Simultaneous mastopexy and augmentation for correction of the small, ptotic breast

A technique for aesthetic reconstruction of the small ptotic breast is described. The procedure combines a mastopexy of the Aries-Pitanguy type, accomplished after retromammary pocket dissection, and placement of an inflatable silicone prosthesis. The method provides maximum flexibility in selecting the volume of augmentation and the subsequent appropriate contouring of the reconstructed breast.     

三平面法隆乳术在乳房萎缩伴下垂矫正术中的应用

目的 探讨应用胸大肌后放置假体,并于胸大肌中央部位切开,形成假体表面胸肌-腺体-胸肌三平面覆盖的方法,矫正乳房萎缩伴下垂的效果.方法 选择环乳晕切口,进行乳房上象限腺体表面分离及真皮帽折叠固定.再由乳腺外下象限边缘进入乳房后间隙,于新的乳头、乳晕水平将胸大肌横行及纵行部分离断,将假体植入胸大肌后.于术前及术后对乳房各解剖径线进行标准化测量.结果 2011年6 ～12月,应用上述方法行乳房上提联合隆乳手术14例,患者术后乳房上极形态、乳房凸度及乳头、乳晕位置均得到了明显改善,且无严重并发症发生.术后随访6～12个月,乳房形态良好.结论 三平面法能够在不离断胸大肌起点及止点的情况下,保证假体在乳头、乳晕水平良好的凸度,避免了乳房下垂联合隆乳手术时易发生的双泡畸形或阶梯现象,且损伤较小.     

Mondor's disease and aesthetic breast surgery: Report of case secondary to mastopexy with augmentation

Although the etiology of Mondor's disease remains obscure, trauma of some form is the most commonly cited cause. Surgical trauma has frequently been quoted, but references in the literature specifically implicating aesthetic breast surgery are scarce. In this article, we report a case of Mondor's disease secondary to mastopexy with concomitant augmentation mammaplasty.     

Revision augmentation mastopexy: indications, operations, and outcomes

In the absence of any published information on the indications, frequency, and outcomes of revision augmentation/mastopexy, an 8-year retrospective review was undertaken of all patients undergoing revision of a previous augmentation/mastopexy in the senior author's practice. The data collected included original implant type, location and mastopexy type, indication for revision, interval from original surgery, new implant type, location, and associated corrective surgical procedures. A simultaneous review was also performed of all primary augmentation/mastopexies done during the same period.Twenty patients underwent revision of 34 previously performed augmentation/mastopexies. Five patients underwent revisions of a prior revision. Fourteen were bilateral, while 6 were unilateral, for a total of 34 breasts. Forty patients underwent primary augmentation/mastopexy during the same period. Among the revisions, 10 implants were originally subglandular, while 24 were either partly or totally submuscular. Twelve of the previous mastopexies were periareolar, 2 were vertical, and 20 were of the inverted T-type. The indications for revision included capsular contracture in 11 of 20 (55%) patients, nipple ptosis in 11 of 20 (55%) patients, implant malposition in 7 of 20 (35%) patients, dissatisfaction with implant size in 6 of 20 (30%) patients, poor scar in 5 of 20 (25%) patients, breast ptosis in 4 of 20 (20%) patients, nipple malposition in 2 of 20 (10%) patients, and patient preference in 1 of 20 (5%) patients. Most patients had 2 or more indications for revision. The average duration to revision was 7 years. In 13 of 20 (65%) patients, no change in implant type was made. The remainder had exchanges to a different type. In 12 of 20 (60%) patients, no change in implant location was made, whereas 8 of 20 (40%) patients had a change to the subpectoral or dual plane position. In 18 of 20 (90%) patients, the revision included the same type of mastopexy, while in 2 of 20 (10%) patients, the type of mastopexy was changed. Corrective surgical procedures performed included repeat mastopexy, capsulectomy, change of implant type, change of implant location, change of implant size, capsulotomy, capsulorrhaphy, and scar revision. To date, all of the patients are satisfied with their appearance. Follow-up ranged from 2 months to 4 years.Revision augmentation mastopexy is not an uncommon procedure, occurring half as often as primary augmentation/mastopexy in our series. There were 8 common indications for revision, with capsular contracture and recurrent ptosis being the most common. Eight surgical procedures, in various combinations, were performed during revision, with repeat mastopexy being the most common.     

