Suspicious Node Found at the Time of Reduction Mammaplasty

A case of a patient with a suspicious glandular node found during reduction mammaplasty is described. The preoperative search for such nodes, the management of cases on which a suspicious node is found intraoperatively, and a situation on which the diagnosis of breast cancer is made during histology are discussed. When a suspicious small node (with a diameter up to 2 cm) is detected during a cosmetic breast surgery, lumpectomy can be performed. It may be a definite surgical treatment, depending on stage and tumor type. In the case presented, histology revealed intraductal papiloma, a benign tumor, therefore lumpectomy was a suitable procedure with an acceptable cosmetic result. With the increased incidence of breast cancer, this situation will happen more often and technical options for the management of such cases deserves the attention of plastic surgeons.     

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.     

Vertical Mammaplasty: A Personal Approach

We have been using the vertical mammaplasty technique with personal adjustments for reduction mammaplasty and glandular resection since 1989. There were 63 cases of aesthetic reduction mammaplasty and mastopexy and 38 cases of reduction mammaplasty and mastopexy contralateral to breast reconstruction with implants and/or autologous tissues performed during the period from 1989 to 1993. The aim of this work is to discuss the complications, long-term results, and limitations to this technique.     

Specimen Radiography: An Assessment Method for Reduction Mammaplasty Materials

Although, one out of every eight women has a risk of developing breast cancer, the reported incidence of breast carcinoma detection in reduction mammaplasty materials is rather low. To our knowledge, specimen radiography, which is used for breast biopsies has not been used for the assessment of breast reduction materials. We investigated the applicability of specimen radiography and its potential benefits in detection of the breast pathologies, especially malignancies in reduction mammaplasty materials. Forty patients scheduled for reduction mammaplasty operation were included. In all cases an inferior pedicle reduction technique was preferred and the radiographs of the resected breast tissues were taken immediately. The radiographs were evaluated for any possible pathologic appearance and all abnormal findings were marked. For the histopathologic evaluation, in addition to the random sampling of the pathologist, any marked areas were also microscopically examined. In two cases fibrocystic changes were found in radiographs and the same results were obtained in the histological examination. No false negative mammogram was seen. Specimen radiography, which is applicable for breast reduction materials is an easy and cheap method and does not cause any patient discomfort. It seems that the radiographs of reduction mammaplasty materials are useful to provide guidance to the pathologist during tissue sampling for microscopic examination especially when large amounts of breast tissue is excised.     

Vertical Mammaplasty for Breast Reduction

All of our breast reduction surgeries during the last 3 years have been done in such a manner that only the vertical scar is left. Due to placing a precise marking to obtain a very nice projected breast reduced to an appropriate size and with no complications, significant patient satisfaction has been achieved. The reduction of the scar is down to almost 40% of what it would have been with an inverted ``T' scar.     

Mammaplasty for Mild and/or Ptotic Breast Through Short Incision at the Inframammary Sulcus: A Personal Approach

Small to moderate pexy and breast reduction have been treated through a 5-cm length access view incision placed at the inframammary sulcus. Resection of up to 450 g in each breast are obtained. Overlapping and plication of two glandular flaps dissected from the lower breast quadrants complete the suspension and fixation of the breast in its ideal position. The areola remain untouched.     

Augmentation Mammaplasty with a New Cohesive Gel Prosthesis

We present our experience with augmentation mammaplasty on 14 patients with a thin chest wall and poor subcutaneous tissue. Thanks to Polytech Silimed code 20675, a new anatomical prosthesis filled with ``soft' cohesive gel, the lodging in a subglandular position was possible without anomalous salience in the upper pole, and a more natural mammary profile was achieved without capsular contracture, dislocation, or misplacement of the mammary implants.     

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 Utilizing the Periareolar Approach

An analysis of 300 cases of reduction mammaplasty done utilizing a periareolar approach at the University Hospital of the State of Rio de Janeiro and our own private clinic during the period from September 1989 through October 1995 is presented in this article. The technical evolution of this procedure is described in detail as well as how the complications were eliminated and the aesthetic results improved. A thorough analysis of recommendations and comments on the results are made by the authors.     

Liposuction Breast Reduction

All breast reductions since 1996 have been performed with only liposuction. Removal of up to 2250 ml per breast has been obtained in 45 patients, without any complications. Significant skin retraction results from a very superficial subcutaneous liposuction, with a significant volume reduction of the gland. One bilateral mastopexy was performed subsequently.     

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 Triangular Suture to Simplify Reduction Mammaplasty

A technique to facilitate correct preoperative marking for an en bloc resection in superiorly based mammaplasty is presented. A temporary triangular suture is placed to control the estimated resection lines for the removal of the medial and lateral tissue block. The described technique helps to avoid the formation of medial and lateral dog ears and the unpleasant and visible scars that result.     

