Vertical Scar with the Bipedicle Technique: A Modified Procedure for Breast Reduction and Mastopexy

Background Reduction mammaplasty and mastopexy are commonly performed aesthetic procedures. One such procedure, the vertical scar technique, has gained popularity in recent years, and various types of pedicles have been designed and associated with it. The vertical scar with the bipedicle technique is one such combination that ensures nipple safety and minimizes scarring, with a good aesthetic result. Method With the vertical scar marked on the outside and the bipedicle flap marked on the inside, the procedure was performed for 23 patients. Results Between 2004 and 2006, 17 reduction mammoplasties and 6 mastopexies were performed. The average tissue resection was 360 g, and the average blood loss was 70 g. The average preoperative nipple–areolar complex was 28 cm (range, 23–41 cm). Good results were achieved for the majority of the patients, with no nipple loss or loss of sensation. Conclusion The vertical scar bipedicle technique, a combination that meets the requirement of minimum scarring and a robust blood supply to the nipple–areolar complex, is a suitable option for selected reduction mammaplasty and mastopexy.     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上,设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过10例20只乳房的临床应用,取得了满意效果。     

乳房外上真皮乳腺单蒂瓣巨乳和垂乳缩小整复术

目的　探讨乳房缩小美容术保持乳头乳晕血运感觉的方法。方法　采用宋氏巨乳缩小术方法设计切口,以乳头乳晕上方及外侧真皮乳腺单蒂供应乳头乳晕血运和神经支配,完成乳腺整形。１９９６ 年１ 月～１９９８ 年１２ 月对１８ 例３０ 侧巨乳和１２ 例２２ 侧垂乳进行手术。结果　新乳房外形满意,乳头乳晕血运感觉保留好。结论　该法切口瘢痕小、乳头乳晕血运感觉良好,适合于不同轻重程度的巨乳垂乳,可作为乳房肥大或松垂的重要手术方法     

乳腺基底蒂乳房缩小整形术

在乳房深部血供的解剖学研究基础上，设计了以乳腺基底部的腺体组织为蒂携带乳头、乳晕移位的乳房缩小整形术。通过１０例２０只乳房的临床应用，取得了满意效果。     

Reduction mammaplasty: A medicolegal hazard?

In spite of the potential for complications and poor results, reduction mammaplasty remains a procedure with a high degree of patient satisfaction. Although thousands of cases are done annually, only a small percentage of the patients are unhappy enough to consider a law suit. A questionnaire was sent to the members of the ASPRS. Thirty-eight percent of the members responded and 11% indicated that they had been sued at least once for this procedure. A review of the results of the questionnaire and suggestions for reducing the number of dissatisfied patients are presented.Presented at the annual meeting of the American Society for Aesthetic Plastic Surgery, New Orleans, LA, April 15, 1986     

Long-Lasting Evolution of Ptosis Control After Reduction Mammaplasty Using the Hammock Technique

Background The hammock technique combines inferior pedicle mammaplasty with retropectoral and inferior suspensions to prevent displacement of breast tissue toward the inferior mammarian pole. This study aimed to assess the long-lasting internal suspension with the author’s mammary reduction technique. Methods From 1987 to 2005, the hammock technique was performed for 623 breast reduction patients (1,201 breasts), including 318 women (636 breasts) who underwent the technique between 1994 and 2005. From the latter group, the author retrospectively reviewed the case histories of 281 patients who had come for long-term follow-up evaluation. All had significant ptosis associated with breast hypertrophy. Preoperative and postoperative examinations included evaluation of postoperative bottoming out by monitoring of three measurements: the sternal notch-to-nipple length, the inferior areolar border-to-inframammary fold length, and the distance between the inframmary fold and the projection of the lowest breast contour on the chest wall. Results The evaluation data on postoperative ptosis are derived from a control study at 30 months, 5 years, and 7 years or more for 281 women (562 breasts) of the 318 who underwent surgery using this technique over the 11-year period. Review after 2.5 to 7 years or more shows that inferior areolar border-inframammary fold distance increases no more than 10 mm. Conclusions The hammock technique suspension achieves true permanent breast lifting through dermis strips from the inferior pedicle itself. This procedure also gives predictable results, a low morbidity rate, and good breast shape.     

