Autoaugmentation Mastopexy with an Inferior-Based Pedicle

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.     

A型肉毒素肌注胸大肌对硅凝胶假体隆乳术形态影响的临床研究

目的:本研究旨在探讨A型肉毒素对假体隆乳病人术后乳房形态变化的影响。方法:40例小乳症患者行硅胶囊乳房假体隆乳术。试验组术中在胸大肌中下段注射A型肉毒素,对照组直接行隆乳术,术后两组采取照片测量进行形态评估。结果:在整体乳房形态上,试验组术后3个月大部分乳房乳头位置基本位于乳房中部,术后6个月可稍上移,幅度不大,对照组于术后3月乳头位置基本固定,大部分乳房乳头位置集中于乳房分区中部靠下,P<0.05。结论:A型肉毒素在早期可以使乳房形状更自然。     

Inferior Pedicle Autoaugmentation Mastopexy After Breast Implant Removal

Background  

A new method of autoaugmentation mammaplasty is presented to correct ptosis and to increase the projection and volume of the breast in patients who would like a reposition augmentation mammaplasty after breast implant removal but do not want a new implant.     

A False-Positive Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) Imaging Result for a Patient After Augmentation Mammaplasty

Background  Various materials and methods have been used for augmentation mammaplasty since it was first performed in Japan in the late 1940s. Although augmentation mammaplasty is not associated with an increased risk of breast cancer, a number of studies have reported that breast implants, or subsequent changes around these foreign substances, can affect images made by mammography, CT, or MRI during breast cancer screening. A method that is increasingly being used to detect cancer is positron emission tomography (PET). Methods  To determine the effect of augmentation mammaplasty on PET imaging, we subjected ten women who had previously undergone augmentation mammaplasty to PET imaging as well as other imaging methods. We also measured tumor markers and performed pathologic studies. Results  The histologic analyses failed to detect any cases of malignancy. We assess the efficacy of PET for detecting breast cancer in women who had undergone augmentation mammaplasty and describe the features of the PET images of these women. Finally, we discuss future research objectives in relation to PET-based screening for breast cancer. Conclusion  It is important to identify an imaging methodology that improves the detection of breast cancer in patients with a previous mammaplasty. We show here that FDG-PET may improve breast cancer detection after mammaplasty.     

Correction of Capsular Contracture by Insertion of a Breast Prosthesis Anterior to the Original Capsule and Preservation of the Contracted Capsule: Technique and Outcomes

Background  

This study aimed to explore the treatment of capsular contracture after augmentation mammaplasty by insertion of a breast prosthesis anterior to the original capsule.     

Measurements of Breasts of Young West African Females: A Guideline in Anatomical Landmarks for Adolescent Breast Surgery

Background  

There have been few studies to develop standardized methods of measuring female breasts’ shapes in clinical settings in West Africa. The objective of this study was to determine the clinical variation in breast measurements among a large group of adolescent female subjects, with the goal of providing guideline metrics to surgeons performing reduction mammaplasty and mastopexy on patients desiring a more adolescent shape and nipple position.     

Dynamic Breasts: A Common Complication Following Partial Submuscular Augmentation and its Correction Using the Muscle-Splitting Biplane Technique

Background  Dynamic breast deformity following partial submuscular augmentation is not uncommon. The complication is due primarily to the release of the pectoralis and the true incidence of this complication is not known. The submuscular biplane pocket is a new pocket and is used to correct dynamic breasts following augmentation mammaplasty in the partial submuscular plane. Methods  After the first submuscular biplane muscle-splitting augmentation mammaplasty in October 2005, the author has performed 58 secondary augmentation mammaplasties for various reasons. Of these, nine patients showed marked dynamic breast deformity following partial submuscular augmentation and the submuscular muscle-splitting biplane was used to correct this complication. Results  Good to excellent results were achieved in all patients with complete elimination of the dynamic breast deformity. Conclusion  The submuscular biplane is a new and versatile pocket and is used to correct dynamic breast deformity seen following partial submuscular augmentation mammaplasty.     

