply the Lejour vertical mammaplasty as a standard technique. This can be due to the use of a superior pedicle for the NAC, an inferomedial resection, and different approaches to the skin and to the glandular tissue. Moreover, the result is not obtained immediately.
Article
The goals of modern surgery of the breast are improved shape, symmetry, good function and sensibility and minimal visible scarring. Over 22 years of surgical practice reduction mammaplasties were initially performed with the inverted T technique [1, 2]; however, it was realized that, besides the long scar, the breast ended up with no projection or shape. After this period, authors started to perform oblique or L incisions [3]-[9], which eliminated the medial branch of the scar, quite often the one with the worst aesthetic quality.
Article
The central mound technique (also known as the central pedicle technique) of breast reduction was first described by Hester et al in 1985 [1]. This technique is extremely versatile in that it involves separation of the breast skin from the gland, direct reduction of the glandular tissue, and custom tailoring of the skin to obtain projection while controlling the amount of tension on the closure. This method maintains the robust vascular supply to the gland which consists of branches of the lateral thoracic and thoracoacromial arteries superiorly and laterally. Additional vessels enter the gland posteriorly consisting of pectoralis major perforators supplied by the anterolateral and anteromedial intercostal perforators, and the internal mammary perforators. The primary sensory nerve to the nipple is the lateral cutaneous branch of the fourth intercostal nerve which is preserved with this technique. The majority of the lactiferous ducts and underlying glandular tissue are maintained, allowing breast-feeding postoperatively for most patients. Extensive clinical experiences attest to the safety and reliability of this technique even in patients requiring large reductions or with marked pto-sis, therefore obviating the need for free nipple/areola grafting [2-5]
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Article
Background: Breast hypertrophy can cause a variety of symptoms and affect lifestyle and quality of life. Breast reduction, being the most effective treatment, is sometimes difficult to establish as standard treatment in obese patients (difficulties to differentiate symptoms from macromastia or from obesity, higher rate of complications). Aim: To evaluate the effect of reduction mammaplasty (quality of life and symptoms) in obese patients comparing with non-obese. Methods: This is a prospective study of patients undergoing reduction mammaplasty. Patients were allocated in non-obese (BMI < 29) and obese (BMI > 30). Demographic data, comorbidities, specific symptoms questionnaire, data from the surgical procedure, Spanish version of the Health-Related Quality of Life (SF-36) questionnaire, complications and sequels were recorded and collected before the operation and at 1 month and 1 year after. Chi-square, Fisher's exact t test, McNemar, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis. Results: One hundred twenty-one consecutive patients were operated on; 54 (44.6 %) obese and 67 (55.4 %) non-obese. The average age of patients was 40.7 (18-78), average volume of resected tissue was 1.784 g (401-5.790), and average hospital stay was 2.94 days (1-11). There were no differences between obese and normal BMI patients with regard to length of hospital stay, complications, sequels, or reoperations. Symptoms improved in both groups. Physical and mental components of the SF-36 improved at 1 year in both groups (p < 0.001). The mental health component improved at 1 month (p < 0.001) in both groups. Conclusions: Obese patients should be considered for reduction mammaplasty surgery in the same way as women of normal weight. Level of evidence iii: 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 .
Article
In the search for a well-formed breast with less scaring and more symmetry, liposuction of the breast tissue is very helpful. Liposuction of the breast is an adjunc-tive procedure for the refinement of the form, especially the fat pads before the axilla and in the axilla that can be easily treated with liposuction, and the slight asymmetry at the end of the operation and dog ears may be treated as well. In specific cases it maybe an advantage to reduce the fat volume before the resection in order to make the tissue more pliable and the scars shorter.
Article
Vertical mammaplasty has been perfected and popularized by Madeline Lejour; this technique is one of the most versatile methods of manunaplasty today. The vertical scar from the nipple areola to the submammary line is often much longer and distorted than the conventional mammaplastys. The length of the vertical scar can be reduced by 2–3 cm by combining the skin pattern of the periareolar and vertical mammaplasty. The aesthetic result can be improved by shortening the vertical scar.