Vertical Mammaplasty as Secondary Surgery After Other Techniques

Vertical mammaplasty, a technique that avoids submammary scars, has proved to be a reliable method of breast reduction because it is adaptable to most cases and produces beautiful and durable results. What about secondary cases? In the last 14 cases referred for secondary mammaplasty, at 1–19 years after their initial surgery, patients' indications were poor shape (14), visible and improperly located scars (9), excess volume (8), asymmetry of the areolas (5) or the breasts (1), insufficient volume (2), and asymmetry with reconstructed breast (2). The original scars were inverted T (10), periareolar (2), oblique (1) or vertical (1). Their appearance was a concern for nine patients. All patients but one, who had long submammary scars surrounded by heavy stitch marks requiring correction, could benefit from a vertical mammaplasty. This avoided long months of scar redness and visibility along the submammary folds. Good symmetry and shape could be obtained in all cases by adjusting the markings to the needs. Liposuction was a great help to remove volume without endangering the blood supply of the areolas, possibly transforming reductions in simple mastopexies.     

Blood Loss and Hematological Recovery Following Reduction Mammaplasty and Dermolipectomy: A Prospective Study

A study was made to assess the impact of surgery on the hematological status and postoperative hematological recovery of 75 consecutive patients undergoing either reduction mammaplasty or dermolipectomy. Blood losses were estimated the morning after surgery, measuring decreases in hemoglobin level and hematocrit, while postoperative recovery was evaluated in terms of hemoglobin level and hematocrit at 10 weeks. The postoperative hemoglobin decrease was 2.69 g%, and the hematocrit dropped 7.25%. By 10 weeks, however, the patients had recovered their preoperative values. We found no significant differences in the evolution of hemoglobin level and hematocrit during the study between reduction mammaplasty and dermolipectomy patients. A significant positive correlation between surgical piece weight and postoperative reduction in hemoglobin concentration and hematocrit was observed. Conversely, at 10 weeks, a significant but negative correlation between surgical specimen weight and hemoglobin concentration and hematocrit was recorded. The anticipated weight of the surgical piece could thus be used as a predictor of intraoperative blood loss and of the speed of postoperative recovery. Since patients with surgical resection of >3 kg remained anemic at 10 weeks, oral iron supplements could benefit this subset of patients.     

Histologic Profiles of Breast Reduction Specimens

Reduction mammaplasty is one of the most common procedures performed by plastic surgeons all around the world. This procedure is performed for aesthetic or reconstructive purposes, but also offers the opportunity to examine all resected breast tissue histopathologically. The purpose of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens retrospectively and to determine the incidence of breast lesions in otherwise asymptomatic and healthy women. Therefore, 149 patients who had undergone reduction mammaplasty were reviewed with regard to their histologic diagnoses. We found that 61% of these women have pathologic alterations in at least one of their breasts, so each patient who requests a breast reduction surgery should be evaluated carefully and the specimens should be handled with particular care.     

Axillary Reduction Mammaplasty—Yhelda Felício's Technique

The problem most common to the majority of mammary reductions is patient dissatisfaction due to breast scarring or lateralization of the breast. Many of these complications can be avoided by use of an axillary approach for correction of breast ptosis via the axillary skin incisions.     

Pectoralis Major Muscle Flap: A New Support Approach to Mammaplasty, Personal Technique

Despite the significant evolution of mammaplasty techniques, some undesirable changes on the operated breasts result in evident dissatisfaction for both patients and doctors. The main reason is that the breast has a tendency to resume its previous shape months after the operation. In pursuit of a procedure that would avoid this untoward morphologic evolution, we set to work on the development of a new approach of broad fixation to maintain the breast shape and to avoid ptosis by using the inferior third of the pectoralis major muscle. The authors report their experience with 46 consecutive cases of breast reduction and mastopexy operated between March 1994 and November 1995, studying the surgical procedure employed, its advantages, limitations, and possible complications.     

Aesthetic Breast Surgery with Inverted-T Scar Placed above the Inframammary Sulcus

This article describes the inverted-T incision technique with the scar placed above the inframammary sulcus for cases of pexy, breast reduction, and augmentation–reduction mammaplasty. This technique preserves the inframammary fold as an important factor in natural breast suspension; the breast mound is easily shaped independent of the skin tension. The gland- and skin sutures are placed separately and independently. This technique has been used on 380 patients in the last 13 years.     

Blepharoplasty: A Personal Tactical Approach

The author presents his tactical approach and personal instruments for blepharoplasties. To remove the skin excess in the upper eyelid, a special half-moon forceps grasps the excess of skin, and with a very sharp scissors, it is removed in just one cut. Treatment of fat pads uses a special hemostatic forceps, unlike the conventional one that has transverse grooves, with longitudinal grooves to prevent fat sliding after the fat pads are cut, thereby preventing problems with hemostasis. In the lower eyelid, wide undermining and excision of a significant strip of skin and muscle allow an adequate correction. Ectropion is prevented, and the correction done is stabilized with orbicular muscle and skin flap anchorage on the lateral canthal tendon. Fifteen years of experience with this technique has provided excellent results.     

Our Experience with the Triple-V Transareolar Incision for Augmentation Mammaplasty

There have been many important analyses of prosthesis selection, techniques of implantation, and subpectoral or subglandular pockets, but only a few studies comparing and discussing the different approaches. The best incision must achieve a good and simple approach to the retromammary location, subpectoral or subglandular, preserving the anatomy to maintain the nerves and vessels responsible for the sensitivity and blood supply of the breast and avoiding cutting the ductus, and it must result in an inconspicuous scar. This article reports the authors' experience with the last 100 consecutive patients operated on with the triple-V transareolar technique based on the original reported by Ely. Follow-up took place over more than 2 years. The authors discuss the advantages and disadvantages of different incision placements.