Contralateral mastoplasty for breast reconstruction: A good opportunity for glandular exploration and occult carcinomas diagnosis

Background: Exploration of the contralateral breast in case of breast cancer has been advocated by many investigators, based on the incidence of contralateral cancer expected to be around 10–15%. Method: From 1978 to 1993, 813 contralateral mammaplasties were performed to obtain symmetry in the course of breast reconstruction, including 373 mastopexies and 440 reduction mammaplasties (RMs). All these operations were performed in patients treated for a cancer of the opposite breast. Clinical and radiologic examination before the reduction mammaplasty showed tissue to be free of evident tumor. Results: Twenty clinically and radiologically occult contralateral cancers were found in the reduction specimen (4.6%). Most of them were located in the lower and central quadrants (70%). The macroscopic size of the tumors varied from 3 to 16 mm. Twelve carcinomas were in situ, and eight cases were infiltrating. Conclusion: The symmetry procedure allows a good check-up of the glandular tissue of the contralateral breast at the time of the breast reconstruction, especially when there is no evidence of tumor. The different techniques of breast reduction provide specific possibilities for such exploration and should be chosen according to the preferential area that should be explored.     

乳房神经血管解剖学研究及在乳房缩小成形术中的意义

目的　探讨乳房的血供模式和神经支配走向 ,寻找适合各型乳房肥大的短小瘢痕乳房缩小成形术术式。方法　应用血管铸型、标本透明技术和大体解剖对 12具成年女性尸体的胸壁乳房血供模式和乳房的神经支配进行研究 ,并设计出改良的双环形切口乳房缩小成形术 ,用于 2 8例乳房肥大患者。结果　成年女性前胸壁软组织乳房或为两层血管构筑或为三层血管构筑 ,各层间均通过垂直穿支形成吻合并首先在胸肌筋膜表面形成致密的血管网 ,这些垂直穿支在乳房下部粗大 ,上部细小。乳头乳晕的神经支配以第 4肋间神经外侧皮支的深支为主 ,在下垂乳房于腺体内呈S形走行。 2 8例患者行乳房缩小成形术后外形满意 ,乳头乳晕完全成活 ,仅 1只乳房感觉减退或消失。结论　改良的双环形切口乳房缩小成形术是较为理想的术式 ,除具有原术式瘢痕不明显、乳房突出度好、效果持久等优点外 ,还最大限度地保留了剩余腺体的血供和乳头乳晕的神经支配     

The advantages of a lower central breast segment in reduction mammaplasty

A method is described, which achieves reduction in the size of the breast and allows determination of breast shape, without the distortion of breast tissue and the production of unfavorable postoperative connective tissue tensions, inherent in most currently used techniques. Aesthetically pleasing breasts can be produced more consistently by a sculptural rather than an origami-like approach.     

A new technique for reduction mammaplasty

A new surgical technique for reduction mammaplasty is described. Incisions are chosen according to Strömbeck's procedure and deepithelialization of the major part of the skin in the resection area is carried out. The upper part of the breast with the total skin for the planned breast is separated from the lower part with the dermis flap and the nipple and the desired resections are carried out from the lower part. A dermis cone or tube is then created with the mammilla at its apex and the skin is closed around the dermis cone.     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术。方法用双环形切口，保留乳头乳晕深动脉和乳房下限的组织，对肥大的乳房进行缩小和重新塑形。结果23例惠者的乳头乳晕均无坏死，感觉良好，乳房形态自然。结论本手术设计简单，操作容易，术后瘢痕隐蔽，效果稳定，是修复各种肥大或下垂乳房的较好方法。     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上,设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过10例20只乳房的临床应用,取得了满意效果。     

Reliability of inferior dermoglandular pedicle reduction mammaplasty in reconstruction of partial mastectomy defects: surgical planning and outcome

