Maximizing the use of precapsular space and the choice of implant type in breast augmentation mammaplasty revisions: review of 49 consecutive procedures and patient satisfaction assessment

Background  

Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction.     

Intraoperative Modification of Pitanguy Technique of Reduction Mammaplasty for Elevation of the Nipple�CAreola Complex in Case of Severe Breast Ptosis

Background  

The Pitanguy method of reduction mammaplasty has been shown to be an anatomically safe technique in the management of the ptotic breast. However, the technique, as first described, cannot be applied in gigantomastia or severe breast ptosis cases or cases of dense parenchyma of the breast. The senior surgeon suggested an intraoperative modification of the Pitanguy method of reduction mammaplasty to make it applicable for such cases.     

Correction of Capsular Contracture by Insertion of a Breast Prosthesis Anterior to the Original Capsule and Preservation of the Contracted Capsule: Technique and Outcomes

Background  

This study aimed to explore the treatment of capsular contracture after augmentation mammaplasty by insertion of a breast prosthesis anterior to the original capsule.     

Correlation Between Scoliosis and Breast Asymmetries in Women Undergoing Augmentation Mammaplasty

Background  

Breast asymmetries and scoliosis influence the results of augmentation mammaplasty. Although a variety of methods have been proposed to resolve breast asymmetries, to date, no simple preoperative algorithm has been proposed for predicting the breast volume and decreasing breast asymmetries in the place of subjective or expensive evaluation. The relationship between the scoliosis and breast volume asymmetry was further analyzed statistically in this study.     

Breast Sensitivity Before and After the L Short-Scar Mammaplasty

Background  

Breast sensitivity preservation is among the aims of modern breast surgery. Large-volume resection, extensive undermining, and resections at the breast base have been associated with breast sensitivity alterations. The L short-scar mammaplasty technique is designed to preserve breast sensitivity by resection of tissue in the middle and inferior portions of the breast, but specifically dissection and preservation of the breast lateral neurovascular pedicle. Using this technique, a prospective study was designed for measurement of breast sensitivity quantitatively and subjectively to determine whether different resection volumes of the breast correlate with alteration of sensitivity postoperatively.     

Temperament and Character Traits of Women Admitted for Breast Reduction and Comparison with Body Perception

Background  

Reduction mammaplasty improves self-esteem and low body perception. Previous reports comprise either retrospective data or sectional analysis in which women were evaluated postoperatively. Furthermore, temperament and character properties of women applying for breast reduction have not been investigated. This study aimed to compare the temperament and character traits of women admitted for breast reduction surgery with those of healthy volunteers and to investigate the interaction of body perception with temperament and character.     

Oncoplastic reduction mammaplasty,an effective and safe method of breast conservation

INTRODUCTION

Oncoplastic breast conserving surgery (BCS) can enhance both cosmetic and oncologic breast cancer outcomes. This study evaluates the outcomes and complications associated with oncoplastic reduction mammaplasty performed by surgical breast oncologists.

Breast reduction surgery—an easy formula to estimate the resection weight to be removed

Background

The preoperative prediction of therapeutic breast reduction weights which achieve both relief of symptoms and excellent shape and size breasts remains a challenge and, in addition, in the selection of patients with symptomatic macromatia for being treated by reduction mammaplasty the estimation of the amount of tissue to be removed plays an important role because this criterion is required almost universally. The objective of this study is to calculate a formula for the preoperative prediction of the amount of breast tissue which has to be removed in the treatment of symptomatic macromastia based on data obtained from a series of patients with symptomatic breast hypertrophy treated with reduction mammaplasty characterized by the fact that successful outcome (functional and cosmetic) had previously been achieved and assessed objectively.

