Axillary silicone lymphadenopathy secondary to augmentation mammaplasty

We report a case involving a 45-year-old woman, who presented with an axillary mass 10 years after bilateral cosmetic augmentation mammaplasty. A lump was detected in the left axilla, and subsequent mammography and magnetic resonance imaging demonstrated intracapsular rupture of the left breast prosthesis. An excisional biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Histological analysis showed that the axillary lump was lymph nodes containing large amounts of silicone. Silicone lymphadenopathy is an obscure complication of procedures involving the use of silicone. It is thought to occur following the transit of silicone droplets from breast implants to lymph nodes by macrophages and should always be considered as a differential diagnosis in patients in whom silicone prostheses are present.     

垂直切口乳房缩小术

目的　探讨应用垂直切口巨乳缩小术以减少术后瘢痕的方法与体会。方法　采用Lejour手术设计 ,切除乳房下方的皮肤、腺体 ,乳头乳晕以上方真皮腺体组织蒂转移提高到正常位置 ,进行乳房塑形 ,术后仅留有垂直瘢痕。结果　采用垂直切口巨乳缩小术治疗 2 4例 ,手术效果满意。 1例术后 6个月切口下端局部修整残留的“猫耳朵”。 1例单侧乳头乳晕完全坏死。结论　垂直切口巨乳缩小术疗效良好 ,术后瘢痕细小 ,乳房形态良好。     

Volume reduction mammaplasty

I present an operation for breast reduction in which a prosthesis-shaped mass of breast tissue is removed through a transverse inframammary incision. No skin is removed. With time the breast tissue and skin shrink. No skin markings are required. There is very little interference with blood or nerve supply to the skin, areola, and nipple. The breast appears normal postoperatively.     

Circumvertical reduction mammaplasty

The main indication of the circumvertical technique is the removal of 400-1000 mg of breast tissue. It is also an intermediate method and an alternative between the periareolar and the vertical techniques. The advantages of the circumvertical technique is that it is simple and fast to accomplish, only the inferior half of the gland is operated, there is no transection of the lactiferous ducts, at the end of the surgery there is an harmonious redistribution of the pleats, the vertical scar never crosses the submammary fold, and at the end of the surgery an acceptable result is almost always observed. The posterior skin retraction will improve this initial result even more. The Marcaine infiltration allows some hours of postoperative pain relief. In brief, this technique is ideal for young women because it neither distorts the remnant anatomy nor alters the future lactation, being a good alternative to moderate and large hypertrophies.     

改良Biesenberger乳房缩小整形术

乳房缩小整形术常用方法很多，效果均较为满意，但困扰着人们的是常留有较为明显的手术瘢痕。为了探求一种瘢痕隐蔽、塑形良好的手术方法，我们对古老的Ｂｉｅｓｅｎｂｅｒｇｅｒ乳房缩小整形术式加以改进：在保留乳房内侧双重血供的情况下，皮下广泛游离，直视下进行乳腺塑形，操作便捷；乳腺组织外上象限切除，切除了肿瘤好发部位，切除量达１／４～１／３，切除量大；游离乳腺下瓣旋转上移塑形，双“Ｓ”形吻合，塑形灵活；乳腺组织悬吊固定在第二、三肋骨骨膜上，固定确切；采用双乳晕切口入路，乳晕周围皮肤裙褶样缝合，经一段时间机体的调节恢复，皱褶逐渐消失，瘢痕不显。随访表明，该法既克服了原法因皮肤潜行分离过广、乳腺游离过大，易发生乳头、乳晕及皮肤坏死的弊端，又展示了切口隐蔽、瘢痕不显的优点。     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术。方法用双环形切口，保留乳头乳晕深动脉和乳房下限的组织，对肥大的乳房进行缩小和重新塑形。结果23例惠者的乳头乳晕均无坏死，感觉良好，乳房形态自然。结论本手术设计简单，操作容易，术后瘢痕隐蔽，效果稳定，是修复各种肥大或下垂乳房的较好方法。     

改良双环法乳房缩小术

目的探索一种简单可靠的乳房缩小成形手术.方法用双环形切口,保留乳头乳晕深动脉和乳房下限的组织,对肥大的乳房进行缩小和重新塑形.结果 23例患者的乳头乳晕均无坏死,感觉良好,乳房形态自然.结论本手术设计简单,操作容易,术后瘢痕隐蔽,效果稳定,是修复各种肥大或下垂乳房的较好方法.     

Breast lumps after reduction mammaplasty

This paper examines the diagnostic problems raised when breast lumps develop after a reduction mammaplasty. We postulate the etiology and describe how xerograms can help in the diagnosis. We also make a strong case for preoperative xerography.     