Article
La ptosis mamaria es consulta frecuente en la práctica del cirujano plástico, y las opciones quirúrgicas para su corrección son múltiples. A pesar de los avances en el tratamiento de esta alteración, los resultados impredecibles y las posibles complicaciones siguen siendo frecuentes, sobre todo cuando se asocia la colocación de implantes mamarios. La dehiscencia de la herida, la exposición del implante y la modificación de la forma de la mama, en especial del polo inferior, pueden estar presentes a corto o largo plazo en las pacientes sometidas a cirugía de pexia mamaria con implantes. Presentamos una nueva técnica quirúrgica para suspensión y protección del polo inferior de la mama a partir de un colgajo dermoglandular de pedículo interno inferior que llamaremos "hamaca". Este colgajo, nos permite mantener más estable la forma de la mama a lo largo del tiempo y brindar así una mayor protección al implante en caso de dehiscencia de la herida.
Chapter
A technique is described that takes advantage of the superior and medial pedicle to improve the appearance of the breast and an inferior flap which contributes a good padding to the inferior pole of the implant, thus minimizing complications. Use of the technique presented herein for a single-stage augmentation mastopexy procedure enables the surgeon to achieve good and consistent results, avoiding some of the complications inherent to the simultaneous augmentation and breast lift operations, especially implant extrusion. The technique has two advantages: it provides a good vascularization for NAC and keeps a medial dermoglandular subareolar flap to cover the inferior pole of the implant, fixed to the inframammary fold level. At the inferior pole, the implant will be covered by two layers the dermoglandular flap and the cutaneous lateral and medial pillars, obtaining a good long-term stability.
Article
Zusammenfassung Grundlagen: Das Auftreten von Narbenhypertrophien nach Mammareduktionsplastiken submammär medial haben uns veranlaßt, eine Operationstechnik zu wählen, die die Schnittführung in diesem Bereich vermeidet. Seit 1991 wurde daher zur Verkleinerung einer mittelgroßen oder Hebung einer kleinen ptotischen Brust die sogenannte B-Technik angewandt. Methodik: Wir haben 31 Patientinnen, die von 1991 bis 1995 an unserer Abteilung nach dieser Technik operiert worden waren, nachuntersucht, um den Operationserfolg zu überprüfen. Die Narbenbreite und der Areola-Durchmesser wurden gemessen, die Areola-Sensibilität wurde geprüft und die Zufriedenheit der Patientinnen erfaßt. Ergebnisse: Wir fanden eine verbreiterte Narbe periareolär bei 6 Patientinnen, am Steg bei 4 Patientinnen und submammär bei 2 Patientinnen. Der Areola-Durchmesser betrug 3,5 bis 6 cm. Die Areola-Sensibilität war bei 12 Patientinnen beeinträchtigt. 94% unserer Patientinnen waren mit dem Operationsergebnis zufrieden. Schlußfolgerungen: Die B-Technik ist eine komplikationsarme und narbensparende Methode zur Brustverkleinerung und eignet sich bestens für die Reduktion einer mittelgroßen Brust bzw. für eine Ptosekorrektur. Besondere Sorgfalt muß dabei für die Areola aufgewandt werden, um verbreiterte Narben zu vermeiden.
Article
Mammaplasty is now a very common operation. However, it took nearly a century from the first attempts to the latest evolution of techniques improving safety and providing long-lasting results and minimal scarring. As with any surgical technique, it has pitfalls and complications, but a good knowledge of anatomy and rigorous operative technique makes it possible to obtain excellent results in the majority of cases.
Article
A technique for breast reconstruction following explantation of implants is presented. The reconstruction uses local autologous tissues. The Lassus-Lejour mastopexy is considered to be the best technique compared to older procedures.
