Mammographic findings following reduction mammoplasty

Breast reduction mammoplasty is becoming an increasingly common procedure. A baseline mammogram is recommended after 35 years of age as the most effective method for detection of small breast cancers. A prospective study was conducted for the evaluation of the mammographic findings after reduction mammoplasty. During the last 7 years, 113 patients over 35 years of age underwent bilateral reduction mammoplasty. All patients had a preoperative mammogram. A new mammogram was obtained at 6 and 18 months after the procedure. All films were reviewed by the same two radiologists. Breast reduction was performed with the vertical bipedicle flap technique (McKissock) and the inferior pedicle technique. There were no apparent differences in the findings between the two methods. Most common findings were parenchymal redistribution in 102 (90.2%) and elevation of the nipple in 96 (84.9%), produced by a shift of the breast tissue to a lower position. Calcifications were seen in 29 (25.6%), and ``oil cysts' in 22 (19.4%), caused by localized fat necrosis. A retroareolar fibrotic band was found in 23 (20.3%), from the transposed flap. Areolar thickening was observed in six (5.3%), and skin thickening in only two (1.7%), from scar tissue. Mammographic findings after reduction mammoplasty are predictable, thus preventing unnecessary biopsies and making the diagnosis of lesions unrelated to the procedure easier. All patients over 35 years of age should have a preoperative and a postoperative mammogram for future reference.     

Short Scar Mastopexy with Flap Transposition

A personalized technique using a vertical scar mastopexy is described. The breast tissue is utilized as a transposition flap behind the nipple–areolar complex to increase its projection. The inferior pole of the breast can be developed either as a superiorly pedicled or inferiorly pedicled flap for that purpose and the indication for each version is described. The technique has been successfully utilized in 80 patients with pleasing results. Illustrative cases are presented.     

Mammoplasty: Breast Fixation with Dermoglandular Mono Upper Pedicle Flap Under the Pectoralis Muscle

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.     

突发性青春期巨乳症的诊断和治疗(附4例报告)

目的 探讨突发性青春期巨乳症的命名,诊断和巨大乳房缩小手术的治疗方法.方法 对4例突发性青春期巨乳症,用改良垂直双蒂进行缩小手术.结果 4例患者术后乳头、乳晕及两侧皮瓣血运良好,术区一期愈合,效果满意.结论 突发性青春期巨乳症,手术治疗是最佳选择,因乳房巨大,为保证其乳头、乳晕血运及术后外形,采用改良垂直双蒂法乳房缩小是较好的手术方法.     

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple

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.     

Breast reconstruction with perforator-based inframammary de-epithelized flap: a case report

Patients with silicon gel-injected breasts sometimes appear even now, demanding removal of this foreign body. These requests are often challenging for us—the removal leaves distortion of the breast contour. Musclocutaneous flap transfer is a good method for reconstruction, but scar formation for flap harvest is a problem. Most patients are reluctant to accept these scars. Reconstruction with prostheses has been another method. But the absence of subcutaneous tissue and degenerated muscle make implantation difficult. For one of these patients, the authors applied a method for breast reconstruction with perforator-based inframammary flap. After the removal of the siliconoma with surrounding degenerated tissues, a crescent-shaped skin flap was designed on the inframammary area. Preserving perforators into the flap, it was elevated with adipose tissue. After the skin was de-epthelized, the adipose tissue and skin flap were turned over to make the breast protrusion. The donor site is closed primarily. Ten months after the operation, there was little atrophy of the reconstructed breast, and the patient is satisfied with the result, especially with the softness of the reconstructed breast. Although this method has limitation for volume, less morbidity for donor site and volume reduction in inframammary area are advantageous. In conclusion, this inframammary flap seems to be a good tool for breast surgery.     

Modification of Vertical Scar in Vertical Mammaplasty Technique

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.     

Mammaplasty with a Periareolar Dermal Cloak for Glandular Support

Analyzing the main surgical element of mammaplasty, almost all procedures incorporate a smaller or bigger dermal flap. The periareolar dermal cloak is a dermis flap corresponding to the skin pattern and pedicled to the nipple areola. The shape of the flap can be tailored as required but 2 cm of the dermis flap around the nipple should not be touched. The periareolar dermal flap has been used as a cloak; this dermal cloak is suitable for positioning the nipple and covering a part of the glandular tissues with support. With fastening of the cloak, a better tone of the breast tissues can be achieved. Mastopexy, reduction mammaplasty presented by technical detail of dermal cloak positioning and glandular support, has been done in 178 breast operations since 1992. The dermal cloak technique was used in 114 cases. The technique, clinical results, advantages, disadvantages, and complications are discussed.     

