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1.
The critical points which should not be overlooked when performing reduction mammaplasty are to minimize scar on the breast
and to ensure a sufficient blood supply for the viability of the nipple–areolar complex. Periareolar reduction mammaplasty
has been widely used because it left only one scar around the areola. However, with the typical periareolar reduction mammaplasty
technique, it is difficult to remove a large amount of breast tissue and mobilize the remaining breast tissue. It may result
in necrosis of the nipple–areolar complex in some cases. To overcome these limitations we combined the periareolar incision
with the inferior dermal pedicle, which has a relatively good blood supply. This new technique was employed in 22 consecutive
women (44 breasts) with hypertrophy and a varying degree of ptosis. Infiltration of a tumescent solution and liposuction were
performed in all cases. After periareolar incision, dissection of the skin was performed, and the breast was elevated from
the fascia of the pectoralis major muscle, leaving the inferior dermal pyramidal pedicle. An adequate amount of tissue was
resected in the superior, medial, and lateral areas. After mastopexy, closure was done with a purse-string suture. The amount
of tissue resected ranged from 180 to 1510 g per breast, and the mean was 466.1 g. The mean length of elevation of the nipple
was 10.6 cm along the meridian of the breast. There were a few complications which needed revision operation: hematoma collection
in one breast (2.3%), wound dehiscence in one breast (2.3%), and fat necrosis in one breast (2.3%). There was no necrosis
of the nipple–areolar complex. With this new technique of periareolar reduction mammaplasty utilizing the inferior dermal
pedicle, we were able to minimize the scar, preserve the nipple–areolar complex, and improve the motility of the breast tissue.
But we also observed a flat or square appearance in the case of a large amount of resection in the patients with poor skin
elasticity. This technique is safe and versatile and produces aesthetically acceptable results in selected patients. 相似文献
2.
Abramo AC 《Aesthetic plastic surgery》2012,36(1):134-139
Background
Nipple–areola nourishment and sensation have been the main concern in reduction mammaplasty for severe breast hypertrophy and ptosis. Free grafting for the nipple–areola can cause flatness and loss of sensation. These complications can be improved by pedicle techniques for the nipple–areola, no matter the pedicle orientation. The aesthetic outcomes and complications are similar for the inferior and superior pedicle techniques. The pedicle length has been crucial to nipple–areola viability and sensation. 相似文献3.
Chiummariello S Cigna E Buccheri EM Dessy LA Alfano C Scuderi N 《Aesthetic plastic surgery》2008,32(2):294-297
Background This study reviewed mammary glandular function and breastfeeding after reduction mammaplasty performed via four different
surgical techniques. Patients who underwent this procedure were asked to answer questions concerning the birth of a child,
natural breastfeeding, and the reasons why natural breastfeeding was not performed or was interrupted.
Methods Between 1992 and 2001, 368 reduction mammaplasties were performed in the Department of Plastic Surgery at the “La Sapienza”
University of Rome. After reduction mammaplasty, 105 patients had a child and were enrolled in the study. Breastfeeding data
were compared with data from hospital records at the time of surgery in terms of patient age, reduction mammaplasty technique,
sensitivity of the nipple–areola complex after the operation, and proportion of the gland removed.
Results Maternal breastfeeding was considered to have occurred if it lasted more than 3 weeks and was not accompanied by any nutritional
supplements. Babies were breastfed by 60.7% of the patients who underwent a superior pedicle reduction mammaplasty, by 43.5%
of those who underwent an inferior pedicle reduction mammaplasty, by 48% of those who underwent a medial pedicle reduction
mammaplasty, and by 55.1% of those who underwent a lateral pedicle reduction mammaplasty.
Conclusions The findings demonstrate that conservative reduction mammaplasty techniques supported by medical and paramedical staff permit
subsequent breastfeeding. In particular, the best outcomes resulted from superior pedicle reduction mammaplasty. Skilled execution
of the surgical technique is mandatory to guarantee adequate vascularization and sensitivity of the nipple–areola complex
and to spare as many of the glandular ducts and lobules as possible. 相似文献
4.
Background
Issues of poor circumareolar scars and asymmetry or malposition of the nipple–areola complex (NAC) are frequently associated with those breast reduction or pexy techniques that rely on an ample excision of skin around the areola, either alone or associated with a vertical scar in a circumvertical approach. To prevent such problems, in 2007 Hammond et al. introduced the “interlocking suture.” The objective of this study was to demonstrate the true ability of this suture to reduce the common complications of periareolar surgery simply by managing the existing contrast between NAC centripetal and outer breast tegument centrifugal forces. 相似文献5.