Article
One major objective of all types of breast reduction procedures is to achieve a long-lasting, stable and aesthetically pleasing three-dimensional (3-D) breast shape, but current surgical outcome evaluation is limited. This study compares the extent of soft-tissue oedema and breast tissue migration related to 3-D breast morphology changes after inverted T-scar and vertical-scar breast reduction over 12 months. 3-D breast surface scans of patients undergoing inverted T-scar (n = 52 breasts) and vertical-scar (n = 44 breasts) reduction mammaplasty were obtained preoperatively and 2-3 days, 1 week, 1 month, 3 months, 6 months, 9 months and 12 months postoperatively. 3-D images were analysed at each time point comparing distances, 3-D breast contour deviations (%), breast surface (cm2) and volume (cc) measurements including volumetric distribution between the upper portion (UP) and the lower portion (LP) of the breast (%). Total postoperative breast volume decreased by 11.7% (T-scar) and by 7.8% (vertical-scar) during the first 3 months (both p < 0.001) without relevant changes in the following months, indicating that soft-tissue oedema is resolved after 3 months. The T-scar (vertical-scar) group showed a preoperative UP to LP volumetric distribution of 43:57% (45:55%) versus 86:14% (91:9%) immediately after surgery. Breast tissue significantly redistributes (both p = 0.001) from the UP to the LP during the first postoperative year by 16.5% (T-scar) and 21% (vertical-scar), resulting in a final UP to LP ratio of 70:30% for both techniques, without further breast contour deviations (both p > 0.05) after 6 months (T-scar) and 9 months (vertical-scar). Breast morphological changes after reduction mammaplasty are completed after a period of 3-6 months in the T-scar group and 6-9 months in the vertical-scar group.
Chapter
A vast array of techniques have been developed and abandoned since the first reported breast reduction by Dieffenbach, 160 years ago. The current trend, particularly in Europe, is toward short scar techniques. In this chapter the pertinent aspects of breast anatomy and physiology are delineated as well as the medical indications and psychological aspects inherent in macromastia patients. In addition, necessary preoperative classification and planning are discussed in conjunction with technique selection and execution. This is followed by a detailed description and step-by-step photograph demonstration of our preferred technique, mainly influenced by the Z-plasty technique of Maillard and the short vertical scar technique of Lassus. The complication and revision rates of major studies are compared to our own series of 3,554 breast reductions using this technique. Finally, the medicolegal aspects are discussed focusing on the fact that breast reductions and mastopexies are the most frequent causes of law suits in plastic surgery in the U.S. due to scar problems. There is no doubt that breast reduction provides enormous benefits to patients, physically als well as psychologically. Even from an economic point of view, insurance companies would benefit from paying for this procedure, since the health condition of patients improves enormously after breast reduction. Breast reduction and mastopexy are among the most common procedures in plastic surgery. Outcome studies demonstrate that patients' satisfaction postoperatively is very high for this procedure. However the degree of patient's overall satisfaction is strongly correlated with patient's satisfaction with her scars. Therefore, there is an urgent need for techniques that are associated with shorter and/or less visible scars.
Article
Eine Anzahl von ca. 1,7Mrd. Menschen wird weltweit als übergewichtig oder adipös eingestuft. Die äußerst facettenreiche chirurgische Therapie der Adipositas blickt auf eine kurze Geschichte zurück. Nach erfolgreicher Gewichtsreduktion mit Stabilisierung des Gewichts benötigt etwa ein Drittel der Patienten einen plastisch-chirurgischen rekonstruktiven Eingriff. Im Rahmen eines Therapiekonzeptes der modernen bariatrischen Chirurgie bildet die Plastische Chirurgie stets die abschließende Einheit der Therapiemaßnahmen. Die postbariatrische Plastische Chirurgie mit Entfernung von Hautfettgewebe und angleichender Körperformung dient nicht primär der Behandlung von Übergewicht, sondern der Körperkonturierung und funktionellen Rekonstruktion. Dieser Beitrag stellt die Möglichkeiten und Grenzen der modernen Plastischen und Rekonstruktiven Chirurgie bei bariatrischen Patienten zusammen. Approximately 1.7 billion people around the world are defined as being overweight or obese. Various surgical options to treat obesity have quite recently been developed. Following efficient and lasting weight loss, up to one-third of the patients will require plastic and reconstructive surgery. Plastic surgery will thus be the final part of a modern bariatric treatment plan. Postbariatric plastic surgery interventions do not treat obesity but rather remove excess skin and restore the normal body contour and function of the bariatric patient. The presented work summarizes current concepts and limitations in modern plastic and reconstructive surgery of the bariatric patient population.