A New Technique for Levator Lengthening to Treat Upper Eyelid Retraction: The Orbital Septal Flap

Correction of upper eyelid retraction can be achieved by numerous techniques. We have developed a new flap, the orbital septal flap, to interpose between the recessed levator complex and the tarsus to correct the retracted upper eyelid of a young girl. The orbital septum is a facial structure; it is readily available and easy to dissect. The flap acts like a vascularited spacer without the problem of resorption; normal anatomical continuity of the levator mechanism can be functionally restored. We believe the orbital septal flap is a promising technique for correcting upper eyelid retraction; however, more case studies are needed.     

Dermal suspension flaps for McKissock's vertical bipedicle flap vs. classical McKissock's technique: comparison of aesthetic results and patient satisfaction.

McKissock's vertical bipedicle flaps technique is a common technique used in reduction mammaplasty. This technique includes a well-vascularised dermal-parenchymal pedicle for safe nipple-areola transposition, but it has been criticised as resulting in a flat breast with inadequate projection after long-term follow-up. Various techniques in which dermal suspension flaps are used have demonstrated decreased secondary ptosis. We used a dermal suspension flap technique for the vertical bipedicled flap of the McKissock's breast reduction and compared it with classical McKissock's technique by review of the patient charts, photographic analysis and patient-satisfaction questionnaire. Evaluations and measurements with postoperative photographs for the dermal brassiere group compared with the classical McKissock breasts were found to be statistically different. There were no differences in complication rates and patient satisfaction between the groups. McKissock's technique with dermal suspension flap is an easy and uncomplicated modification that provides additional advantages for prevention of the secondary ptosis of the reduced breasts in the long term.     

One-Stage Reconstruction of an Upper Part Defect of the Auricle

A one-stage procedure for the reconstruction of a defect of the upper auricle is described. The anterior surface of a carved costal cartilage graft was covered with an anterosuperiorly based skin flap, and the posterior surface was covered by the superficial mastoid fascial flap and a skin graft. This method can be performed easily, without leaving any scar in the hair-bearing area or visible postauricular region, and can be applied to cases in which the condition of the margin scar of an auricular defect is poor.     

Bipedicle Orbicularis Oculi Flap in the Reconstruction of the Lower Eyelid Ectropion

Background Lower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid. Methods This study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion. In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect. Results No problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period. The incision scars were almost invisible. Conclusions The application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion is effective and reduces postoperative morbidity.     

Vertical Scar with the Bipedicle Technique: A Modified Procedure for Breast Reduction and Mastopexy

Background Reduction mammaplasty and mastopexy are commonly performed aesthetic procedures. One such procedure, the vertical scar technique, has gained popularity in recent years, and various types of pedicles have been designed and associated with it. The vertical scar with the bipedicle technique is one such combination that ensures nipple safety and minimizes scarring, with a good aesthetic result. Method With the vertical scar marked on the outside and the bipedicle flap marked on the inside, the procedure was performed for 23 patients. Results Between 2004 and 2006, 17 reduction mammoplasties and 6 mastopexies were performed. The average tissue resection was 360 g, and the average blood loss was 70 g. The average preoperative nipple–areolar complex was 28 cm (range, 23–41 cm). Good results were achieved for the majority of the patients, with no nipple loss or loss of sensation. Conclusion The vertical scar bipedicle technique, a combination that meets the requirement of minimum scarring and a robust blood supply to the nipple–areolar complex, is a suitable option for selected reduction mammaplasty and mastopexy.     

Staged TRAM Breast Reconstruction: Combining the Advantages of Tissue Expansion with Surgical Delay

The TRAM flap has become the gold standard in breast reconstruction but suffers from the disadvantages of poor color match, different texture, and impaired sensation compared to the normal breast. This study reports on a two-stage procedure to address these problems. The first stage consists of insertion of a tissue expander and surgical delay of the TRAM flap. The second stage consists of removal of the tissue expander and transposition of a deepithelized TRAM flap into the tissue expanded cavity. (The capsule is excised.) Four cases of breast reconstruction are reported. The advantage of this procedure is that it offers the benefits of tissue expansion, viz., normal color match, texture, and sensation, and in addition, reconstruction is achieved with autologous tissue by a pedicled TRAM flap. The vascularity of the TRAM is enhanced by a surgical delay procedure.     

