The value of non-prefixed marking in reduction mammoplasty

The advantages of non-prefixed marking for breast reduction are discussed in this paper. The authors use a curved incision modification of the Pitanguy technique, stressing the value of changing the demarcation depending on the skin-gland relationship of each patient.     

Intraoperative pulmonary function dynamics in adolescents undergoing reduction mammoplasty: A prospective case series

BACKGROUND:

Improvement of lung function following reduction mammoplasty has been previously reported among adult populations in the medical literature.

OBJECTIVES:

To evaluate the intraoperative dynamics of pulmonary function in adolescents undergoing reduction mammoplasty.

METHODS:

The present study is a prospective case series of female patients 13 to 18 years of age who underwent inferior pedicle reduction mammoplasty between November 20, 2006 and April 4, 2011. Documented variables included patient baseline characteristics, operation duration, muscle relaxant use and total breast tissue removed. Intraoperative pulmonary function data documented included: tidal volume, respiratory rate, peak inspiratory pressure, positive end-expiratory pressure, oxygen saturation percentage and pulmonary compliance. Differences in pulmonary function data were calculated as ratio between final and initial intraoperative values.

RESULTS:

Twenty-six patients were included in the analysis. Mean (± SD) age was 16.9±1.1 years and mean body mass index was 28.9±6.1 kg/m². Mean operation time was 218±52 min, with average total bilateral breast tissue removal of 1810±1065 g. Improvement in lung compliance was observed in 24 patients (92.3%; P<0.0001). Mean intraoperative lung compliance improvement was 23.92% (95% CI 8.3% to 37%; P=0.001).

CONCLUSION:

Intraoperative improvement in lung compliance was observed in adolescent patients undergoing reduction mammoplasty.     

Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia

BACKGROUND: Bilateral reduction mammoplasty has been described as a surgical option for treatment of breast cancer in women with large, pendulous breasts. Using this technique can provide unique surgical oncologic challenges. METHODS: Retrospective chart review. RESULTS: Thirty-seven patients were identified. The average weight of tissue removed was 653 g. Tumor size ranged from 0.6 to 5.2 cm. One patient had microscopically positive surgical margins on final pathology. The tumor bed was not marked, and completion mastectomy was required. Two patients had unexpected malignancy in the contralateral breast. One patient required completion mastectomy for positive nonoriented margins. In another patient, tissue from the contralateral side was oriented, and mastectomy was avoided. CONCLUSIONS: Bilateral reduction mammoplasty with lumpectomy is an ideal option in women with macromastia. We recommend marking the tumor bed on the flaps and pedicle as well as orienting tissue removed from the contralateral side as maneuvers that will decrease need for completion mastectomy.     

Can reduction mammoplasty patients be promised a particular size postoperatively?

This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m² preoperatively and 29.3 kg/m² postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g.These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients’ satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results.     

Bilateral reduction mammoplasty following breast cancer: A case-control study

PURPOSE:

Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed.

METHODS:

A matched case-control study with patients serving as their own control (treated breast cancer breasts were ‘cases’, healthy breasts were ‘controls’) was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions.

RESULTS:

Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%).

CONCLUSIONS:

Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.     

Repairing errors of Nipple-areolar placement following reduction mammoplasty

Although the newer techniques for reduction mammoplasty generally give excellent results, some patients may develop recurrent ptosis as a result of greater tissue elasticity, or the breast may sag beneath the inframammary line, elevating the nipple. Proper preoperative evaluation and planning can help to prevent such results, and such advanced planning is even more necessary when repair is contemplated.     

环乳晕切口腺体瓣悬吊并沿等高线环缩缝合法乳房缩小成形术

目的 介绍经环乳晕切口采用乳腺瓣悬吊，并沿等高线呈梯级环缩缝合的乳房缩小成形术的方法和经验。方法 经乳晕周缘切口，在皮下脂肪组织和乳腺腺体之间广泛分离，形成“帐篷状”皮瓣和“圆椎形”乳腺腺体；在乳腺上部形成3cm宽纵向乳腺瓣，切除乳腺瓣内、外侧部分乳腺组织，将乳腺瓣上提折叠缝合固定(或切断后重叠缝合)以悬吊乳房；将“帐篷状”皮瓣和“圆椎形”乳腺腺体沿等高线环缩缝合，缝针交替穿经皮瓣和乳腺腺体，最后环乳晕间断缝合皮肤。结果采用此法矫治轻中度巨乳房、单纯乳房下垂共8例16侧，术后乳房外形美观，效果满意。结论本术式简便易行、瘢痕不明显，对轻中度巨乳及乳房下垂者可作为理想首选术式。     