The trend in breast reduction, as in other types of surgeries, has been a reduction in the length and number of scars. The use of liposuction in the breast has also been gaining in acceptance, although it can be difficult to perform because of the fibrous nature of breast tissue. Ultrasound-assisted liposuction (UAL) makes liposuction of the breast easy and effective and can be used by itself in selected cases or as an adjunct to shorter scar techniques, expanding their applicability to a larger range of breast sizes. Two representative cases are shown: one showing breast reduction with UAL alone and the other showing resolution of a difficult gynecomastia problem using only the ultrasound device. Preliminary studies show no adverse effect on postoperative mammograms. We have found UAL to also be very useful as an adjunct to other types of breast surgery, such as transverse rectus abdominis musculo-cutaneous (TRAM) flap revisions. Although further investigation is very much needed, we believe that UAL will become a valuable asset not only in surgery of the breast, but in liposuction in general.
Article
The use of dermoglandular flaps in reduction mastopexy was advocated by Paul Tessier, who never published his method, but had actually almost finished the following article before his death in June 2008. Dr. Tessier is acknowledged as the "father" of craniofacial surgery, but he had interest in aesthetic surgery, and was quite proud of the technique he had developed using dermoglandular flaps in reduction mammoplasty. He had literally hundreds of techniques and methods that he had developed but which never found their way into print, both because of his enormous surgical schedule, and perhaps his self-imposed standards for anything that he published, which were almost impossibly high. The technique proposed by Dr. Gargano is similar in some ways to Dr. Tessier, it seemed good that they will be published together.
Article
Background: Inverted T-pattern breast reduction does not directly address axillary or lateral chest wall fullness. Lipoplasty of this tissue has been advocated by some surgeons to reduce additional scarring. Objective: A prospective study was designed to examine the differences in wound healing of the breast reduction skin flaps when ultrasound-assisted lipoplasty (UAL) and suction-assisted lipoplasty (SAL) were each used as an adjunct to inverted T-pattern breast reduction surgery. Methods: The prospective study involved 15 consecutive nonsmoking female patients undergoing a standard inferior pedicle, central mound breast reduction and contouring of the lateral chest wall. Contouring of the left lateral chest wall and axilla was done with UAL and contouring of the right lateral chest wall with SAL. Lipoplasty was not used elsewhere in the breast tissue. The height and length of skin ischemia or necrosis at the inverted T incision was measured at postoperative day 2 or 3. Patients were placed on dressing changes and followed frequently until fully healed. Results: The amount of breast tissue removed and the amount of UAL/SAL axillary aspirate were not significantly different from side to side (for the mean UAL side, tissue 828 ± 190 g and aspirate 195 ± 102 mL; for the mean SAL side, tissue 780 ± 187 g and aspirate 194 ± 94 mL; P > .05). The mean area of lateral skin flap ischemia at the inverted T incision was significantly less on the UAL side than on the SAL side (UAL, 47 ± 128 mm2; SAL, 361 ± 500 mm2; P = 0.02). The time to complete skin wound healing of the lateral flap was significantly less in the UAL-treated flaps than in the SAL-treated flaps (UAL, 9.6 ± 8.6 days; SAL, 22.1 ± 22 days; P = .02). The study was terminated once these resounding differences in lateral skin flap necrosis and time of wound healing became obvious. Conclusions: UAL offers significant benefits in comparison with SAL as an adjunct to standard breast reduction surgery for contouring of lateral chest wall fullness.
Article
“Surgical Strategies” focuses on refinements in aesthetic surgical techniques. Contributors are Aesthetic Society members or other recognized experts.
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Article
Mammaplasty for breast enhancement and correction of ptosis augmentation is described. Between 2002 and 2007, autoaugmentation mammaplasty was performed for 27 patients (age, 48 +/- 7.3 years) using an inferior-based flap of deepithelialized dermoglandular tissue inserted beneath the breast parenchyma of a superior-based nipple-areolar complex pedicle. The results confirmed that autoaugmentation mammaplasty corrects ptosis while increasing the projection and apparent volume of the breast. The degree of inframammary fold (IMF) descent 6 months after surgery generally paralleled that of the nipple. The mean level of the IMF was below the mean level of the nipple. Postoperatively, the optimum distance had been largely achieved. The advantage of the technique is that it optimizes the shape and volume of the breast without the use of an implant.
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