Mammoplasty using liposuction and the periareolar incision

The major dilemma of reduction mammoplasty and mastopexy has been the difficult choice between a procedure that yields an ideal shape of the breast versus the size of the scar. With our technique, selected breasts can now be reduced through liposuction and the mastopexy performed through a periareolar incision, resulting in virtually imperceptible scarring.     

可吸收性缝线在隆乳术中的应用

隆乳术切口用丝线或尼龙线缝合,难免留下针眼疤痕,患者不尽满意。本文介绍我部采用可吸收性缝线缝合切口皮肤,并加用闭合性粘带的方法。术后不用拆线,切口疤痕不显。文章对操作方法及其优缺点进行了讨论。     

Augmentation/Mastopexy: How to Select and Perform the Proper Technique

During a period of 8 years, 384 female patients underwent simultaneous surgery for placement of implants and mastopexy. The surgical techniques used were selected according to the characteristics of each particular case. The determining variables in the selection were ptosis of the nipple–areola complex (NAC) and distance from the NAC to the inframammary fold. Only three surgical techniques were used: NAC lifting (n = 30), periareolar pexy (n = 196), and inverted T pexy (n = 158). The degree of general satisfaction with each of the techniques was 89%, 82%, and 92%, respectively. Round and anatomic implants were used, respectively, for 258 (67%) and 126 (33%) of the patients, with their use depending on the medical indications and each patient’s choice. All complications were minor, and their overall incidence was 18%. Factors such as proper choice of the surgical technique, type of implant, approach to placement of the implant, type of suture, and removal of tissue for the pexy are fundamental to obtaining a good result. With these factors kept in mind, it is possible to perform the combined procedure of mastopexy and implantation, to minimize the complications, and to obtain satisfactory results over the mid and long terms.     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的　一次性完成隆乳并矫正乳房轻度下垂。方法　经乳晕上切口切除半月形皮肤 ,不切开乳腺置入乳房假体 ,将乳腺组织上移悬吊固定于胸大肌深筋膜。结果　 2 3例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好 ,乳晕切口瘢痕不明显 ,乳头感觉及勃起正常。结论　该方法隆乳同时矫正下垂乳房效果可靠稳定 ,创伤小 ,止血彻底 ,瘢痕不明显。     

Periareolar Breast Reduction

A personal approach to periareolar breast reduction is presented. The circular demarcation of periareolar skin must be limited to twice the demarcated areolar diameter (2 × 4 = 8 cm). A cylindrical resection of volume is removed, as in Strömbeck’s technique, from below the areola to the aponeurosis of the pectoral muscle. Through this space, two to four “keel-like” parenchymal pieces are removed to reduce the breast at the cardinal points. The breast cone is assembled by suturing the raw areas from bottom to top, hyperprojecting it. A “round-block” suture around the areola is made, and the procedure is concluded with skin suture. Indications, limitations, and possibilities for use of the technique are analyzed, and the equation is summarized as follows: residual ptosis versus long scars inside the limits and indications of more or less 300 g of removed volume and small or medium breast ptosis. Only after the first 10 cases was the limit of the technique determined. Therefore, these results were not homogeneous. The results were satisfactory and regular for 68 of the 78 patients subjected to surgery and follow-up evaluation.     

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.     

Combination of the vertical and periareolar mammaplasty

Vertical mammaplasty has been perfected and popularized by Madeline Lejour; this technique is one of the most versatile methods of manunaplasty today. The vertical scar from the nipple areola to the submammary line is often much longer and distorted than the conventional mammaplastys. The length of the vertical scar can be reduced by 2–3 cm by combining the skin pattern of the periareolar and vertical mammaplasty. The aesthetic result can be improved by shortening the vertical scar.     