The horizontal breast reduction: Surgical tips for maintaining projection

Reduction mammoplasty is one of the most common procedures performed by plastic surgeons in Canada. The Wise and vertical scar techniques are two of the most commonly published and performed. Although the horizontal breast reduction is a less commonly used technique, it offers added benefits over other procedures. These include elimination of the vertical scar and a consistently round nipple. However, one of the criticisms of the horizontal technique is the loss of projection of the breast mound. The present article outlines several important points that can aid in achieving an optimal aesthetic result when performing a horizontal breast reduction.     

缩小整形与保乳术相结合在乳腺癌伴巨乳症病人中的临床应用

目的：评估对乳腺癌伴巨乳症病人行双侧乳房缩小整形术与保乳手术的可行性。方法：我院对105例巨乳症病人作了缩小整形术，对其中9例同时患乳腺癌病人在保乳基础上同时行双侧乳房缩小整形术，中位随访时间为14．2个月。结果：平均年龄45岁，平均切下含肿瘤一侧乳房标本重量为561g，肿瘤大小0．5～3cm。其中1例因切缘阳性行乳房全切除。本组术后没有出现明显的并发症，病人随访显示满意率达87％。结论：对于希望行保乳术的乳腺癌伴巨乳症病人，双侧乳房缩小整形术是可行且安全的一种方法，将是对乳腺肿瘤外科的一种挑战。     

The management of incidental findings of reduction mammoplasty specimens

Reduction mammoplasty is one of the most commonly performed procedures in plastic surgery. Occasionally, there are findings reported by pathologists that are unfamiliar to the treating surgeon. The aim of the present study was to determine the types of pathologies encountered in reduction mammoplasty specimens. From this list of diagnoses, a best practice guideline for management will be organized to better assist plastic surgeons in the management of patients with incidental findings on pathology reports. A total of 441 pathology reports from patients who underwent bilateral or unilateral reduction mammoplasty in the past three years were identified. A list of 21 different pathologies was generated from the pathology reports, along with supplemental data from recent texts and articles. Occult carcinomas were encountered in two cases (0.45%) and high-risk lesions were found in three cases (0.68%) at the authors’ institution. An algorithm was then constructed to organize the pathologies according to risk of malignancy and assign them to a management guideline. There are many different lesions encountered incidentally in reduction mammoplasty specimens that may or may not confer some cancer risk. It is important for plastic surgeons to know which lesions need closer follow-up to provide the best care for their patients.     

中国妇女巨乳缩小整形术乳腺组织切除量的设计

目的：为使巨乳症患者的乳房经缩小整形术后，既恢复正常的外形，又能使其胸围符合人体美学的标准。研究一种较精确的计算乳房切除量的设计方法。方法：将胸围符合美学标准的女子的乳房相关体表测量指标、乳房总体积等有关数据，经GRAFTOOL软件进行处理与分析计算。结果：获得身高与胸围、胸围与乳房总体积的关系曲线及回归方程，并以此为依据，再结合患者的体形及主观期望，从而得出乳房组织切除量的设计方法。结论：经临床验证，该法计算准确，适用于各种体形的巨乳症患者。临床应用结果表明，只有按照术前科学的设计，切除适量的乳房组织，手术后方能重塑一个具有理想大小和形态的乳房。     

Differential diagnosis and management of giant fibroadenoma: Comparing excision with reduction mammoplasty incision and excision with inframammary incision

Abstract

Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12–46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12–18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28–46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6–24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.     

Meta-analysis of antibiotic prophylaxis in breast reduction surgery

BACKGROUND:

Breast reduction surgery is a very common procedure; however, there is still no consensus as to whether antibiotics should be used perioperatively.

OBJECTIVE:

To review the world literature and perform a meta-analysis of studies comparing wound infection rates with antibiotic use in breast reduction surgery.

