The infra-areolar longitudinal incision in reduction mammoplasty

The author presents a reduction mammoplasty technique in which an infra-areolar longitudinal incision is used. The incision can be either one line, without skin removal, or an ellipse, with some skin to be removed. The gland is totally freed from the pectoral muscle and the resection of the mammary cone's base is then done, using pre-established measurements. The skin retracts spontaneously over the remaining breast tissue, which maintains its original shape in a smaller size.     

Reduction mammoplasty for macromastia

Macromastia is a common cause of physical and emotional suffering. Reduction mammoplasty can provide relief from shoulder grooving, back and neck pain, intertrigo, and symptoms of ulnar nerve compression. Similarly, emotional well being is enhanced by improved self-image, increased capacity to participate in sports and work, and the ability to wear normal, attractive clothes. In the last three years, we have performed reduction mammoplasty using the inferior pedicle technique or free nipple graft in 75 patients. Preoperative symptoms typically included back pain, shoulder grooving, and a stooped posture. Fat necrosis was the most common complication and was associated with large resections. Patient satisfaction was high for both procedures.     

A technique for reduction mammoplasty

The author presents a technique for reduction mammoplasty in which the amount of skin removed is limited to a small area in the middle part of the breast. The glandular tissue is resected laterally and medially at the caudal part of the circumference of the breast, along with a midline wedge. With this technique and with the retraction of the skin and the sutures that pull this skin to the midline, the final result is a very short horizontal scar.Presented at the VIIIth International Congress of Plastic Surgery, Montreal, 1983     

Experience with a vertical technique in mammoplasty

The authors describe their personal modification of Airé's technique which they have used since 1971 with about 160 patients. They list its significant advantages, and they also stress the limits of the technique. In particular, no more than 500 g tissue per breast are to be removed to ensure a proper mastopexy. This limit, however, is fully offset by the advantage that, when coupled to a thorought preoperative examination and performed by an experienced surgeon, the procedure cannot but result in successful mammoplasties.     

The devil's incision mammoplasty

Combination of an oblique ellipse with a halfmoon incision around the lower half of the areola is presented by the author to treat breast hypotrophy and moderate ptosis without resorting to implant of foreign material. The crescent combined with an oblique ellipse forms a little devil's figure. A deepidermized dermafat flap, with blood supply coming from the areolar area, increases the apparent volume of the breast. This technique is best used in cases of moderate ptosis in which no change in the position of the nipple is necessary. When there is hypertrophy, excess mammary tissue can be removed simultaneously with the cutaneous ellipse.     

乳晕切口巨乳缩小整形术

目的行巨乳缩小整形手术后不遗留明显瘢痕。方法采用以乳头为中心的双同心圆切口,去除表皮,同时切除以外上象限为主的乳腺组织,最后环形缩拢缝合。结果采用此法手术8例16侧,取得了仅有乳晕切口痕迹的满意效果。结论本术式行巨乳缩小简单、实用、易于掌握,值得推广应用。     

改良双环法行乳房巨大肿瘤切除成形术

目的 探讨一种既能完整切除乳房巨大肿瘤,又能保持乳房功能和良好外形的手术方法 .方法 在传统双环法基础上,根据乳房肿瘤的大小及乳头下垂的程度,设计不同形状的外环及乳房外侧S形切口线,削除两环之间皮肤的表皮,沿乳房外侧S形切口线切开皮肤、皮下组织,直达瘤体包膜,沿包膜表面完整剥离肿瘤,可见遗留一个巨大的乳房皮下腔隙,充分利用去表皮的真皮脂肪瓣或真皮脂肪乳腺瓣填充肿瘤切除后的腔隙,重建乳房形态.结果 5例乳房巨大肿瘤,术后均维持了较好的形态和功能,无1例发生乳头乳晕感觉障碍和坏死,切口愈合良好.最长随诊2年,未见瘤体复发.结论 改良的双环法行乳房巨大肿瘤切除成形术,手术设计灵活,方法 简单,术后乳房外形良好,瘢痕轻,患者满意率高.     