The versatility of the inferior dermal flap in implant/expander-based immediate breast reconstruction and its application in augmentation–mastopexy

The inferior dermal flap technique with the Wise pattern skin resection has been used in the authors practice, mainly in patients who required bilateral or unilateral risk-reducing mastectomy for prophylaxis. The versatility of this procedure allowed the senior authors (MPS and PL) to extend its applicability for vertical scar augmentation–mastopexy in asymmetrical breast and for Wise pattern skin resection mastopexy–augmentation in massive weight loss. Between 2006 and 2009, the inferior dermal flap was performed in 18 patients with a total of 34 breasts, 20 of which had the Wise pattern skin resection following risk-reducing mastectomy, two of which were unilateral, six had a Wise pattern skin resection after massive weight loss and six had a vertical skin excision for asymmetrical breasts. No haematoma, infection or seroma were seen with this technique. No breakdown at the T junction was reported. One patient had a capsular contracture which required a capsulectomy and replacement of implants. We report our experience of this technique in patients undergoing unilateral skin-reducing mastectomies for prophylaxis and we demonstrate the versatility of the dermal flap when applied for vertical scar augmentation–mastopexy in the asymmetrical breast and for Wise pattern skin resection mastopexy–augmentation in massive weight loss.     

Chest morphology and breast augmentation

When one considers breast augmentation, it is quite important to study the patient thoracic morphology, since the ribs are the base on which the implant rests. They are responsible for the implant orientation, and, in part, for the breast projection. Some malformations are obvious, neither the surgeon nor the patient underestimates the difficulties... However, often exist discreet abnormalities, which don't stick out right away. One must not ignore them, because they affect the result of an ordinary augmentation procedure. They must be identified and evaluated prior surgery. Thus, she will not be surprised or disappointed if the result is not exactly symmetrical, or what she was expecting. Aesthetic surgery requires the same demand than reconstructive surgery. The physical examination must be very thorough, looking for any asymmetry, even minimal, concerning volume, skin and bone. The position of the implants must be discussed not only according to the type of implants (inflatable or gel filled) but also according to the state of the skin, the thickness of the subcutaneous tissue, the amount of gland and the shape of the thorax.     

Simultaneous transareolar breast augmentation with areola and nipple reduction by inner areolar "donut" excision

Simultaneous areola-nipple reduction and augmentation mammaplasty were performed by the inner areolar donut excision technique with translocation of the periareolar scar to the peri-nipple area in order to create a more acceptable scar in a patient whose areolar border is not distinct.     

Predictability in breast augmentation

Plastic surgery literature does not teach us much about the size of breast prostheses required to get the cup size the patient wants in breast augmentation. The purpose of this study is to allow predictability of the increase in cup size using a series of measurements and to correlate them with volume changes and the required volume of implants to achieve the desired change in bra cup size.     

Alternatives and trade-offs in breast augmentation

Selection of alternatives for breast augmentation should be prioritized in the order in which those selections are most likely to affect short- and long-term outcomes. Every selection of alternative must be reconciled with patient priorities and patient tissue limitations. This discussion addresses selection of alternatives for breast augmentation sequenced in order of priority, including the following: assuring adequate soft tissue coverage (pocket location), implant size and type, patient tissue limitations, long-term implant-soft tissue dynamics, incision approach, intraoperative techniques and instrumentation to optimize control, and intraoperative techniques to minimize tissue trauma.     

Postoperative compression after breast augmentation

In a randomized study of 130 patients undergoing breast augmentation, postoperative compression did not reduce the frequency of postoperative bruising or hematoma formation, and 37.5% of the 64 patients having compression had complaints regarding their use. Postoperative compression is of no value after breast augmentation.