Breastfeeding After Reduction Mammaplasty Using Different Techniques

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.     

Vertical Mammaplasty for Gigantomastia

A 48-year-old female patient presented with gigantomastia. The sternal notch-nipple distance was 55 cm for the right breast and 50 cm for the left. Vertical mammaplasty based on the superior pedicle was performed. The resected tissue weighed 3400 g for the right breast and 2800 g for the left breast. The outcome was excellent with respect to symmetry, shape, size, residual scars, and sensitivity of the nipple-areola complex. Longer pedicles or larger resections were not found in the literature on vertical mammaplasty applications. In our opinion, by using the vertical mammaplasty technique in gigantomastia it is possible to achieve a well-projecting shape and preserve NAC sensitivity.     

Long-Lasting Evolution of Ptosis Control After Reduction Mammaplasty Using the Hammock Technique

Background The hammock technique combines inferior pedicle mammaplasty with retropectoral and inferior suspensions to prevent displacement of breast tissue toward the inferior mammarian pole. This study aimed to assess the long-lasting internal suspension with the author’s mammary reduction technique. Methods From 1987 to 2005, the hammock technique was performed for 623 breast reduction patients (1,201 breasts), including 318 women (636 breasts) who underwent the technique between 1994 and 2005. From the latter group, the author retrospectively reviewed the case histories of 281 patients who had come for long-term follow-up evaluation. All had significant ptosis associated with breast hypertrophy. Preoperative and postoperative examinations included evaluation of postoperative bottoming out by monitoring of three measurements: the sternal notch-to-nipple length, the inferior areolar border-to-inframammary fold length, and the distance between the inframmary fold and the projection of the lowest breast contour on the chest wall. Results The evaluation data on postoperative ptosis are derived from a control study at 30 months, 5 years, and 7 years or more for 281 women (562 breasts) of the 318 who underwent surgery using this technique over the 11-year period. Review after 2.5 to 7 years or more shows that inferior areolar border-inframammary fold distance increases no more than 10 mm. Conclusions The hammock technique suspension achieves true permanent breast lifting through dermis strips from the inferior pedicle itself. This procedure also gives predictable results, a low morbidity rate, and good breast shape.     

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。     

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。     

竖直切口内上蒂巨乳缩小术的临床应用

目的 根据巨乳缩小术的手术原则,探讨一种既能保证乳房血供和功能,又能保持良好乳房外观的手术方式,并观察其临床疗效.方法 本组共10例乳房肥大症患者,采用竖直切口结合内上蒂法行乳房缩小术.根据术前设计,去除内上蒂表皮,形成腺体蒂,再切除外下象限多余的皮肤及腺体,重塑乳房形态.结果 术后无皮肤坏死、脂肪液化、乳头乳晕感觉减退、血肿和感染等并发症发生,切口均Ⅰ期愈合.术后随访3～12个月,患者对术后乳房外观形态及功能均表示满意,能接受术后瘢痕.结论 竖直切口内上蒂巨乳缩小术操作简单、安全,对轻、中度,特别是中度乳房肥大患者特别适用,术后和远期均能达到满意疗效.     

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。     

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。     

Axillary Reduction Mammaplasty—Yhelda Felício's Technique

The problem most common to the majority of mammary reductions is patient dissatisfaction due to breast scarring or lateralization of the breast. Many of these complications can be avoided by use of an axillary approach for correction of breast ptosis via the axillary skin incisions.     