A versatile standardization for mammoplasty

This report presents a variable standardized technique for reductive mammoplasty, based on techniques used by Pontes and Skoog, which is easily performed, carries low risk, and gives good postoperative results. This method enables the surgeon to perform a greater variety of physiologic mammoplasties, through nipple-areola migration by the dermomammary pedicle, which is transformed easily into a dermolateral pedicle, in order to enable wider breast resections and migration of the nipple-areolar complex over greater distances. The localized submammary undermining permits greater reduction of the mammary cone base and larger filling of the upper pole.This method may be applied in any type of breast, even those which are voluminous, hard, and nonelastic.     

A fast and simple de-epidermization in corrective mammoplasty

Many corrective mammoplasty techniques are based on the use of large dermal pedicles. The author describes a fast and simple method for de-epidermization of large, dermal buried flaps or pedicles using a Mini-Dermatome.     

Augmentation mammoplasty with autologous fat grafting

Considering the issues that can accompany prosthetic breast implants, augmentation mammoplasty (AM) with autologous fat grafting (AFG) has attracted growing interest globally, especially in the last two decades, as breast implant-associated anaplastic large cell lymphoma has been increasing in incidence over time. Here, we review the detailed processes of AFG to the breast and the pertinent complications associated with this procedure. This study aims to elucidate the critical points and technique improvements in AM with AFG in recent years, as well as discuss how to decrease complications related to this procedure. Attention was focused on the specific AFG steps, clinical outcomes, and complications to highlight the advantages and disadvantages of the available protocols.     

充注式乳房假体隆乳术的改进与体会

充注式乳房假体隆乳术在我国已较广泛开展，但其手术方式、麻醉方法和术中术后处理等方面，仍有许多可探讨之处。为此，作者对６１例１２１侧小乳症、轻度乳房萎缩、乳房下垂症等行充注式乳房假体隆乳术。术中采用腋顶皱襞切口，胸大肌下间隙置入，封闭式灌注加适量抗生素的生理盐水，放置负压引流术后穿紧身衣。改用肋间神经阻滞麻醉，加静脉内麻醉，效果良好、安全，受术者术后无痛苦记忆，使隆乳术更趋完善。６１例受术者中５５例外形满意、柔软、感觉良好，２例２侧乳头和乳房外侧象限有早期感觉减退，３例乳房假体位置偏高，１例因伴乳房下垂外形欠佳。作者认为，腋顶切口，封闭式灌注加有抗生素的生理盐水，术后引流及改良的麻醉方法，值得推荐。     

A twelve year experience with reduction mammoplasty and abdominoplasty

In the last 12 years we performed mammoplasty on 191 patients, using the Wise pattern and the Strömbeck technique. In the same 12-year period, we also performed abdominoplasty in 108 patients, using the Pitanguy and the Grazer procedures. In the last four years we performed suction lipectomy in 43 patients, using the Illouz technique. In this article we present our moderate modifications on these techniques and the complications.     

Male reduction mammoplasty in serious gynecomastias

This article is a report on long-term followup of a total of 44 serious gynecomastia cases in the stages I–III (according to Deutinger). The treatment consisted of either a semicircular incision and subcutaneous mastectomy or a superiorly or an inferiorly based nipple transposition while performing male reduction mammoplasty. Aesthetically pleasing results could be obtained by a periareolar approach and mastectomy. This inconspicuous procedure is feasible even in massive gynecomastia cases (stage III) or in cases of male breast asymmetry. On the other hand, all cases with breast reduction plasty and nipple transposition resulted in wing-shaped, mainly broad scars, and subjectively unfavorable results. Consequently, we favor the semicircular approach in male reduction mammoplasty in treating serious gynecomastias. With regard to possible male breast cancer etiology, the histological specimen of the mammary gland in gynecomastia is excised prior to any additional liposuction for supplementary body contouring.     