Customized Planning of Augmentation Mammaplasty with Silicon Implants Using Three-Dimensional Optical Body Scans and Biomechanical Modeling of Soft Tissue Outcome

The aesthetic results of augmentation mammaplasty are essentially determined by the size and the shape of the implant as well as its position on the chest. To achieve successful aesthetic results, customized surgery planning based on a reliable visual concept of the prospective surgery outcome and quantitative methods for assessment of three-dimensional (3D) breast shape could be of considerable additional value. This report evaluates a novel method for customized planning and quantitative optimization of breast augmentation based on 3D optical body scanning of the patient’s breast and computational modeling of soft tissue mechanics. This method allows a 3D photo-realistic appearance of postsurgery breasts to be simulated for different surgical scenarios. It also allows the result of a virtual simulation to be implemented using measurements derived from a computationally predicted breast model. A series of clinical studies are presented that demonstrate the feasibility and accuracy of the proposed approach for customized 3D planning of breast augmentation, including direct comparison between simulated and postsurgery results. Our experimental results show that for 89% of the breast surface, the average difference between the simulated and postsurgery breast models amounts to less than 1 mm. The presented method for customized planning of augmentation mammaplasty enables realistic prediction and quantitative optimization of postsurgery breast appearance. Based on individual 3D data and physical modeling, the described approach enables more accurate and reliable predictions of surgery outcomes than conventionally used photos of prior patients, drawings, or ad hoc data manipulation. Moreover, it provides precise quantitative data for bridging the gap between virtual simulation and real surgery.     

The use of a combined technique in reduction mammaplasty (inferior pyramidal and superior glandular techniques)

The management of mammary hypertrophy is a developing process. The common surgical options for reduction mammaplasty include amputation with free nipple graft as well as the bipedicled, inferior pedicle and vertical pedicle techniques. All techniques are used widely. Disadvantages of these procedures include nipple areola necrosis, insensitivity, hypopigmentation, and poor breast projection. Even with the standard modifications of the original techniques, the resultant breast and nipple may be wide and flat. The purpose of this study was to assess whether combined inferior pyramidal pedicle and superior glandular pedicle reduction mammaplasty can optimize nipple and breast projection. Attention will focus on the viability and sensation of the nipple areola complex. Nine patients with mammary hypertrophy were studied. The change in nipple position ranged from 7 to 13 cm. The amount of tissue removed from each breast ranged from 500 to 1150 g. Nipple/areola sensation was retained in all cases with the exception of one breast. Nipple/areola necrosis or hypopigmentation were not observed. Optimal central breast projection was maintained in all patients, and postoperative evaluation was carried out at 12 and 22 months. The patient satisfaction was very high.     

Areola-Nipple Perception Threshold to Faradic Electricity: A New Measure of Sensibility of the Breasts

Background  We describe a new method to study the sensibility of the nipple-areola complex of the breast with faradic electricity delivered through an electromyographic device used to monitor peripheral nerve conduction. Methods  The objective results of faradic pulses (2–50 mA per pulse) delivered to the nipple-areola complex of the breast through a Nihon-Kohden II machine (Evoked potential/Electromyographs, Nihon-Kohden Co., Japan) were evaluated in normal volunteers to get a basal measure that was defined by the patient as “a soft electric discharge.” The measures were recorded and their output discharges averaged (at least 5 to each complex). Results  Twenty-eight volunteers with normal breasts, 28 patients with breast hypertrophy before and after breast reduction, and 28 patients before and after breast augmentation were studied. The faradic pulses were perceived from 1.5 to 3.5 mA in the areola and from 3 to 5.5 mA in the nipple in the control group and from 4.5 to 7.0 mA in the areola and from 6.5 to 9.5 mA in the nipple in the breast hypertrophy group with no significant changes before and after surgery. In the breast augmentation group the faradic pulses were very similar to the volunteers that had normal breasts, but 13 months after breast augmentation with silicone gel prosthesis, a difference was found because all the patients had a higher threshold and three cases had lost sensibility of the nipple-areola complex. Conclusion  In normal breasts the areola had a lower threshold for faradic pulses compared to the nipple. Hypertrophic breasts had a higher threshold to the faradic stimulation than normal subjects in the pre- and postoperative period. Hypoplastic breasts before breast augmentation had a perception threshold similar to that of the normal volunteers but after breast augmentation this perception was much higher. This study received the Scientific Exhibit Award at the ASAPS/ASERF Annual Meeting in Vancouver, British Columbia, Canada, 2005.     

