Augmentation Mastopexy with Implant and Autologous Tissue for Correction of Moderate/Severe Ptosis

Purpose: Breast augmentation combined with mastopexy is associated with a significantly higher complication rate than augmentation alone. The combination of mastopexy and breast implants has revealed a moderate recurrence of breast ptosis in many patients particularly with use of medium to large implants. Ptosis is the “bottoming out” of the breast tissue with loss of the desired roundness, due to the ptosis of the breast implant and the mammary tissue. In this study, we hypothesize the need for careful planning and careful preoperative surgical execution to minimize this complication. Patients and Methods: Between January 2007 and July 2011, augmentation mastopexy with implant and autologous tissue (“double implant”) was performed for 25 patients with grade III mammary ptosis. All patients underwent inverted-T mastopexy with supramuscular moderately cohesive gel breast implant using an inferior-based flap of de-epitelialized dermoglandular tissue and a superior-based nipple-areola complex pedicle. Results: An inferior-based flap of deepithelialized dermoglandular tissue was used to stabilize the implant and is projection. Breast lifting was performed through a strong anchorage to fascia and to muscle of second intercostal space, improving the profile of the breast. Results were analyzed, no breast ptosis recurrence was noted at 30-month follow-up. Conclusions: Our technique presents the challenge of determining the amount of excess skin to be removed after implantation to create symmetry and provide for skin tightening without compromising tissue vascularization.     

应用解剖型假体隆乳治疗轻中度乳房下垂

目的探讨应用解剖型假体隆乳术治疗小乳症伴轻中度乳房下垂的方法及效果。方法对15例患小乳症伴乳房轻中度下垂者应用解剖型ST-410假体行乳腺下隆乳术，根据术后患者满意度判断手术治疗效果。结果15例乳房轻中度下垂者通过此方法均获得很大改善，患者均感满意。结论应用解剖型假体行乳腺下隆乳术可明显改善轻中度乳腺下垂。     

A Systematic, One-stage Approach in the Treatment of Tuberous Breast Deformity

During a 2-year period, we performed a single-stage procedure on 7 patients with unilateral “tuberous” breasts after thorough analysis of the deformity and the contralateral breast. Deficient breast envelope skin was replaced by use of a laterally based random inframammary cutaneous flap. Breast tissue rearrangement with or without augmentation was required to address the parenchymal maldistribution and volume abnormalities. Associated tuberous breast ptosis was adequately corrected by tissue rearrangement, augmentation, and circumareolar mastopexy. Areola herniation and size were adjusted by performing a circumareolar mastopexy. Relocation of the inframammary crease was necessary to achieve symmetry. There were two complications in two patients: In one patient a staphylococcal infection developed in the breast pocket after a traumatic hematoma that occurred 2 weeks after surgery. Another patient required implant exchange for a smaller one to achieve better symmetry. Nipple sensation was not affected adversely by the surgery. Ultimately, all patients achieved acceptable symmetry and were satisfied with the results.     

Development of the inframammary fold and ptosis in breast reconstruction with textured tissue expanders

Tissue expansion has become the most important method for postmastectomy breast reconstruction. However, well-defined inframammary fold and ptosis are difficult to achieve with this technique. This study was performed to evaluate the inframammary fold and ptosis achieved in breast reconstruction using a textured tissue expander, later replaced by a textured implant. In ten postmastectomy patients, a textured tissue expander was inserted into a submuscular pocket. Every two to three weeks the volume of the expander was increased by about 30%. About three months after the last filling, the expander was removed and replaced with a permanent textured, gel-filled implant. The profile of the reconstructed breast was recorded before and after the tissue expansion, as well as before and after the change of the implant. The results showed that the inframammary fold did not move significantly upwards or downwards during the expansion period when a textured tissue expander was used. Waiting three months after the last inflation of the expander before replacing it with the permanent implant resulted in a more ptotic breast mound. Usually, however, no real ptosis was achieved, meaning that the angle between the lower part of the breast and the lower chest wall was more than 90 degrees. These findings indicate that a textured expander could help create a pronounced inframammary fold, but without ptosis. A three-month waiting period before inserting the permanent implant may improve the development of an inframammary fold.     

