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1.
Background:Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result.Results:Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method.Conclusion:The superomedial pedicle shows better long-term cosmetic results.KEY WORDS: Bottoming out, inferior pedicle, patients’ satisfaction, reduction mammoplasty, superomedial pedicle  相似文献   

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Breast reduction is a common cosmetic surgical procedure. It aims not only at bringing down the size of the breast proportionate to the build of the individual, but also to overcome the discomfort caused by massive, ill-shaped and hanging breasts. The operative procedure has evolved from mere reduction of breast mass to enhanced aesthetic appeal with a minimum of scar load. The selection of technique needs to be individualised. Bilateral breast reduction is done most often. Haematoma, seroma, fat necrosis, skin loss, nipple loss and unsightly, painful scars can be the complications of any procedure on the breast. These may result from errors in judgement, wrong surgical plan and imprecise execution of the plan. Though a surfeit of studies are available on breast reduction, very few dwell upon its complications. The following article is a distillation of three decades of experience of the senior author (L.S.) in reduction mammoplasty. An effort is made to understand the reasons for unfavourable results. To conclude, most complications can be overcome with proper selection of procedure for the given patient and with gentle tissue handling.KEY WORDS: Breast, complications, fat necrosis, reduction mammoplasty, seroma  相似文献   

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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.  相似文献   

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There is an increasing awareness that psychosocial outcome and health status are important outcomes following breast reduction surgery. In this study, patients awaiting breast reduction surgery completed detailed and comprehensive psychosocial assessments before and after surgery. Of 33 patients who completed the preoperative assessment, 20 patients were operated on and 19 were reassessed 4 months post-surgery. Patients expressed high levels of satisfaction with specific and overall results of surgery. Scores for anxiety, depression, body image and body satisfaction improved significantly using specific questionnaires. Patients also reported significant improvements on five out of eight subscales on the Short Form 36 health status questionnaire. This study provides further evidence for overall improvement in health status and psychological functioning in patients undergoing breast reduction surgery and supports the provision of this service by the NHS.  相似文献   

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BACKGROUND:There is a strong body of evidence addressing short-term outcomes following wrist ganglion aspiration; however, few studies have investigated long-term outcomes and patient satisfaction.OBJECTIVE:To evaluate patient satisfaction and the long-term rate of recurrence following wrist ganglion aspiration.METHODS:Charts of all patients with a wrist ganglion treated by a single surgeon from 2001 to 2011 were reviewed. Demographic and clinical data were retrieved from patient charts. Patients were contacted by telephone and asked to complete a questionnaire addressing recurrence, satisfaction and symptom improvement. Improvement was assessed using a Likert scale, with 1 indicating ‘significantly worse’ and 5 indicating ‘significantly improved’. Statistical analysis was performed using Pearson χ2, Mann-Whitney-Wilcoxon and Fisher’s exact tests.RESULTS:Forty-one consecutive patients were identified using hospital records; 21 (51%) consented to the telephone questionnaire. There were no differences in demographic or clinical data between patients who completed the telephone questionnaire and those who did not. The mean age at treatment was 45.3 years, mean time to follow-up was 6.3 years and 52.4% of ganglions recurred. Overall, 95% (20 of 21) of patients were satisfied with their treatment and would proceed again given the option; satisfaction was independent of recurrence. Following treatment, there was improvement in pain, function, range of motion and appearance; improvement in symptoms was independent of recurrence.CONCLUSIONS:Long-term recurrence of ganglions treated with aspiration appeared to be similar to the short-term rates reported in the literature. Independent of recurrence, patients remained satisfied with aspiration and reported improvement in symptoms.  相似文献   

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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.  相似文献   

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The assessment of viability of a pedicled nipple-areola complex after reduction mammoplasty frequently may be frustrating due to equivocal clinical signs of adequate blood flow. Although conversion to a composite graft is always a safe option, the aesthetic result may be inferior. An objective monitor might be beneficial to maximize the surgical outcome while minimizing the risk of nipple necrosis. Laser Doppler flowmetry provides a safe, simple, and noninvasive objective monitor that allows continuous intra-operative or postoperative evaluation of nipple perfusion. An evaluation of 31 nipples in 16 patients undergoing breast reduction based solely on the surgeon's judgment would have resulted in 9 false positive or negative results as compared with 3 using the laser Doppler. Four nipples that may otherwise have been converted to free grafts were instead preserved. However, conclusions from this data limit the laser Doppler as a valuable supplement, but not a replacement, for experienced clinical acumen.  相似文献   

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A survey from 1983 through 1988 of patients who underwent augmentation mammoplasty performed by the transaxillary subpectorial approach revealed the operation to be amazingly trouble-free, with patient satisfaction reaching 98.5%. The severe problem of capsular contracture seen in the 1978 prepectoral (submammary) cases was virtually eliminated by this operation.  相似文献   