Double-circle-incision for reduction mammaplasty]

The authors have used the double-circle incision for reduction mammoplasty on 55 breasts in 28 patients. The main features of the technique are: 1. Complicated and rigid preoperative markings are substituted by a simple and flexible double-circle incision; 2. Proper dissection between the skin and glandular tissue instead of non-dissection; 3. A conic stump of residual glandular tissue is formed instead of a cylindrical stump; 4. Glandular remodelling is substituted by skin "brassiere" retailoring; 5. The nipple-areola site is determined at the end instead of being the first step of the operation. The clinical results revealed that this new method is suitable for medium or large hypertrophy, especially for young women with good, thick and elastic skin, but it is not suitable for macromastia or severe breast ptosis.     

Pyoderma gangrenosum following reduction mammaplasty

The failure of a postoperative local infection to resolve after appropriate antibiotic therapy should prompt consideration of other diagnoses. Reported here is a case of pyoderma gangrenosum, a rare necrotizing disorder, occurring after reduction mammaplasty. The clinical presentation was one of progressive wound deterioration with associated erythema and intense pain. After failure of antibiotic therapy and local wound care, tissue biopsy of the enlarging wound edge confirmed the diagnosis, which then responded rapidly to systemic steroid treatment. Given that the treatment for pyoderma gangrenosum is at odds with the standard treatment for an infection (steroids versus antibiotics), differentiating between the two diagnoses is vital to providing resolution of the process and limiting any untoward scarring resulting from the advancing open wounds that can develop. With this in mind, the physical signs and symptoms that characterize this condition and thus allow early diagnosis are presented, and treatment options discussed.     

Mammographic findings following reduction mammaplasty

Clinical and mammographic follow-up checks were made on 64 women with a record of breast reduction surgery. Mammographic changes, such as thickened skin, distortion of nipples as well as thickening and dislocation of parenchymal tissue, can be relatively easily differentiated from malignant changes, primarily in cases in which such changes are symmetrical and in which case histories and earlier clinical findings are known. Bilateral calcifications in most cases are caused by calcified fat necrosis.     

A new technique for reduction mammaplasty

A new surgical technique for reduction mammaplasty is described. Incisions are chosen according to Strömbeck's procedure and deepithelialization of the major part of the skin in the resection area is carried out. The upper part of the breast with the total skin for the planned breast is separated from the lower part with the dermis flap and the nipple and the desired resections are carried out from the lower part. A dermis cone or tube is then created with the mammilla at its apex and the skin is closed around the dermis cone.     

Preoperative breast marking in reduction mammaplasty

A simple method of preoperative marking for reduction mammaplasty is described. This method may be used in macromastias when the technique chosen implies a postoperative scar with the shape of an inverted T. The marking sequence follows standard steps, but the drawing is always different because it is a consequence of the shape of the breast. This marking method reduces the chance of making mistakes due to excessive personal evaluations or to the use of standard drawing patterns that may be not suitable for all breast shapes.     

双环法缩乳技术的改进

目的：寻找一种设计简单、易于掌握且切口瘢痕较隐蔽的巨乳缩小整形手术方法。方法：将传统双环法缩乳术加以技术改进，使内外环的设计定位合理、简单。结果：临床应用此方法为32例63只乳房行巨乳缩小或乳房下垂矫正，仅1例部分切口学期愈合，无乳头乳晕坏死或乳头感觉受损等并发症发生，效果满意。结论：改良后的双环法缩乳术具有设计容易、效果理想的     

改良双环切口巨乳缩小术

目的：探讨一种设计简单、操作灵活，术后切口隐蔽、外形恢复较好的乳房缩小整形术式。方法：在保留双环切口的基础上加以改良，尤其是塑形后乳腺组织和肋骨骨膜的牢靠固定。结果：术后乳房切口隐蔽，外形恢复较好，未见下垂复发。结论：改良的双环形乳房切口是一种设计简单、操作灵活、切口隐蔽、外形恢复较好的乳房缩小整形术式。     

Quality of life after reduction mammaplasty

Reduction mammaplasty is a common procedure in plastic surgery. Patients seek the operation for neck and lower back pain, and social and emotional problems. The evaluation of health results based on the patient's opinion has become an important and reliable method for the analysis of alterations resulting from treatment. To evaluate the impact of plastic surgery on the quality of life of patients with mammary hypertrophy we used the SF‐36 standardised questionnaire in a prospective study of 44 patients preoperatively and three and six months postoperatively. There were significant improvements in seven of the eight aspects of the SF‐36 (physical function, physical role, pain, energy, social function, emotional role, and mental health). Only general health was unchanged.