Our own experience in the treatment of hypotrophy and ptosis of the breast]

The outcome of surgical of small, ptotic breasts is reported in a retrospective series of fifteen patients operated between 1983 and 1989. Seven patients underwent breast augmentation by insertion of breast implant supplemented in one case by a dermopexy while eight patients underwent cutaneous and glandular remodeling alone. Simple breast augmentation with breast implant gave good results with mild to moderate ptosis (i.e. when the distance between the inferior margin of the clavicle and the upper margin of the areola was equal to or less than 17 cm) provided that: the subareolar segment III did not exceed 5 cm, the skin had good static qualities for breast suspension, the amount of glandular, adipose and cutaneous tissue present allowed the prothesis to be covered by a sufficiently thick layer. With breast ptosis greater than 17 cm or when segment III exceeded 5 cm, cutaneous remodeling by dermopexy was associated with insertion of breast implant. In this group of patients treated, either by breast implant alone, or associated with dermopexy, results were good in 33%, and satisfactory in 50% of cases. Better results were obtained in patients with marked ptosis and breasts which, although hypotrophic, conserved a amount of adipose and glandular tissue sufficient to allow breast reconstruction by soft tissue remodeling alone (without the insertion of an implant). Patients in this group were treated by glandular and cutaneous remodeling with good to excellent results in 80% of cases.     

The correction of breast ptosis with the expander mammary prosthesis

The major disadvantage of breast ptosis correction using the standard mastopexy procedure is the visible scarring. The use of an implant alone is often inadequate, especially in the more ptotic breast. A technique employing a submuscular expandable mammary prosthesis together with release of the breast tissue from the underlying muscle is described. This method enables correction of greater degrees of ptosis than is possible with implant placement alone.     

不同方法乳房重建术的患者报告结局

乳腺癌术后乳房重建可以提高患者的自尊和健康相关的生活质量,重建方式有自体组织重建与假体重建。自体重建有不同自体组织;假体重建有一步法与二步法,假体植入物有不同类型,按重建时间分为即刻与延期重建;重建后可能需要放疗。不同重建材料、重建时机和术后放疗,都可能会对乳房重建患者的报告结局产生影响。本文就不同方法乳房重建术的患者报告结局的研究进展作一综述。     

乳房再造术的临床研究

目的 回顾总结了乳癌根治术后应用单纯假体植入、Becker可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣(TRAM)移植、扩大的背阔肌肌皮瓣(ELDF)移植乳房再造术的经验,探讨手术的适应征、方法和效果.方法 16例行保留皮肤的乳癌根治术一期假体植入乳房再造;13例行Becker可扩张假体植入一期乳房再造;4例行单蒂下腹部横形腹直肌肌皮瓣(TRAM)移植乳房再造手术,其中2例为一期再造,另2例为二期再造.应用Becker可扩张假体行二期乳房再造1例.扩大背阔肌肌皮瓣(ELDF)移植二期乳房再造1例.结果 手术效果满意,优良率超过90%.3例病人出现轻微并发症,其中1例皮瓣局灶坏死,一例出现保留的乳头乳晕部分坏死,1例出现血清肿.结论 单纯假体植入适用于瘦小病人,对侧乳房小且没有明显下垂.优点是不增加额外瘢痕,术后恢复快;可扩张假体植入乳房再造适用于乳房大或改良乳癌根治术的患者,此法结合了单纯假体植入法和组织扩张术乳房再造术的优点;TRAM和ELDF皮瓣移植乳房再造的优点是自体组织移植,安全、手术效果好.     

扩大背阔肌肌皮瓣乳房再造

目的 介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法.方法 将背阔肌周围脂肪组织分为5个区,切取背阔肌及周围脂肪组织,不应用乳房假体,进行即时或后期乳房再造.结果 应用该方法再造乳房95例,其中保留乳头乳晕改良根治术后即时再造24例,保留皮肤改良根治术后即时再造36例,改良根治术后即时再造26例,后期再造9例,其中1例为改良根治术后,其他8例为改良根治术后,再造乳房均形态良好.术后6例乳头部分坏死;14例胸部皮肤表皮脱落,自行愈合;2例背部供区部分坏死;背部顽固性血清肿2例,再次手术后愈合.结论 扩大背阔肌肌皮瓣乳房再造安全有效,再造乳房形态良好,尤其适用于中、小乳房的乳房再造.     

The use of implants in ptosis, hypertrophic and breast deformities

Breast precise analysis, due to a partial or global diformity, total or minor tuberous breast allows an interesting appreciation of the skin and gland importance in breast modifications. This same analysis enables us to consider the ptosis and hypertrophies under a different angle. Thus, the relative proportions in between the various segments, their evolution in the time and especially the glandular distribution mode, sometimes leads to a different technical approach. To ensure a better glandular distribution, an important factor of the breast stability, the use of a mastopexy, which everyone knows the limits, appears under a new light and, more often than one thought, the use of a breast implant ensures homogeneity of consistency and a more long term result. Concerning the various skin modifications, their specific analysis permit to establish the type of incision used for a better-adapted scar result. The approach we suggest, (detailed analytic study of the breast, glandular distribution, relative proportion of the different breast levels and a more frequent use of an implant) which in any case should not be systematic, can obviously in certain situation optimize the quality of the result (long term projection and a better stability of the mammary shape).     