Methods

A prospective study was performed on 39 patients undergoing reduction mammaplasty for breast hypertrophy. The Short Form (SF)-36 quality of life questionnaire (Spanish version 1.4, June 1999) and the Breast Reduction Assessed Severity Scale Questionnaire, which was double-blind translated, were both answered preoperatively, a week before, and postoperatively, 6 months after surgery, for testing the effectiveness of the treatment. The patients were asked to score cosmetic results (1 to 10, very bad to excellent) and how satisfied with the new breast size they were. Data were collected from these patients to calculate a formula for preoperative prediction of breast resection weight. Regression analysis was performed separately on each of 78 breasts of these patients with breast weight as dependent variable and sternal notch-to-nipple distance (SNN), inframammary fold-to-nipple distance (IMFN), age, body mass index (BMI) and ascent of the nipple areola complex (ANAC) as independent variables.

Results

A simple model combining two variables (IMFN, ANAC) is strongly correlated with actual resection weight with adjusted r ² coefficient of 0.701. The formula breast weight (g)?=?(60(ANAC) (cm)?+?50(IMFN) (cm))???648 can predict resection weight which obtains satisfactory cosmetic results and a relief of symptoms improving quality of life.

Conclusions

A new easy formula to estimate preoperatively the amount of breast tissue to be removed is offered to surgeons who are planning a breast reduction mammaplasty. Level of evidence: level IV, risk/prognostic study     

Mammaplasty with Inferior Pedicle Flap After Massive Weight Loss

Background  

After massive weight loss, one of the stigmas that afflict women is the remaining deformity of the breasts which become flaccid and ptotic, with an absent or flat upper pole. The authors propose the use of a well-established mammaplasty technique to fill the upper pole, reshape the breast cone, and correct ptosis with nipple–areola complex (NAC) repositioning.     

Measurements of Breasts of Young West African Females: A Guideline in Anatomical Landmarks for Adolescent Breast Surgery

Background  

There have been few studies to develop standardized methods of measuring female breasts’ shapes in clinical settings in West Africa. The objective of this study was to determine the clinical variation in breast measurements among a large group of adolescent female subjects, with the goal of providing guideline metrics to surgeons performing reduction mammaplasty and mastopexy on patients desiring a more adolescent shape and nipple position.     

Skin-Reducing Mastectomy With Immediate Implant Reconstruction as an Indispensable Tool in the Provision of Oncoplastic Breast Services

Background  

Skin-reducing mastectomy (SRM) is a method of immediate breast reconstruction derived from a Wise breast reduction incision pattern that enables immediate subpectoral implant placement after mastectomy. Its virtue lies in the manner it provides for adequate implant coverage using muscle and a deepithelialized dermal flap, thus reducing the risk of implant extrusion and providing good inframammary contour. Our experience with this technique is elaborated.     

Modified Lateral Thoracodorsal Flap: A Way Out of a Difficult Problem

Background

Breast deformities, often attributable to surgical mutilations as a result of mammary carcinoma treatment, still are a challenge to plastic surgeons. Interesting alternatives for the frequently used musculocutaneous flaps are local flaps such as the lateral thoracodorsal flap developed by Holmström in 1986. This flap is simple to raise and involves no sacrifice of important muscular structures. This report aims to demonstrate the use of the modified lateral thoracodorsal flap in an immediate mammary reconstruction for a patient who refused any other scar.

Methods

A case report describes a patient presenting with breast cancer after reduction mammaplasty who was treated with a skin-sparing mastectomy and immediate reconstruction.

Results

Satisfactory defect correction was accomplished with adequate silicone implant covering and a natural ptotic breast shape.

Conclusions

The versatility of this flap and its simple execution make it an important option for diverse breast reconstruction situations. The lateral thoracodorsal flap provides aesthetic results similar to those with other reconstruction methods, but without major complexity. The authors believe that it could be an interesting tool for the treatment of a breast anomaly.     

Myofibroblasts and Capsular Tissue Tension in Breast Capsular Contracture

Background  

This study aimed to observe the relationship between the number of myofibroblasts, the tensile strength of the breast implant capsule, and the degree of breast capsular contracture.     

Keyhole pattern for preoperative marking for reduction mammaplasty

BACKGROUND

There are many techniques used for reduction mammaplasty; however, the most frequently performed procedures result in an inverted T scar. Preoperative marking is an important step for the success of the procedure, especially for surgeons at the initial learning stage. However, there is no consensus regarding the best method. In 1981, Strömbeck designed a pattern for preoperative marking for reduction mammaplasty. This pattern provides stable parameters that promotes an acceptable symmetry marking.