Wineglass Pattern for Vertical Mammaplasty

The ideal reduction mammaplasty technique should create a pleasing breast shape with minimal scarring. The long and conspicuous scar associated with the classic inverted ``T' pattern mammaplasty techniques are not acceptable for many patients. Periareolar mammaplasty techniques cause less scarring, but they have major disadvantages such as scar widening, areolar distortion, and insufficient breast projection. We used a new pattern for vertical mammaplasty to overcome the insufficient breast projection caused by the round block technique and applied it to 51 patients during the last 3 years. This method results in a single vertical scar and a periareolar scar, allows sufficient volume reduction, and provides good breast shape and projection; the results are durable. This procedure is safe, causes few complications, and is easy to learn and perform.     

The pedicled TRAM flap in breast reconstruction

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a viable option in breast reconstruction. This article documents the history of the TRAM flap and puts in context the vascular anatomy through a discussion of the vascular zones. Options for flap delay are discussed and an algorithm is presented for patient selection. Finally, the issue of unipedicle versus bipedicle flap harvest is discussed and complications are examined.     

应用下唇双蒂口轮匝肌黏膜瓣修复上唇红唇缺损畸形

目的探讨下唇双蒂口轮匝肌黏膜瓣修复上唇红唇缺损畸形的临床效果。方法根据红唇缺损量及部位,设计下唇口轮匝肌黏膜瓣的长度和宽度,双侧蒂部切口适当向口角内延伸,红唇复合组织瓣转位修复红唇缺损。结果本组8例患者术后口轮匝肌黏膜瓣血运良好,随访6~12个月,修复红唇饱满对称,口角形态自然,张口不受限,术区瘢痕不明显,上唇外观改善良好,下唇形态良好,无与手术相关的并发症发生。结论采用下唇双蒂口轮匝肌黏膜瓣修复上唇红唇缺损畸形具有手术操作简单,安全性高,切口隐蔽,修复效果好等优点,值得临床推广应用。     

Open Rhinoplasty Through a Forked Flap Incision

Surgical elongation of the short columella is a challenging problem for the surgeon. Although some flaps from the upper lip are successfully used to correct this deformity on cleft lip patients with a scarred upper lip, these methods cannot be applied to noncleft patients with a smooth upper lip. Distant flaps and composite grafts do not give the best aesthetic results. The use of an external approach for rhinoplasty is preferred by many surgeons, especially for difficult or secondary cases. Most incisions for open rhinoplasty are placed on the columella. This report describes a new incision for open rhinoplasty to be used on patients with a short columella. The incision is a standard forked flap with a columellar base but the legs of the flap extend to the nostril bases instead of to the upper lip. This method was used on eight aesthetic rhinoplasty patients with a short columella between March 1995 and March 1998. The results of the method are discussed.     

Technique for Correction of the Retracted Columella, Acute Columellar-Labial Angle, and Long Upper Lip

The excess tissue from upper lip vertical length reduction provides bulk for opening the columella–labial angle and increasing the visibility of the columella and upper lip vermillion. Decorticated centrally based transverse flaps from the lip and nostril floor, when transposed into a columellar pocket, correct commonly combined degenerative or developmental deformities. The technique delivers premaxilla, columella, and columella–labial angle mass, which simultaneously corrects the retracted columella, opens the columella-labial angle, shortens the upper lip length, and enhances vermillion visibility.     

Breast Implantation and the Incidence of Upper Extremity Somatic Complaints

Attention has been drawn to elevated laboratory tests of inflammation as indicators of a possible reaction to silicone breast implants. These patients have complaints of joint pain, pain, and myalgia that were possibly caused by a reaction to silicone. This study is a retrospective review of 100 consecutive patients (79 female, 21 male) who were evaluated because of a purported industrial injury to the upper extremity. Patients were examined by a single examiner and all had laboratory screening for indicators of inflammation (sedimentation rate, anti-nuclear antibody levels, C-reactive protein, anti-streptolysin, rheumatic factor), endocrine abnormalities (thyroid panel), and serum glucose. None of the patients had any history of breast augmentation with any implant. Of the 79 female patients, 50 had an identifiable clinical diagnosis and 18 of them had elevation of at least one of the indicators of inflammation. The remaining 29 did not have an identifiable diagnosis and 21 of them had elevation of at least one indicator of inflammation (P < 0.01). There were 74 out of 79 females with subjective complaints of upper extremity pain, joint pain, and aching. Forty-five of these patients had an identifiable diagnosis and 17 of them had elevation of at least one inflammatory indicator. Of the 74 female patients, 29 had no identifiable diagnosis and 21 of them had elevation of at least one inflammatory indicator (P < 0.01). In summary, there were a high number of female patients with complaints of upper extremity symptoms with no prior exposure to silicone from breast implantation. There was a statistically significant correlation in these patients who had no identifiable diagnosis and elevated indicators in inflammation. This study suggests these markers of inflammation should not be used as indicators of a reaction to silicone from breast implantation in patients with upper extremity subjective complaints.