Breast Augmentation in Asymmetrically Placed Nipple-Areola Complex in the Horizontal Axis: Lateralisation of Implant Pocket to Offset Lateralised Nipples

Background  Nipple-areola complex (NAC) lateralisation in the horizontal axis is understudied with respect to its potential effects on the outcome of augmentation mammoplasty. An implant pocket dissected slightly laterally on the affected side offsets the lateralised nipple and improves the quality of breast enhancement in the lateral quadrant with an aesthetically positioned NAC. It also prevents the appearance of medially malplaced implants. Methods  Medial and lateral halves of breasts were measured in 312 mammaplasties performed by the author in 2007; of these, 39 (12%) had NAC asymmetrically positioned in the horizontal plane, 29 (9%) were right lateralised, 4 (1.2%) left lateralised, 5 (1.5%) bilaterally lateralised, and 1 (0.3%) was bilaterally medialised. In the more common right-lateralised group (n = 25), the mean medial half measurement was 8.76 ± 1.22 cm compared with 8.96 cm in the control group (n = 170), with no statistical significance (P = 0.45). However, the lateral half measurement in the lateralised nipple group (n = 25) was 9.06 ± 1.53 cm compared with 9.7 ± 1.67 cm in the control group (n = 169) and it showed a borderline significant value (P = 0.06). On the affected side, the medial boundary of the breast pocket is marked 0.25–0.5 cm further away from the routine 2.5-cm intermammary distance with the goal of offsetting the lateralised NAC and to improve its visual aesthetic position on the breast. Results and Conclusion  Lateralisation of the breast pocket in a breast with a lateralised nipple improves the aesthetic position of the NAC. In compensated augmentation mammaplasties, lateral quadrant enhancement of the breast is aesthetically superior to uncompensated cases and prevents the appearance of medially malplaced implants. The intermammary distance in compensated cases was acceptable without any compromise to the aesthetic outcome. Presented as a poster presentation at the Sixth Croatian Congress of Plastic, Reconstructive and Aesthetic Surgery with International Participation, Split, Croatia, 1–5 October 2008, and as an invited lecture at the International Master Course on Ageing Skin (IMCAS), Agra, India, 1–2 December, 2008.     

Breast and chest asymmetries: classification and relative distribution of common asymmetries in patients requesting augmentation mammoplasty

Asymmetries of the breast and chest wall are common but a comprehensive classification of these asymmetries and their relative distribution is lacking in the literature. These asymmetries can be primarily due to breast size and shape or nipple areolar complex size or level discrepancy respectively. Breast asymmetries may also arise secondarily due to abnormalities of the underlying bony or soft tissues. A prospective recording of 312 augmentation mammoplasties performed by the author, from January to December 2007, were reviewed to assess breast and chest wall deformities together with an incidence and their relative distribution. From January to December 2007, 312 augmentation mammoplasties were performed. Mean age of the patients was 30.4 ± 9.1 years (range 18–58). Mean size of the implant was 325 ± 53 cm³ (range 200–620). Different size implants were used in 9% patients with a mean difference of 56.3 ± 33.7 cm³ (range 20–180). Patients were assessed for asymmetry of breast, chest, distance between jugular notch to nipple areolar complex and nipple areolar complex to inframammary crease. Breast Volume Asymmetries: Breasts were symmetrical in 53.5% (n = 167). Left breast was larger in 29.8% (n = 93) as compared to 16.7% (n = 52) on the right, and the difference was significant (P value < 0.001). Chest Wall Asymmetries: Chest wall was symmetrical in 89.7% (n = 280) and thoracic deformities or asymmetries were seen in 8.6% (n = 27). Chest wall and ribs were more prominent on the left side in 6.7% (n = 21) as compared to 1.9% (n = 6) on the right, and the difference was significant (P value < 0.003) Pectus excavatum and carinatum was seen in 0.6% (n = 2) and 1% (n = 3), respectively. Jugular Notch to Nipple Areolar Complex Distance Differences: Jugular notch to nipple areolar complex (NAC) distance was same on two sides in 67.2% with a mean distance of 19.7 cm (n = 207). In group (21.4%) with the left breast NAC lower (n = 66) the mean left NAC was 20.7 cm when compared to 19.04 cm on right. In group (11.2%) with right NAC lower than the left (n = 35), the mean NAC on the right was 21.2 cm as compared to 20.4 cm on the left. The left breast NAC (n = 66) was measured almost twice as low as the right (n = 35), and the difference between the two groups was significant (p value < 0.001). Nipple Areolar Complex to Inframammary Crease Distance Differences: Nipple to inframammary crease (IMC) distance was similar in 77.1% of patients with a mean of 6.69 cm. The group (n = 40) with higher measured distance on the left (13.1%), left mean nipple to IMC crease distance was 6.9 cm as compared to 6.17 cm on the right. The group (n = 30) with a higher measured nipple to IMC distance on the right (9.8%), the mean distance on the right was 7.12 cm as compared to 6.52 cm on the left. Though the incidence of the measured nipple to IMC distance was more common on the left (n = 40) than to the right (30), the difference between the two groups was without any statistical difference (p value = 0.2). A tuberous breast were seen in 3.9% (n = 12). Breast and chest wall asymmetries are common and majority of hyperplasias is seen on the left side. The majority of these patients may not require additional surgical manipulation or intervention however proper documentation is essential.     