OBJECTIVE

To evaluate the use of the Strömbeck pattern for preoperative marking for reduction mammaplasty.

METHODS

Fifty-seven patients who underwent reduction mammaplasty between April 2006 and April 2007 were prospectively evaluated. Patient ages ranged from 17 to 61 years; the mean body mass index was 22.2 kg/m². After defining the standard landmarks of the breast, preoperative markings were made using the Strömbeck pattern. Breast reduction surgery was performed under local anesthesia with sedation. Postoperative results were evaluated according to a numerical visual analogue scale, at the seven-, 15- and 30-day follow-up periods. The Student’s t test and the Kruskal-Wallis test were used for statistical analysis (P<0.05).

RESULTS

The mean weight of resected breast tissue was 317.5 g for the right breast and 305.8 g for the left breast (P=0.17). Scores obtained using a visual analogue scale showed a progressive increase in the scores during the postoperative follow-up period (P<0.0001).

CONCLUSION

The use of the Strömbeck pattern enabled surgeons to perform reduction mammaplasty with good postoperative results as seen in the follow-up periods.     

Subpectoral and precapsular implant repositioning technique: correction of capsular contracture and implant malposition

Background  

Although capsule formation is a natural-healing process following breast augmentation using implants, a contracted capsule around a poorly positioned implant can act as an obstacle during the corrective procedure to reposition the implant. The ideal treatment of capsular contracture is removal of the capsule and covering the implant with a healthy envelope without scar tissue. However, total capsulectomy in the submuscular space may be difficult, especially if the capsule is firmly attached to the chest wall. This situation may require a highly skilled technique because aggressive capsulectomy could injure the intercostal muscles and vasculature and cause further complications such as pneumothorax. Therefore, the authors have developed a new, less traumatic method of leaving the capsule behind the new implant.     

三维扫描技术测量隆乳术后乳房体积变化的研究

目的：研究一种全新的使用三维扫描技术测量隆乳术后乳房体积变化的方法,并将其与传统的方法进行重复性和准确性比较。材料和方法：10名隆乳术后3个月以上接受随访的患者接受了两次标准化的乳房三维扫描。使用方法1（新方法）和方法2（传统方法）测量两次扫描乳房的体积差值,并进行两种方法的重复性和准确性比较。测量重复性比较：对1例病例的乳房模型分别使用方法1和方法2进行重复测量9次,计算两种方法得出的乳房体积变化值的变异系数。测量准确性比较：对另外9例病例的乳房模型分别使用方法1和方法2进行重复测量3次,配对t检验比较两种方法得出的乳房体积变化值。结果：重复性比较：方法1和方法2的变异系数分别为10．7％和80．4％。准确性比较：使用方法1测量的平均乳房体积变化值为8．8ml,使用方法2测量的平均乳房体积变化值为37．7ml,两者有统计学差异。结论：本文提出的测量隆乳术后乳房体积变化的全新方法较目前通用的方法重复性和准确性明显提高,应当成为使用三维扫描技术测量乳房体积变化的标准。     

Subpectoral-Subfascial Breast Augmentation for Thin-Skinned Patients

Background  

Among thin patients, upper pole skin of less than 2 cm on a pinch test is an indication for submuscular implant placement. However, rippling, palpability, and visibility of the implant are frequently observed in the lower and lateral aspects of the breast due to the lack of muscle coverage in the area. To overcome these problems, a subpectoral-subfascial breast augmentation was performed including subfascial dissection of the rectus abdominis, external abdominal oblique muscle, and serratus anterior muscle as one sheet to cover the inferolateral aspect of the implant.     

Implant Infection After Augmentation Mammaplasty: A Review of the Literature and Report of a Multidrug-Resistant Candida albicans Infection

Background  

Implant breast augmentation is one of the most frequently performed surgical procedures, and fungal infection still is considered exceptional. This report presents a case of bilateral breast implant infection by multidrug-resistant Candida albicans treated with a targeted antifungal therapy.