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A survey from 1983 through 1988 of patients who underwent augmentation mammoplasty performed by the transaxillary subpectorial approach revealed the operation to be amazingly trouble-free, with patient satisfaction reaching 98.5%. The severe problem of capsular contracture seen in the 1978 prepectoral (submammary) cases was virtually eliminated by this operation.  相似文献   

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Free nipple graft reduction mammoplasty is the procedure of choice in patients with massive breast hypertrophy, or those high-risk patients less able to undergo a more extensive procedure. A major criticism of the technique is that it creates a flat, boxy breast that lacks projection. A technical modification of free nipple graft reduction mammoplasty is presented. In this modification, a central, bulky, superiorly based dermal-parenchymal flap extending from the "key-hole" site to the superior aspect of the areola is designed. After tailoring, this central flap is folded superiorly and secured beneath the medial and lateral flaps to create the bulk of the breast mound. This central flap can be accurately tailored to achieve the desired breast size and projection. The medial and lateral breast flaps do not create the breast mound, and are only contoured over the top of this central flap to complement the final breast form.  相似文献   

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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.  相似文献   

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Between 1969-1989 340 mammaplasty operations were performed in 172 patients. The mean weight of resected breast tissue was 704 +/- 418 g for one breast. In 18.2% more than 1000 g were resected. 1990 the patients were reexamined. Physical complains could be eliminated in nearly all mammaplasty patients. The cosmetic result at the time of evaluation was good or very good in 82% if judged by the patients and in 70% if judged by the surgeon. The assessment of the clinical examination was normal in 89% and in the mammographic examination in 80%.  相似文献   

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The authors report a case of familial pyoderma gangrenosum following a mammoplasty reduction. This disease should be known by all surgeons, because its occurrence may follow all surgical procedure. The only efficient treatment is based on steroids and large surgical excisions must be contraindicated.  相似文献   

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Klippel Trenauney syndrome is a rare congenital abnormality that includes extremity hypertrophy. We report an unusual case of breast asymmetry due to unilateral chest and limb hypertrophy and describe successful unilateral breast reduction. We highlight the potential problems of surgery within this group and a management approach to minimise complications.  相似文献   

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Background: While functional breast reduction surgery has been shown to lead to increased quality of life in adult patients, the effects of this operation has not been investigated as thoroughly in adolescent patients. This study uses the BREAST-Q, a validated, surgery-specific questionnaire, to measure changes in adolescent patient well-being and satisfaction following reduction mammaplasty.Methods: All patients presenting for breast reduction consultation between February and December 2016 were asked to complete the BREAST-Q. Post-operative surveys were completed at three-month follow up. A matched control cohort was established using patients who completed a pre-operative survey and were deemed appropriate surgical candidates, but then were denied by insurance and did not undergo surgery.Results: Of the 28 adolescent patients who presented for breast reduction consultation, 15 met inclusion criteria; 11 patients underwent reduction mammaplasty, and 4 patients were included in the control cohort. When these groups were compared, statistically significant improvements were observed in all BREAST-Q categories except for sexual well-being. Overall patient satisfaction correlated most highly to satisfaction with information.Conclusions: This study examines quality of life outcomes in adolescent breast reduction patients using the BREAST-Q survey. Our findings indicate that adolescent patients have an improved quality of life following breast reduction, but that their satisfaction stems from different sources from those of adult patients. Further characterization of outcomes specific to young patients with surgically managed symptomatic macromastia will increase the practice of tailored, evidence-based medicine for adolescent patients.Level of Evidence: Treatment Study, Level III  相似文献   

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The diagnosis of invasive carcinoma presents a surgical dilemma when discovered incidentally at breast reduction mammoplasty. Subsequent surgical and therapeutic management for such cases have not been established. Although management and treatment may vary according to patient preference, a review of the literature of the past four decades yielded scant discussion of the topic. We describe two cases of occult breast carcinomas that were not evident on preoperative breast screening, but were discovered on the pathology exam of reduction mammoplasty specimen. The purpose of our publication is to recommend a surgical approach for the patient in such a situation.  相似文献   

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Reducing mammoplasty is medically justified a surgical intervention to handle certain indications. Results obtained from this approach are discussed in comparison to other methods, primarily the Str?mbeck technique, with reference being made to 217 patients of whom the majority had undergone McKissock operations. Ninety per cent of these patients were absolutely satisfied, and only eight per cent had restrictions. However, broadened or hypertrophic scars were recorded from 21 per cent in objective assessments by follow-up examiners. The method according to McKissock can be recommended for cases of mammary ptosis and macromastia. A two-stage approach, according to Joseph, should be taken to cases in which more than 1,400 g of tissue are removed from one side. No increased incidence of mammary tumours was recordable in the wake of reducing mammoplasty.  相似文献   

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