Eed MD 《Aesthetic plastic surgery》2000,24(3):206-211
A series of 40 patients operated from 1995 through 1997 is reviewed. The women ranged in age from 18 to 40 and were seen
in either a university- or a private-hospital setting. Thirty-eight of the patients underwent reduction mammaplasty, which
was performed using an inferior pedicle technique with a straight-line incision; two patients underwent mastopexy only. The
reduction procedure depends on the formation of a cap from medial, lateral, and superior flaps. Following resection of breast
tissue the cap is joined to a cone—the nipple–areola complex carried on a subcutaneous inferior pedicle. The cone is fixed
to the chest wall with simple vertical stitches, minimizing the recurrence of ptosis. This technique is safe and versatile,
avoids a submammary scar, and offers an aesthetic and long-lasting result. 相似文献
6.
Brett Andrew Frenkiel Marc D. Pacifico Morris Ritz Graeme Southwick 《Aesthetic plastic surgery》2010,34(4):525-527
There are limited techniques described in the literature on how to lower the nipple–areola complex following surgery to the
breast. We present a case of successful correction of a high-riding nipple using a Z-plasty technique with an 8-year follow-up
in a breast reconstruction patient. The technique described may also be applicable to cases of high-riding nipples following
aesthetic breast surgery such as reduction mammaplasty. 相似文献
7.
Mammoplasty: Breast Fixation with Dermoglandular Mono Upper Pedicle Flap Under the Pectoralis Muscle
Ailton de Araujo Cerqueira 《Aesthetic plastic surgery》1998,22(4):276-283
A surgical procedure for breast fixation to avoid secondary ptosis of the lower quadrants and nipple–areola complex bascule
and to maintain the breast upper pole projection is described and evaluated after long-term pexy and reduction mammoplasty.
A superior monopedicle dermal–adipose–glandular flap with the areola–nipple complex placed in its base is mobilized and its
extremity sutured to a ``trapdoor' type of flap dissected in the pectoralis muscle. This procedure determines the permanent
areola–nipple complex and the upper breast quadrant position, avoiding the common secondary breast ptosis, when the breast
tissue is sutured to the pectoralis muscle. One thousand seven hundred patients have undergone this procedure in the last
15 years. 相似文献
8.
The ``flip-flap' mastopexy modifies the McKissock vertical bipedicle design by creating a wide superiorly based flap of
breast tissue deep to the vertical bipedicle. Transposition of this flap up and beneath the upper breast, with suture anchoring
to the pectoralis fascia at the level of the second rib, restores upper breast fullness, decreases mastopexy-wrecking lower
breast bulk, and provides a pleasant forward thrust of the nipple–areolar complex. The ``flip-flap' is effective for improving
the long-term aesthetic outcome for both reduction mammaplasty and mastopexies of moderate- to full-sized breasts. 相似文献
9.
It is known that the desired shape and position of the nipple–areola complex may be difficult to achieve in vertical-scar
reduction mammaplasty. The marking of a mosque-shaped areolar pattern varies from one surgeon to another, and therefore, periareolar
trimming or resection may be inevitable with the use of such technique. We have developed a device to standardize the periareolar
marking, and reduce the irregularity of the periareolar region. This device mimics the elasticity of normal breast tissue,
and has the flexibility to be applicable to all breast types. We believe that this device improves the results of vertical-scar
reduction mammaplasty and can eliminate the necessity of “last-minute” modifications intraoperatively. 相似文献
10.
Many modifications of the vertical mammaplasty procedure used to shorten the learning curve have been described. The authors
advocate marking the breasts for the vertical mammaplasty operation according to the key hole pattern. They have used inverted
T techniques on the upper breast and Lejour’s vertical mammaplasty on the lower breast. A total of 14 patients who had breast
hypertrophy and ptosis underwent operations with this marking modification. The amount of removed breast ranged from 285 to
875 g per breast. Hematoma, skin necrosis, skin dehiscence, loss of nipple–areola sensitivity, and distortion were not observed
in these cases. 相似文献
11.