Fascial Suspension Mastopexy Combined with Augmentation Mammaplasty

Background  We have modified our technique of fascial suspension mastopexy to be used in combination with augmentation mammaplasty. This study aimed to assess the results of the combined procedure in our first consecutive 10 patients. The surgery aims to maximize long-term upper-pole fullness as well as optimal projection and shape in volume-depleted ptotic breasts. Methods  A retrospective case notes review was carried out, with details of patient demographics, indications, operative detail, and postoperative assessment recorded. In addition, patients were directly questioned to gain their opinion of the procedure. Results  Nineteen breasts were operated on in ten patients. On preoperative assessment two women (20%) had grade 3 ptosis and the rest had grade 2 (83%). The majority of women had had children and had breast-fed (70%). The mean follow-up period was 33 months (range = 4–55) and overall patient satisfaction was high despite six of the 10 patients undergoing minor scar revisions for dog-ears under local anesthetic and two undergoing implant exchange to correct minor asymmetries. There were no major postoperative complications in this series. All patients demonstrated good projection and upper-pole fullness at postoperative review. Conclusion  The combined technique of fascial suspension mastopexy and breast augmentation with implants is a safe and reliable method to correct ptosis in volume-depleted breasts. Patients should be counseled on the possible need for minor revisional procedures. Importantly, the technique achieves excellent upper-pole fullness and the projected and rejuvenated breast has an overall pleasing result.     

Minimal-Scar Breast Reduction and Mastopexy

Background Classic breast reduction and mastopexy techniques leave a vertical scar, but are difficult to apply in cases requiring a large amount of breast tissue removal. This report describes a new breast reduction technique using a vertical incision for resections involving less than 600 g of tissue removal and an inverted T incision for larger resections. Results for the new technique are reported.Methods For 800 women, the reported technique was used for reduction mammaplasty (n = 640) and mastopexy (n = 160). Peridural anesthesia was used for 90% of the patients, and general anesthesia for 10%. The minimum follow-up period was 6 months for 90% of the patients. All the patients underwent mammary x-ray and ultrasonography before surgery.Results A short scar was obtained for all the patients. A new intervention for breast reduction was chosen by 16 patients (2%). For all the patients followed, the immediate results (projection of the areola and upper pole) remained unaltered at a late follow-up evaluation. There were no cases of infection or seroma. Hematoma occurred in 8 patients who underwent unilateral breast reconstruction, and 16 patients experienced temporary reduced sensitivity.Conclusions The new technique was effective in leaving a short scar and maintaining immediate results in the long term. Liposuction limited to the lateral chest wall prevented complications associated with breast tissue.     

应用聚丙烯单丝网片纠正轻、中度乳房下垂

目的：介绍一种适用于轻、中度乳房下垂的矫正术。方法：采用乳晕周围环状切口，用聚丙烯单丝网片制成内置式乳罩，行乳腺组织的上提、塑形和固定，并为21例乳房下垂者行矫正术。结果：21例均达到较为理想的上提效果，随访2－16个月，无下垂复发和切口瘢痕增生，未发生异物排斥反应。结论：聚丙烯单丝网片用作乳房塑形的支持材料安全可靠，减少了切口的瘢痕增生，避免了下垂复发。     

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.     

The Application of Mesh Support in Periareolar Breast Surgery: Clinical and Mammographic Evaluation