A New Application for Increasing Breast Projection in Free-Nipple-Graft Reduction Mammaplasty

BACKGROUND: Free-nipple-graft reduction mammaplasty is the procedure of choice in patients with massive breast hypertrophy. Breasts that have undergone free-nipple-graft reduction mammaplasty usually cannot maintain projection. Many modifications of free-nipple-graft reduction mammaplasty have been described to treatment this problem. We describe our modification of the free-nipple-graft reduction mammaplasty. METHODS: The technique includes two key points: The first is the fold of the midportions of the breast. The second is suturing the midportion of the breast to the fascia of the pectoral muscle. The fold increases breast projection and the suturing helps to obtain long-lasting breast projection. RESULTS: A total of 16 patients underwent free-nipple-graft reduction with the modified technique between 2003 and 2008. Mean follow-up was 21 months (range = 3-60 months). An average of 2016 g of tissue per breast was excised (range = 1250-2700 g per breast). An average of 4031 g of tissue per patient was excised. All patients had long-lasting, pronounced breast mound projection. Satisfactory breast projection was maintained. No "bottoming out" was seen. The level of satisfaction felt by all patients was very high. CONCLUSION: Long-term projection can be maintained by suturing the half-trianges to each other and to the fascia of the pectoral muscle. One more useful alternative technique for increasing projection in free-nipple-graft reduction has been added with the technique presented.     

Refinements of Vertical Scar Mammaplasty: Circumvertical Skin Excision Design With Limited Inferior Pole Subdermal Undermining and Liposculpture of the Inframammary Crease

Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skepticism, vertical reduction mammaplasty is becoming increasingly popular in recent years because it best incorporates the two concepts of minimal scarring and a satisfactory breast shape. At the moment, vertical scar techniques seem to be more popular in Europe than in the United States. A recent survey, however, has demonstrated that even in the United States, it has surpassed the rate of inverted T-scar breast reductions. The technique, however, is not without major drawbacks, such as long vertical scars extending below the inframammary crease and excessive skin gathering and “dog-ear” at the lower end of the scar that may require long periods for resolution, causing extreme distress to patients and surgeons alike. Efforts are being made to minimize these complications and make the procedure more user-friendly either by modifying it or by replacing it with an alternative that retains the same advantages. Although conceptually opposed to the standard vertical design, the circumvertical modification probably is the most important maneuver for shortening vertical scars. Residual dog-ears often are excised, resulting in a short transverse scar (inverted T- or L-scar). The authors describe limited subdermal undermining of the skin at the inferior edge of the vertical incisions with liposculpture of the inframammary crease, avoiding scar extension altogether. Simplified circumvertical drawing that uses the familiar Wise pattern also is described.     

喉罩用于隆胸手术患者气道管理的效果

[摘要]目的观察喉罩通气全凭静脉麻醉用于隆胸术的临床效果。方法选择ASAI～Ⅱ级女性隆胸手术患者40例,年龄23—42岁;体重45—67kg;随机分为气管内插管组（A组,n=20）与喉罩组（B组,n=20）两组,A组静脉注射芬太尼0．2mg、丙泊酚2．0—2．5mg／kg、阿曲库铵0．15mg／kg诱导,插入气管导管;B组静脉注射芬太尼0．1mg、丙泊酚2．0～2．5mg／kg诱导,插入普通型喉罩,两组均接麻醉机行IPPV模式控制呼吸,两组均以微量泵持续泵入丙泊酚6～9tLg／（kg·min）,瑞芬太尼0．1—0．15μg/（kg·min）维持麻醉,A组间断静脉注射阿曲库铵,手术结束前10min停止用药,待受术者呼之能应,呼吸良好时拔除气管导管或喉罩。观察记录两组患者气管内插管和喉罩置入时间及置人情况、监测病人麻醉前（11D）、插管（插喉罩）后即刻（T1）、分离胸部肌肉时（他）、植入假体时（T3）、喉罩和气管导管拔除后即刻（T4）时的MAP、HR及SpO：的变化、通气状态以及操作时及术后的相关不良反应。结果A组1次成功完成气管内插管率与B组1次成功置入喉罩率无显著性差异（P〉0．05）;A组诱导时芬太尼用量显著多于B组（P〈0．05）;A组气管内插管后即刻（T1）以及拔管后即刻（rr4）的MAP及HR较诱导前显著升高（P〈0．05）,分离胸部肌肉时（T2）与植入假体时（T3）SBP、DBP、MAP和HR值均低于麻醉前,而B组T1、T2、T3时均较诱导前低（P〈0．05）;T4与诱导前相比无明显差异（P〉0．05）。A组插管时发生口腔粘膜出血及术后发生咽喉疼痛及呛咳的患者明显多于B组（P〈0．05）。结论与气管内插管全麻相比,喉罩通气全凭静脉麻醉施行隆胸手术,麻醉效果更满意、循环更稳定、并发症更少,术后恢复更舒适。     