A new technique of reduction mammaplasty: dermis suspension and elimination of medial scars. 总被引:1,自引:0,他引:1
M Frey 《British journal of plastic surgery》1999,52(1):45-51
In the last decades new techniques of reduction mammaplasty significantly improved the results obtained and led to a reduced incidence of complications. However, some important problems like the loss of a natural submammary fold and alteration in the shape of the breast with time still remained mostly unsolved and the medial scars in the inverted T techniques are aesthetically unsatisfying. A new strategy for reduction mammaplasty has been developed based on a combination of advantages of other techniques. The principle of using de-epithelialized infra-areolar skin for dermis suspension prevents sagging of the remaining breast tissue behind the inframammary fold to create a long-lasting, natural shape of the reduced breast with an accentuated submammary fold. The central pedicle is favoured because of good modelling even in big reductions. Better vascular and nerve supply of the nipple-areola complex and the continuity of the lactiferous ducts are further advantages of the central pedicle. Secondary operations after reduction mammaplasty or augmentation usually dictate the use of a superior pedicle together with the dermis suspension technique. B-shaped skin incisions prevent medial submammary scars and can be used up to a 10 cm transposition distance of the nipple without disadvantage. The operative technique is described in detail. Examples are given for the primary procedure and the technique as a secondary correction. The principle of dermis suspension in combination with the prevention of a medial scar is applicable to reduction mammaplasty as well as mastopexy. 相似文献
12.
Male patients after massive weight loss often suffer from redundant skin and soft tissue in the anterior and lateral chest
region, causing various deformities of pseudogynecomastia. Techniques with free or pedicled nipple–areola complex (NAC) transposition
are widely accepted. The authors present their approach to male breast reduction with preservation of the NAC on a central
dermoglandular pedicle and a wide elliptical tissue excision of breast and lateral thorax tissue in combination with liposuction.
Male breast reduction was performed on patients after moderate to massive weight loss due to diet or bariatric procedures.
Former procedures included free nipple–areola grafts or inferior pedicled techniques for NAC preservation. As a modification,
we performed a central pedicled breast reduction on nine male patients with excessive liposuction of the pedicle and a horizontal
elliptical skin removal, allowing for sufficient tissue removal at the lateral thorax. From October 2010 until June 2011,
nine male patients had central pedicled breast reconstructions after massive weight loss. Mean age was 29.1 years, mean preoperative
body mass index was 29.2, and mean preoperative weight loss was 63.9 kg. The chest wall improvement was rated “very good”
by eight patients. No major complications occurred in all nine patients. Male chest deformities after massive weight loss
can be dealt by several approaches. The optimal scar positioning and the preservation of NAC may be the most challenging aspects
of these procedures. Therefore, the preservation of the NAC on a central dermoglandular pedicle with a horizontal submammary
scar course may optimize the esthetic outcome. 相似文献
13.
Vertical mammaplasty is a simple and safe procedure that relies on an upper pedicle to the areola with lower central breast
reduction and glandular shaping. We applied this technique to six patients adding a modification of the vertical scar which
distributed skin tension both to the areola and vertical suture line. It prevented an unacceptable puckering vertical scar
and enlargement of areola. This modification also provided satisfactory breast shape with a good vertical scar especially
at the early postoperative period. 相似文献
14.
Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple 总被引:1,自引:0,他引:1
A method of repair is described for correction of abnormally enlarged nipple–areola complex following both periareolar mastopexy
and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control
the enlargement of nipple–areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs
to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast,
especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy
or reduction mammoplasty cases resulting in enlarged nipple–areola complexes, the size of the areola can also be corrected
by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision,
the shape of the breast is more acceptable and the size of the areola does not enlarge with time. 相似文献
15.
Miguel Modolin Wilson Cintra Jr. Maira Marques Silva Liacyr Ribeiro Rolf Gemperli Marcus Castro Ferreira 《Aesthetic plastic surgery》2010,34(5):596-602
Background
After massive weight loss, one of the stigmas that afflict women is the remaining deformity of the breasts which become flaccid and ptotic, with an absent or flat upper pole. The authors propose the use of a well-established mammaplasty technique to fill the upper pole, reshape the breast cone, and correct ptosis with nipple–areola complex (NAC) repositioning. 相似文献16.