乳晕切口法解剖型假体隆乳术治疗轻度乳房下垂

目的探讨应用解剖型假体(又称泪滴型假体)隆乳术矫正轻度乳房下垂的可行性及临床效果。方法术前依据原乳房三维形态,测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据,以确定所需采用的假体类型、容量及下垂乳房下皱襞距离,选用乳晕切口对36例轻度乳房下垂者应用麦格410解剖型假体行隆乳术。结果全部隆乳者术后乳房挺拔,下垂基本得到矫正,受术者均表满意。结论应用解剖型假体的隆乳术是目前矫正有增大乳房容积愿望的轻度乳房下垂者的最佳选择之一。     

扩大背阔肌肌皮瓣乳房再造

目的　介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法。方法　将背阔肌周围脂肪组织分为 5个区 ,在背部设计半月形皮肤切口 ,切取背阔肌及周围脂肪组织 ,不应用乳房假体 ,进行即时或后期乳房再造。结果　应用该方法乳房再造 35例 ,再造乳房形态良好。结论　扩大背阔肌肌皮瓣乳房再造 ,安全有效 ,再造乳房形态良好 ,是乳房再造的重要进展。     

改良双环法乳房下垂矫正术

目的:介绍改良双环法行乳房悬吊术的方法和经验。方法:采用传统的双环法环乳晕切口,切除双环间表皮,在皮肤与上半乳腺的腺体表面之间剥离,去除上半腺体后松弛的浅筋膜深层,上提腺体至正常位置并固定于深筋膜,同时进行腺体的适当折叠塑形或置入乳房假体增加丰满程度。结果:共行轻、中度下垂28例(4例为单侧下垂),其中悬吊加假体隆乳9例;腺体瓣交叉缝合悬吊塑形19例。术后乳房外形改善满意,乳头、乳晕感觉良好,效果持久。结论:本手术方法安全易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法。     

“Tear-Drop Augmentation Mastopexy”: A Technique to Augment Superior Pole Hollow

Breast ptosis classification systems focus on the inferior descent of the nipple, as well as the descent and distribution of the breast parenchyma below the inframammary fold. Common problems, such as development of a superior pole hollow and an excessive width of the superior pole, extending into the axilla, are not addressed. Few procedures specifically address these deficiencies, and even less information is available in terms of preventative maneuvers when augmentation is desired as an adjunct. Round implants worsen the problem by creating a superior pole shelf, and anatomic implants are unreliable alternatives. Here, we present a technique—tear-drop augmentation mastopexy—that addresses superior pole hollow, excess superior pole width, as well as breast ptosis and hypomastia. Patients with moderate to severe breast ptosis (Regnaults classification), tubular breast deformity, and deformities secondary to previous breast surgery are included in the study. Skin is deepithelialized through a circumareolar incision, and a skin-fat flap is elevated completely encircling the breast. A 2-cm area of parenchyma is left attached to the skin in the lower half of the breast. Breast parenchyma in the superior half of the breast is then advanced and plicated in a superiomedial direction to move the nipple areolar complex to the desired new position. Care is taken to redefine the pectoralis major muscle at its axillary border. A 3-cm incision is then placed in the inferior part of the parenchyma at the 6 oclock position to create a subpectoral pocket for placement of the implant. The tunnel is then closed to separate the implant pocket from the subcutaneous dissection. Residual dermal flap is used to define, and add durability to the parenchyma reshaping procedure. A 3-0 mersiline (Ethicon, Somerville, NJ) blocking suture is used for a uniform circumareolar skin closure. Patients (n:35), ages 17–48, underwent tear-drop augmentation mastopexy between January 1999 and September 2002 for correction of the breast ptosis, tubular breast deformity, and deformities secondary to previous aesthetic breast surgery. The average follow-up was 2 years. All patients displayed type 1 or 2 (Baker classification) capsules. One subcutaneous hematoma and one subcutaneous seroma were seen, which were both treated by percutaneous aspiration. No submuscular hematomas, infections, skin or nipple losses, or hypertrophic scars were noted. Patient satisfaction was high. A more natural tear-drop breast shape was created with an improvement in the superior pole hollow and narrowing of the superior breast. The smallest breasts did not benefit from this technique for elimination of the superior pole shelf, as correction was proportional to the amount of breast tissue available for superior advancement. The tear-drop augmentation mastopexy is a novel technique for correction of the breast ptosis with augmentation, avoiding problematic development of superior pole hollow and excess superior width. This technique is also well applied to tubular breast deformity as well as to secondary breast procedures. Long-term follow-up demonstrates a safe and reproducible result with high patient satisfaction. This technique may solve several problems associated with breast ptosis surgery, which before were not specifically addressed, and the technique warrants further investigation.     