The objective of this study is to describe the surgical planning of the inferior dermoglandular pedicle (IDP) technique and its outcome following partial mastectomy reconstruction. A total of 26 patients with breast cancer underwent immediate IDP reconstruction. IDP was indicated to reconstruct superior/central breast defects. Postoperative complications were evaluated and information on esthetic result and satisfaction were collected. About 57.6 percent had tumors measuring 2cm or less (T1). Immediate complications occurred in 34.2 percent with skin necrosis in 11.4 and dehiscence in 7.6 percent. Late complications were observed in 11.4 percent. The cosmetic result was considered to be good or very good in 88.4 percent and the majority of patients were satisfied. All complications were treated by conservative approach. IDP is a reliable technique and should be given consideration in cases of superior/central quadrant reconstruction. The success of the procedure depends on patient selection and careful intra-operative management.     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上，设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过１０例２０只乳房的临床应用，取得了满意效果。     

巨乳缩小术常见手术方法的选择

目的:比较巨乳缩小术常用的临床手术方法,探讨各自的适应证。方法:对15例巨乳症患者行手术治疗,其中垂直双蒂法7例,双环法8例。观察术后乳头乳晕血运及乳房外形。结果:所有患者全部恢复良好,无乳头乳晕坏死,乳房外形均满意。结论:垂直双蒂法较适用于中重度巨乳症,双环法较适用于轻中度巨乳症。     

垂直切口乳房缩小术

目的　探讨应用垂直切口巨乳缩小术以减少术后瘢痕的方法与体会。方法　采用Lejour手术设计 ,切除乳房下方的皮肤、腺体 ,乳头乳晕以上方真皮腺体组织蒂转移提高到正常位置 ,进行乳房塑形 ,术后仅留有垂直瘢痕。结果　采用垂直切口巨乳缩小术治疗 2 4例 ,手术效果满意。 1例术后 6个月切口下端局部修整残留的“猫耳朵”。 1例单侧乳头乳晕完全坏死。结论　垂直切口巨乳缩小术疗效良好 ,术后瘢痕细小 ,乳房形态良好。     

Early experience with Lejour vertical scar reduction mammaplasty technique

The study contains 163 patients who underwent a reduction mammaplasty at the Karolinska Hospital during 1991–1992. Seventy patients were operated on using the Lejour short scar technique (superovertical pedicle) and 93 using the Strömbeck method (medial pedicle). The aim of this study was to compare the results of these two different methods with regard to scar formation, position and sensation in the nipple areola complex, postoperative complications, healing conditions, shape and volume symmetry of the breasts and patient satisfaction. An objective method [20] was used for assessment of postoperative breast asymmetry. Advantages and disadvantages of both methods are presented. The incidence of early complications was low in both groups, compared with the data presented in the literature, but Strömbeck's method was found to be superior in some respects because of fewer early postoperative complications, shorter healing period and better breast symmetry postoperatively.     

双环中央蒂乳房缩小成形术的加网或外侧附加切口技术并发症的特点和适应证

目的 比较双环中央蒂乳房缩小成形术中加网和外侧附加切口的并发症，分析其产生的原因，以避免或减少并发症的发生。方法 回顾2003年8月至2006年5月收治的58例乳房缩小成形术，比较两种方法发生的并发症，包括：感染、血肿、脂肪液化、乳头乳晕血运障碍、皮肤坏死、切口愈合不良、切口瘢痕明显、网片折叠、双侧乳房不对称、缩小程度不足等。结果 加网组19例，发生并发症者6例，其中4例早期并发症患者平均切除腺体重276g；无网也无外侧附加切口3例，无并发症。附加切口组36例，发生并发症者7例（19．4％），其中5例早期并发症患者平均切除腺体重1008g。结论 加网组的并发症主要与网片有关，而附加切口组的并发症与乳房过大、切除腺体多、影响保留的腺体血供有关，改进网片材质和编织工艺、调整网片张力、避免用于表面皮肤过薄的患者，可以减少加网组的并发症。巨大乳房不宜选用双环中央蒂乳房缩小成形术的附加切口法或双环法。     

The bowler's grip in reduction mammaplasty -A new technique for the assistant

Reduction mammaplasty with the inferior pedicle technique using the Strömbeck pattern incurs some risk of undercutting the pedicle, thus endangering the viability of the nipple-areola complex. The authors present a technique of holding the breast similar to the grip of a fast bowler. This stabilizes the tissues and allows for more accurate dissection, thus minimizing damage to the pedicle.     