Jair Jose Pereira 《Aesthetic plastic surgery》1997,21(1):16-22
This article describes the inverted-T incision technique with the scar placed above the inframammary sulcus for cases of
pexy, breast reduction, and augmentation–reduction mammaplasty. This technique preserves the inframammary fold as an important
factor in natural breast suspension; the breast mound is easily shaped independent of the skin tension. The gland- and skin
sutures are placed separately and independently. This technique has been used on 380 patients in the last 13 years. 相似文献
17.
Background
Reconstruction of the nipple–areola complex (NAC) is the last stage of breast reconstruction and represents the search for symmetry in regard to the contralateral breast. The objective of this study was to present an areola reconstruction technique with local skin graft to improve the texture and aspect of the reconstructed areola, searching for a natural look. 相似文献18.
目的:探讨环乳晕切口下蒂瓣矫正特别巨大乳房的临床效果。方法:采取环乳晕切口,以部分去表皮的下蒂瓣为基础,切除乳头乳晕上方、外侧大部分腺体皮肤及内侧部分腺体皮肤组织,上提下蒂瓣,固定重塑乳房腺体形态,再将下蒂两侧的皮肤均匀拉拢,覆盖下蒂瓣,切除多余皮肤,使之形成不超过乳房下皱襞的斜形短切口,乳晕及周围的皮肤真皮层辐射状环缩缝合,缝合皮肤。结果:10例20只乳房,单侧乳房组织平均切除量为1 050g,最大2 200g。随访6~12个月,无乳头坏死、感觉良好,外形饱满。患者对乳房形态、对称性、乳晕大小形状、乳头乳晕感觉及切口瘢痕的满意率分别为100%。结论:环乳晕切口下蒂瓣的巨大乳房缩小整形术,组织切除量大,瘢痕短,并发症少,是一种较好的巨大乳房缩小术式。 相似文献
19.
Background This article provides an algorithm for achieving an aesthetically pleasing nipple–areola complex in cases of skin-sparing
mastectomy and immediate reconstruction
Methods If the contralateral nipple was big enough and the nipple-sharing technique could be used in the future for reconstruction,
we left a round skin paddle at the time of the skin-sparing mastectomy and immediate flap reconstruction. The diameter of
the round skin paddle was approximately the same as the contralateral areola. For nipple reconstruction we placed the graft
from the contralateral nipple in the middle of the aforementioned skin paddle. If the contralateral nipple was not sufficiently
large for use as a donor, then the C-V flap was used for nipple reconstruction. In these cases we deliberately left an oval
skin paddle when the skin-sparing mastectomy and immediate flap reconstruction were performed. The short diameter of the oval
skin paddle was approximately the same as the diameter of the contralateral areola. The position and the height of the C-V
flap were marked in order to transform the oval skin paddle to a round one when the donor site of the C-V flap was closed.
Results Following this algorithm an optical illusion of a nipple–areola complex that is similar to the contralateral normal one is
created.
Conclusion From our experience this algorithm can help create an aesthetically pleasing nipple–areola complex and also provides a ready
pattern to our tattoing experts for the dermatography of the nipple–areola complex. 相似文献
20.
Komorowski AL Zanini V Regolo L Carolei A Wysocki WM Costa A 《World journal of surgery》2006,30(8):1410-1413
Objective The objective was to analyze the frequency and factors influencing necrotic complication in female patients undergoing nipple-
and areola-sparing mastectomy.
Summary and background data Nipple- and areola-sparing mastectomy has recently been shown to yield satisfactory results in a carefully selected group
of breast cancer patients. The technique includes extensive undermining of the nipple–areola complex, which may result in
an increased rate of necrotic complications. We report our early experience with necrotic changes after nipple- and areola-sparing
mastectomy.
Methods The medical records of 38 patients undergoing nipple- and areola-sparing mastectomy were analyzed retrospectively.
Results Mean age of the patient was 44.5 years (range 26–65). Necrotic complications occurred in 15.8% of patients and included: skin
flap necrosis (1 case), partial nipple–areola complex necrosis (2 cases), and complete nipple–areola complex necrosis (3 cases).
Two cases of capsular contraction were also recorded. Statistical analysis showed age below 45 years to be associated with
a lower risk of necrotic complications (OR 4.51, P < 0.05).
Conclusions The nipple- and areola-sparing mastectomy, although resulting in a relatively high frequency of necrotic complications, is
a valuable surgical option for patients with small, peripheral tumors and for women undergoing prophylactic mastectomy. The
procedure seems to be safer for women under 45 years of age. 相似文献