Autoaugmentation Mastopexy with an Inferior-Based Pedicle

Mammaplasty for breast enhancement and correction of ptosis augmentation is described. Between 2002 and 2007, autoaugmentation mammaplasty was performed for 27 patients (age, 48 ± 7.3 years) using an inferior-based flap of deepithelialized dermoglandular tissue inserted beneath the breast parenchyma of a superior-based nipple-areolar complex pedicle. The results confirmed that autoaugmentation mammaplasty corrects ptosis while increasing the projection and apparent volume of the breast. The degree of inframammary fold (IMF) descent 6 months after surgery generally paralleled that of the nipple. The mean level of the IMF was below the mean level of the nipple. Postoperatively, the optimum distance had been largely achieved. The advantage of the technique is that it optimizes the shape and volume of the breast without the use of an implant.     

硅胶假体隆乳术矫正乳腺萎缩伴轻度下垂

目的:一次性完成隆乳并同时矫正乳房轻度下垂。方法:经腋窝切口将乳房假体置入胸大肌后间隙。结果:28例乳腺萎缩伴乳房轻度下垂患者术后乳房及乳头形态位置良好,乳头感觉及勃起正常。结论:经腋窝切口隆乳术能同时矫正下垂乳房,创伤小,瘢痕隐蔽,效果稳定可靠。     

Endoscopic breast subpectoral augmentation for second-degree breast ptosis

Glandular ptosis and first-degree ptosis are treated routinely with breast augmentation in select patients. Second-degree ptosis is difficult to treat with breast augmentation alone. Patients must be well informed and selected properly to obtain a satisfactory result. Historically, second-degree ptosis is treated most commonly with subglandular augmentation. The authors demonstrate that second-degree ptosis may be treated using endoscopic subpectoral augmentation. They think that the endoscopic approach gives more control and precision in the lowering of the inframammary fold and the placement of the implant. Additionally, there may be a decrease or maintenance in the distance from the clavicle to nipple because of shortening the pectoralis major as a result of dividing it from the sixth rib at the sternal attachment laterally to the serratus fascia.     

Deep inferior epigastric perforator flap for successful simultaneous breast and chest wall reconstruction in a Poland anomaly patient

Breast reconstruction in female Poland anomaly remains a surgical challenge with variable chest wall deformity and nipple position. Pedicled latissimus dorsi myocutaneous flap with implant reconstruction may have several drawbacks and complications. Free deep inferior epigastric flap (DIEP) flap is a reliable option for postmastectomy breast reconstruction, but rarely reported in Poland anomaly. We presented a 52-year-old Poland anomaly patient who underwent successful reconstruction for breast and chest wall deformity using DIEP flap. Preoperative ultrasound Doppler study for internal mammary vessels is recommended for microsurgical anastomosis. Care should be taken with regard to the flap inset and the location of the nipple areolar complex.     

Periareolar mastopexy with mammary implants

We present our experience with using a periareolar mastopexy technique combined with prosthesis implantation to correct mammary ptosis, misplaced areolas, and tuberous hypoplastic breasts. We draw a circle around the areola and deepidermize the skin between them. We enter the glandular tissue and introduce the implant in a submuscular pocket. A purse string suture of nonabsorbable material is used to gather the excess skin. Results were satisfactory in all cases. During the immediate postoperative weeks the shape was flatter and protruded less, but a progressive correction was observed. The tuberous breast could be released and reshaped adequately. Misplaced areolas can also be replaced correctly by drawing the periareolar circle and ellipse in eccentric forms. This technique does not allow great elevation of the areola (no more than 4–5 cm), but it is good and safe for correcting minor to moderate ptosis combined with volume augmentation.     

几种乳房再造术的临床应用体会

目的：探讨乳腺癌根治术后应用单纯假体植入、可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造的适应证、手术方法、手术效果。方法：本组共24例病例。14例乳腺癌患者行保留皮肤的乳腺癌根治术，Ⅰ期行假体植入乳房再造；6例采用改良乳腺癌根治可扩张假体植入Ⅰ期乳房再造；4例接受单蒂下腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造手术，其中2例为Ⅰ期再造，另2例为Ⅱ期乳房再造。结果：手术效果较满意，2例出现轻微并发症，其中1例皮瓣局灶坏死，另1例出现乳头乳晕部分坏死。结论：单纯假体植入适用于乳房小，没有明显下垂的瘦小病人。优点是不增加额外瘢痕，术后恢复快；可扩张假体植入乳房再造适用于乳房大或改良乳腺癌根治术的患者，此法结合了单纯假体植入法和组织扩张的优点：TRAM皮瓣移植乳房再造的优点是自体组织移植，安全、手术效果好。