Maximizing the use of precapsular space and the choice of implant type in breast augmentation mammaplasty revisions: review of 49 consecutive procedures and patient satisfaction assessment

Background  

Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction.     

Correlation Between Scoliosis and Breast Asymmetries in Women Undergoing Augmentation Mammaplasty

Background  

Breast asymmetries and scoliosis influence the results of augmentation mammaplasty. Although a variety of methods have been proposed to resolve breast asymmetries, to date, no simple preoperative algorithm has been proposed for predicting the breast volume and decreasing breast asymmetries in the place of subjective or expensive evaluation. The relationship between the scoliosis and breast volume asymmetry was further analyzed statistically in this study.     

应用三维扫描技术测量分析假体隆乳术后乳房形态变化的研究

目的 应用三维扫描技术准确客观地测量并分析隆乳术后乳房三维形态的变化。方法 双侧隆乳者18例（36只乳房）,均为圆形硅凝胶假体,采用胸肌下平面置入。假体体积平均为232．2ml,高度平均为3．46cm,其中低突型12只（h〈3．0cm）,中突型16只（3．0≤h＜4．0cm）,高突型8只（h≥4．0cm）。应用三维扫描仪采集术前及手术后1个月后的乳房三维图像,并用Geomagicl0．0软件测量乳房体积、突度、对称性等参数。结果 获得隆乳前后36只乳房的体积、突度等参数。术后乳房增加的体积与假体体积基本相当（P〉0．05）,乳房突度的增加值小于假体高度,术后乳房突度比预期突度（术前突度＋假体高度）减少12．9％,其中低型、中突型、高突型分别为5．2％、15．1％、20．2％。结论 三维扫描技术能在临床上简便、快捷、准确、非接触性地测量乳房的三维形态,为术前设计及术后评估提供科学性的指导,是理想的乳房形态测量工具。     

Adjustment of the contralateral breast following breast reconstruction

Surgery on the contralateral breast was performed in 64 of 100 patients for adjustment of size and shape or for diagnostic purposes. The patients found it more desirable to adjust size than shape asymmetry on the contralateral breast. There was only one early complication and six late ones. The former was a postoperative hematoma after a reduction mammaplasty. The latter were three cases of capsular contractures after augmentation mammaplasties. In these cases the implant was placed in a submuscular position. In three cases, patients asked for a secondary reduction mammaplasty because of poor symmetry. There were some difficulties in comparing pre- and postoperative mammography after augmentation mammaplasty. In the other adjustment procedures, there were only minor difficulties in a few cases comparing pre- and postoperative mammography. Patients with a high risk of bilateral breast cancer needing size and/or shape symmetry correction should be considered for mastectomy and immediate reconstruction.     

A new technique of reduction mammaplasty: dermis suspension and elimination of medial scars.

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.     

The Graf/Biggs Flap to Increase Upper Pole Projection in Breast Reductions with Free Nipple Grafts

Background  

Macromastia necessitating breast reduction with free nipple grafts often results in a breast shape that lacks upper pole projection. This study aimed to describe and review the experience with use of the Graf/Biggs flap to improve upper pole fullness in patients requiring breast reductions with free nipple grafts.     

Giant fibroadenoma of one breast: Immediate bilateral reconstruction.

A rare case of giant fibroadenoma of the left breast is presented. We performed a nipple sparing subcutaneous mastectomy of the left breast. Since the patient desired larger breasts, a contralateral augmentation mammaplasty was carried out in a single stage operation. A satisfactory result was achieved.