Improved patient satisfaction with augmentation mammoplasty: The transaxillary subpectoral approach

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.     

The management of incidental findings of reduction mammoplasty specimens

Reduction mammoplasty is one of the most commonly performed procedures in plastic surgery. Occasionally, there are findings reported by pathologists that are unfamiliar to the treating surgeon. The aim of the present study was to determine the types of pathologies encountered in reduction mammoplasty specimens. From this list of diagnoses, a best practice guideline for management will be organized to better assist plastic surgeons in the management of patients with incidental findings on pathology reports. A total of 441 pathology reports from patients who underwent bilateral or unilateral reduction mammoplasty in the past three years were identified. A list of 21 different pathologies was generated from the pathology reports, along with supplemental data from recent texts and articles. Occult carcinomas were encountered in two cases (0.45%) and high-risk lesions were found in three cases (0.68%) at the authors’ institution. An algorithm was then constructed to organize the pathologies according to risk of malignancy and assign them to a management guideline. There are many different lesions encountered incidentally in reduction mammoplasty specimens that may or may not confer some cancer risk. It is important for plastic surgeons to know which lesions need closer follow-up to provide the best care for their patients.     

缩小整形与保乳术相结合在乳腺癌伴巨乳症病人中的临床应用

目的：评估对乳腺癌伴巨乳症病人行双侧乳房缩小整形术与保乳手术的可行性。方法：我院对105例巨乳症病人作了缩小整形术，对其中9例同时患乳腺癌病人在保乳基础上同时行双侧乳房缩小整形术，中位随访时间为14．2个月。结果：平均年龄45岁，平均切下含肿瘤一侧乳房标本重量为561g，肿瘤大小0．5～3cm。其中1例因切缘阳性行乳房全切除。本组术后没有出现明显的并发症，病人随访显示满意率达87％。结论：对于希望行保乳术的乳腺癌伴巨乳症病人，双侧乳房缩小整形术是可行且安全的一种方法，将是对乳腺肿瘤外科的一种挑战。     

Giant galactoceles 1 month after bilateral augmentation mammoplasty,abdominoplasty, and tubal ligation: Case report

A case report is presented of the development of giant galactoceles 1 month after bilateral augmentation mammoplasty, abdominoplasty, and tubal ligation.     

Seventeen Years of Experience with Reduction Mammaplasty Avoiding a Vertical Scar

BACKGROUND: It is important to reshape the breast with the least scar possible. This has led us to develop a technique for large breasts where the vertical scar was eliminated. METHODS: The new nipple is positioned at 19-21 cm. The level of the new inframammary line (IML) is marked 6 cm below the new areola. All the area between the marked IML and the present sulcus is de-epithelialized. The upper flap is undermined beginning from the new IML. The tissue excision is performed medially and laterally leaving a central pedicle that also carries the nipple-areola complex (NAC). The dermoglandular pedicle is shaped conically with breast-shaping sutures. The NAC is passed under the upper apron flap through its new opening. RESULTS: We retrospectively reviewed 145 patients who were operated on over the past 17 years. The mean age of the patients was 41 years. The mean distance preoperatively from midclavicle to nipple was 35.3 cm. The average weight of breast tissue excised was 1073 g per side. Seventeen patients (11%) suffered from minor complications. CONCLUSION: This technique works especially well in breast reduction cases where a large mass excision is required. The horizontal scar is obvious only when the patient is lying down and cannot be seen by the patient herself. There is no risk of destroying the circular feature of the areola, which is pulled inferiorly by the vertical scar in the other techniques.     

Reduction mammoplasty utilizing nipple-areola transplantation

Reduction mammoplasty using nipple-areola transplantation has proved to be a satisfactory procedure. It will probably be performed in an ever-increasing number of patients undergoing reduction mammoplasty as more surgeons realize that aesthetically pleasing results can be achieved.