Bilateral Reduction Mammaplasty for Immediate Breast Conservation Surgery Reconstruction and Intraoperative Radiotherapy: A Preliminary Report

Background Breast conservation surgery and postoperative radiotherapy are widely accepted as the treatment of choice for patients with early breast cancer. Despite its oncologic benefits, the radiotherapy may cause unpredictable outcomes in soft tissues, especially in patients undergoing breast reconstruction. Described recently, intraoperative irradiation (IORT) has been indicated for selected patients as an alternative to radiotherapy with fewer adverse local effects. Clinical use of reduction mammaplasty (RM) techniques in oncologic breast surgery has been described previously. However, no previous studies have mentioned its application after breast conservation surgery and IORT. Methods The authors used RM to reconstruct a partial breast tissue defect secondary to breast conservation surgery followed by IORT treatment in a 46-year-old patient with an 11-mm invasive ductal carcinoma between the superior internal quadrants of the right breast. Results Satisfactory breast volume and shape were achieved, and no immediate or late complications were observed. After 2 postoperative years, no evidence of fat necrosis, tumor recurrence, or tissue volume loss was observed. Conclusion The initial data indicate that RM in the setting of breast conservation surgery reconstruction and IORT is feasible. With appropriate patient selection, respecting indications and limitations, RM has its place among the various reconstructive techniques. Additional studies with larger clinical series and longer follow-up periods are necessary to analyze the precise IORT effects in patients submitted to immediate breast conservation surgery reconstruction.     

Patient satisfaction following augmentation mammaplasty with the gel prosthesis

No evaluation of patient responses to augmentation mammaplasty has been published in the medical literature. This has left the area open for opinion and speculation by both physicians and laity.All patients undergoing pure augmentation mammaplasty during 1976 were sought in four plastic surgery practices using gel prostheses in the Southwest. Responses were obtained from 159 of the 221 patients (72%). Some degree of firmness of one or both breasts was reported by 64% of the patients who responded. External capsulotomy was effective in only 1 patient in 5. Shape distortion because of capsular contracture was reported by 10% of patients. Change in nipple sensation was reported by 42% of patients; 9% found it bothersome. There was no difference statistically between the inframammary and periareolar approach. Improved self-image was reported by 91% of patients. Fifty-five percent reported a positive effect on their sexual lives. Only 3% had a negative effect.Although 91% of patients expressed satisfaction with their operations, an even greater number (97%) would have the operation again. This is a striking affirmation of this cosmetic operation as performed by board-certified plastic surgeons. Obviously, the benefits of augmentation mammaplasty outweigh any unfavorable results.     

Vertical Mammaplasty Marking Using the Key Hole Pattern

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.     

横双蒂加中央蒂真皮帽乳房缩小成形术

目的　介绍横双蒂加中央蒂真皮帽乳房缩小成形术的方法,并探讨其疗效。　方法　对8例(16只)乳房肥大病人施行手术治疗, 采用以乳头为中心的中央蒂真皮帽乳房缩小成形术, 设计双同心圆切口, 保留第4肋间神经径路乳腺组织的完整性, 切除多余乳腺组织, 环形切口缩拢缝合。结果　本组单侧切除组织量平均为(310±150)g,术后第2d查乳头乳晕感觉良好,反射存在,乳头乳晕无坏死,除1例伤口裂开行2期缝合外,余均无感染、血肿等并发症。随访6 (3 ~9)个月,外形满意,切口瘢痕不明显。　结论　横双蒂加中央蒂真皮帽乳房缩小成形术设计合理,形态好,可确保乳头乳晕的感觉及功能。