Pyoderma gangrenosum following reduction mammaplasty

The failure of a postoperative local infection to resolve after appropriate antibiotic therapy should prompt consideration of other diagnoses. Reported here is a case of pyoderma gangrenosum, a rare necrotizing disorder, occurring after reduction mammaplasty. The clinical presentation was one of progressive wound deterioration with associated erythema and intense pain. After failure of antibiotic therapy and local wound care, tissue biopsy of the enlarging wound edge confirmed the diagnosis, which then responded rapidly to systemic steroid treatment. Given that the treatment for pyoderma gangrenosum is at odds with the standard treatment for an infection (steroids versus antibiotics), differentiating between the two diagnoses is vital to providing resolution of the process and limiting any untoward scarring resulting from the advancing open wounds that can develop. With this in mind, the physical signs and symptoms that characterize this condition and thus allow early diagnosis are presented, and treatment options discussed.     

巨乳缩小术后的再次修复

目的 探讨巨乳缩小术后继发畸形再次修复的较为安全的手术方法。方法 自1998年3月至2004年1月我们应用乳晕周围环形切口或原手术切口行下外侧楔形腺体切除再次乳房缩小术11例。结果 11例中10例获满意效果，1例术后因瘢痕明显半年后行第3次手术，术后1年因瘢痕挛缩仍对外形不满。结论 无论第1次巨乳缩小整形术采用何种术式，再次手术时应用乳晕周围环形切口或原切口、下外侧楔形腺体切除是较安全可行的一种手术方法。     

改良乳房下真皮乳腺单蒂瓣巨乳缩小术

目的为了进一步保证巨乳缩小术后乳头乳晕的血供和感觉,减少手术并发症。方法设计应用乳房下真皮单蒂瓣,并保留部分乳腺组织的垂直乳腺蒂,及切除的乳腺组织位于乳房下方两侧的巨乳缩小术,自1994年1月至1995年11月,为67例(132侧)巨乳患者在法国斯德拉斯堡欧洲美容整形诊所进行治疗。结果术后全部患者无乳头乳晕并发症,感觉正常。结论结合乳腺垂直蒂和乳房下真皮单蒂瓣的改良巨乳缩小术,不但可以确保乳头乳晕的血供,且可减少感觉损伤,降低手术并发症,及提供良好形态。     

Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions

IntroductionContralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics.Materials and methodsThe study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammaplasty between 1/2007 and 12/2011. The data was retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and postoperative follow-up.ResultsReduction mammaplasty specimens revealed abnormal findings in 68 (21.5%) patients. High-risk lesions (ADH, ALH, and LCIS) were revealed in 37 (11.7%), and cancer in six (1.9%) patients. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Abnormal histopathological findings were more frequent in patients with reduction mammaplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064).ConclusionThe incidences of malignant and high-risk lesions are doubled compared to patients without prior breast cancer. Patients with abnormal histopathology cannot be preoperatively identified based on demographics. If reduction mammaplasty is performed before oncological treatment, the incidence of abnormal findings is higher. In the light of our results, contralateral reduction mammaplasty with histopathological evaluation in breast cancer patients offers a sophisticated tool to catch those patients whose contralateral breast needs increased attention.     

直线法乳房成形术的临床应用

目的介绍直线法乳房成形术(Lejour法)及其改进方法。方法按Lejour法设计手术切口,剥离乳腺组织,仅保留上部蒂营养乳头、乳晕,去除部分肥大下部及基底乳腺组织,将剩余腺体组织的乳腺基底层固定于第2、3肋水平。重新塑形乳腺组织,皮肤无张力缝合。对于部分乳房肥大明显患者可以首先抽吸脂肪,主要减少乳房腺体内、外侧及侧胸部皮下脂肪。结果采用此法矫治巨乳症、单纯乳房下垂共48例,其中辅助脂肪抽吸13例,术后乳房外形美观,术后3个月随访,3例有修整乳晕瘢痕或乳房下皱襞瘢痕。结论本术式简便易行,且远期效果好,乳房外形挺拔,可作为乳房缩小悬吊术的可行术式之一。     

Various dermal flaps with L-shaped sture line in reduction mammaplasty

We review our experience in reduction mammaplasty with L-shaped suture line which we have practiced for more than 7 years. The advantages, disadvantages, and specific indications of three variations of the technique, all of them leading to an L-shaped scar, are discussed.Presented at the IV Congress Mexico City.