METHODS:

A literature search was performed using the MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Database of Clinical Trials, Embase and CINAHL databases. Subject headings and relevant subheadings for “Breast”, “Breast Reduction”, “Reduction Mammaplasty”, “Mammaplasty” were combined with “Antibiotics” and “Antibacterial Agents”. The list of titles was assessed by the study’s authors and abstracts were reviewed. All relevant articles were then independently reviewed by the two primary authors, and Jadad scoring was used to assess the quality of the included articles.

RESULTS:

From the original search, three randomized controlled trials were included in the meta-analysis of preoperative antibiotics. The meta-analysis revealed a 75% reduction in wound infections with preoperative antibiotics (OR 0.25 [95% CI 0.09 to 0.72]). Because only one randomized controlled trial analyzed postoperative antibiotics, no meta-analysis could be performed.

CONCLUSIONS:

Preoperative antibiotics should routinely be used before breast reduction surgery. The use of postoperative antibiotics remains controversial. Additional randomized studies investigating postoperative antibiotics are needed.     

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.     

Incidence of abnormal mammograms after reduction mammoplasty: implications for oncoplastic closure

Background

Reduction mammoplasty requires significant tissue dissection, which may impact the interpretation of future mammograms used in breast cancer surveillance. The aim of this study was to define the incidence of abnormal mammography after reduction mammoplasty and to assess the impact of substantial tissue remodeling on interpreting mammography.

Methods

We conducted a single-center retrospective case-control study examining results of postoperative mammography after reduction mammoplasty over a 5-year period.

Results

Between 2001 and 2005, 87 patients underwent breast reduction and had available postoperative mammography. A control group of 30 patients were identified who underwent consultation for breast reduction but did not have surgery. The median time to postoperative mammography was 52 weeks. The incidence of abnormal first postoperative mammogram (Breast Imaging-Reporting and Data System [BIRADS] 0, 3–6) was not significantly different between reduction mammoplasty patients and controls (n = 23, 26% vs 8, 27%, respectively, P = 1.00). Age, postoperative complications, tissue pathology, history of previous breast biopsy, and abnormal preoperative mammography did not significantly predict abnormal postoperative mammogram. Postoperative mammography led to additional imaging in 20 patients (23%) and breast biopsy in 1 patient (1.1%).

Conclusions

Despite the substantial tissue mobilization performed during reduction mammoplasty, postoperative screening mammography does not lead to significantly more imaging or diagnostic interventions when compared with nonoperative controls. This small case-control study suggests that oncoplastic closure techniques should not adversely impact subsequent mammography.     

Effects of prior augmentation and reduction mammoplasty to sentinel node lymphatic mapping in breast cancer

Previous plastic surgery procedures such as breast augmentation or reduction mammoplasty can potentially alter the lymphatic drainage of the breast. The purpose of this study is to determine the success rates of sentinel node lymphatic mapping in patients with previous plastic surgical procedures of the breast. A total of 83 patients with a history of plastic surgery of the breast that underwent subsequent sentinel node mapping between 1996 and 2008 were retrospectively analyzed. Eight-three patients that underwent a total of 108 sentinel node biopsies. Hundred cases (93%) previously underwent breast augmentation and eight cases (7%) previously underwent reduction mammoplasty. The mean time between the previous plastic surgical procedures and the sentinel node biopsy was 10.3 years (range: 2 months-32 years). Indications for the mapping procedure were invasive cancer (n = 64), ductal carcinoma in situ (n = 17), and prophylactic mastectomy (n = 27). The identification rate of the sentinel node was 95.3% (103/108). The success rate based on type of procedure was 96% (96/100) for augmentation and 87.5% (7/8) for reduction mammoplasty. With a mean follow-up of 3.4 years, there has been only one local axillary recurrence that occurred at the time of an ipsilateral breast recurrence following lumpectomy. Lymphatic mapping can be successfully performed in patients who have previously undergone plastic surgery operations.     

下蒂瓣法乳房缩小整形术的效果

目的:探讨下蒂瓣法乳房缩小整形术治疗中重度乳房肥大症的方法及效果。方法:2010年1月至2019年12月,南京医科大学附属妇产医院整形外科对19例女性患者(年龄18~54岁,平均36.2岁)38侧肥大乳房,以Robbins的垂直下蒂瓣术式为基础,结合乳房血供、神经等解剖学进展,进行乳晕设计、下蒂瓣位置等改进。结果:19...