Background Numerous techniques have been described for the treatment of breast hypertrophy and ptosis. Unfortunately, recurrent ptosis after mammaplasty can occur regardless of the technique used. To avoid this problem, different kinds of supporting devices have been described with variable rates of success. However, the true implications of incorporating prosthetic materials into breast surgery have never been clarified. Therefore, surgeons have traditionally been reluctant to apply any kind of prosthetic material to the breast, fearing inflammation, an unfavorable aesthetic outcome, palpable or visible deformities, and interference with the mammographic evaluation of breast cancer. This study analyzed the aesthetic, clinical, and mammographic implications of using mesh as a supportive device in periareolar breast surgery.Methods For this study, 18 patients (mean age, 42 years) with breast hypertrophy, ptosis, or both were managed with the double-skin periareolar mammaplasty technique, with placement of mixed (60% Polyglactine and 40% polyester) mesh. Clinical assessment was performed by three breast surgeons actively working on cancer surveillance who knew that the patients had experienced mesh application. After a mean follow-up period of 30 months, a standard mammogram was performed for each patient and analyzed by both the surgeons and an expert radiologist. The evaluated factors were hyperemia, calcifications, contour irregularities, capsular contraction, thickening or widening of the scar with extrusion of the mesh, and any palpable or hardened areas.Results According to the authors clinical observations, there were no mesh-related abnormalities in the breast; the mesh was not palpable after the operation; and there was no recurrent ptosis. In terms of mammographic imaging, the mesh was visible as a very fine line in the periphery of the breasts parenchyma (measuring 0.2 mm on the lateral views) in three patients (17%). The mesh did not interfere with the visualization and analysis of the breasts parenchyma. In seven patients (39%), benign localized microcalcifications were detected in the breast and no further investigation was performed. In two patients (11%), grouped calcifications were detected and biopsied, with histopathologic analysis demonstrating epithelial hyperplasia with atypia. In two patients (11%), nodules smaller than 1 cm were detected and biopsied, with histopathologic analysis demonstrating a fibroadenoma in one patient and an invasive ductal carcinoma in the other.Conclusions The use of mesh support in breast surgery can enhance the aesthetic results without inducing visible or palpable deformities or mammographic abnormalities. In terms of surveillance mammograms, the presence of the mesh did not interfere with the diagnosis and treatment of minute lesions such as calcifications and small nodules     

Breast Cancer After Augmentation Mammoplasty

Background:It is thought that implants interfere with breast cancer diagnosis and that cancers in women who have had breast augmentation carry a worse prognosis.Methods:A prospective breast cancer database was reviewed, comparing augmented and nonaugmented patients for details of histology, palpability, tumor size, nodal status, mammographic status, receptor status, nuclear grade, stage, and outcome.Results:Ninety-nine cancers in augmented women and 2857 cancers in nonaugmented women were identified. Among these women, mammography was normal in 43% of those who had had augmentation and in 5% of those who had not. Augmented women were more likely to have palpable cancers (83% vs. 59%) and nodal involvement (48% vs. 36%), and less likely to have ductal carcinoma in situ (DCIS) (18% vs. 28%). When comparing only women younger than 50, the differences in invasiveness and nodal status lost significance. Cancers diagnosed in the 1990s were more likely to be nonpalpable and noninvasive than those diagnosed in the 1980s. This trend was more pronounced in the augmented population.Conclusions:Augmented patients were more likely to have palpable cancers, although the overall stage and outcome were similar to those of nonaugmented women. Although there have been significant improvements in our ability to diagnose early breast cancer over the past two decades, mammography continues to be suboptimal in augmented women.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16-19, 2000     

Complete Submuscular Breast Augmentation: 650 Cases Managed Using an Alternative Surgical Technique

Background An alternative complete submuscular surgical technique for primary breast augmentation is presented. Since 1998, the author has refined the procedure for total submuscular placement of textured silicone gel implants, with good results for more than 650 patients. Methods The submuscular plane is accessed via a semicircular periareolar incision. Round or anatomic implants are placed beneath the pectoralis major and external oblique muscles, the rectus sheath, and the serratus anterior muscle fascia, which together create a contiguous structure that completely separates the implant from the breast tissue. Results High-riding implants were the main complication in early cases, through creation of an insufficiently large submuscular pocket. Only a very low incidence of Baker II capsular fibrosis was observed, and there were no Baker III or IV capsular contracture revisions. There were no cases of infection or “bottoming out.” Areolar scarring was well concealed, and rippling and implant distortion were virtually nonexistent. Even in thin women, the implant edge was scarcely visible or palpable. Patient satisfaction levels were very high, with the majority viewing the implants as their own tissue in terms of natural feel and appearance. Conclusions The advantages of the described surgical method are several-fold, particularly for lean patients. It offers a promising alternative to subglandular and partial submuscular implant placement and to other total submuscular techniques for primary breast augmentation. Furthermore, it provides a solution for tuberous and ptotic breasts, coupled with mastopexy as required, and good results have been achieved with correctional surgery for subglandular capsular contracture, bottoming out, and rippling.