Reduction mammaplasty and axillary-subclavian venous thrombosis

We present a woman with distinct mammahypertrophy and simultaneous catheter-associated axillary-subclavian venous thrombosis characterized only by chronically dilated collateral vein over the chest. Despite this massively dilated subcutaneous vein covering the chest on the affected side, bilateral reduction mammaplasty of modified Pitanguy method was successfully performed among protection of this collateral vein.     

Reduction mammaplasty: A comparison of outpatient and inpatient procedures

A review of the procedure, postoperative outcome, and expense of outpatient inferior pedicle reduction mammaplasty was compared with inpatient hospital treatment. Twenty outpatient procedures were compared with an equal number of inpatient procedures. Medical and social backgrounds of the two patient populations were similar. The findings indicate that bilateral breast reduction can be performed safely and cost-effectively as an outpatient procedure.     

内上腺体蒂乳房缩小成形术

目的 探讨一种能够保持乳房功能和形成良好外观的乳房缩小成形术。方法 根据乳房肥大的程度设计不同类型的皮肤切口，采用内上腺体蒂技术，切除外上方和下方过多的乳腺组织，将保留的乳腺组织重新塑形，切除多余的皮肤后缝合切口。结果 本组36例72侧乳房术后形态良好，无并发症，乳头乳晕感觉良好，效果满意。结论 内上腺体蒂技术是一种安全、有效的手术方法，能获得持久的塑形效果，通过选择不同类型的皮肤切口可以适用于各种程度乳房肥大的矫治。     

The Value of Scintimammography in Reduction Mammaplasties: A Preliminary Study

Reduction mammaplasty results in architectural distortion, fat necrosis, and heavy scarring of the breast. In such conditions, mammography (MG) might not be reliable and an alternative unfailing imaging technique is demanded to prevent unnecessary apprehension and biopsy. With this study, the value of Tc-99m sestamibi (MIBI) scintimammography (SCM) as an adjunct test after reduction mammaplasty was explored. MIBI scintigraphy is not affected by scar tissue or breast density and is able to differentiate benign and malignant lesions. The study was conducted on 12 women undergoing a reduction mammaplasty operation (McKissock technique). The average age was 38 and the average weight of breast tissue removed from each breast was 320 g. All patients, except one who was 21 years old, underwent MG and SCM preoperatively, and these tests were repeated at the sixth postoperative month. Preoperative MG and SCM revealed no pathology except a finding in one patient consistent with fibroadenoma. Postoperatively, the most common findings in MG were parenchymal redistribution, elevation of the nipple, and retroareolar fibrotic bands. Calcifications and oil cysts were not seen. Other findings were areola and skin thickening. Interestingly, these findings were not evident on the SCM, in fact it was not possible to state whether or not the breast had been operated on. In conclusion, SCM may not be used as screening test, but it should be considered when the postoperative MG is not informative or is complicated by scaring. In this condition, SCM may be used as a complementary method to MG and may help to prevent unnecessary breast biopsies.     

改良乳房下真皮乳腺单蒂瓣巨乳缩小术

目的为了进一步保证巨乳缩小术后乳头乳晕的血供和感觉,减少手术并发症。方法设计应用乳房下真皮单蒂瓣,并保留部分乳腺组织的垂直乳腺蒂,及切除的乳腺组织位于乳房下方两侧的巨乳缩小术,自1994年1月至1995年11月,为67例(132侧)巨乳患者在法国斯德拉斯堡欧洲美容整形诊所进行治疗。结果术后全部患者无乳头乳晕并发症,感觉正常。结论结合乳腺垂直蒂和乳房下真皮单蒂瓣的改良巨乳缩小术,不但可以确保乳头乳晕的血供,且可减少感觉损伤,降低手术并发症,及提供良好形态。     

Reduction Mammaplasty in Teenagers

Background Asymmetrical breasts are an aesthetic problem for teenagers that should be dealt with by a plastic surgeon before it causes significant psychosocial problems. Incision placement is crucial, and attempts must be made to ensure that the scar is well hidden. Methods Eleven teenage girls with asymmetrical breasts underwent unilateral reduction mammaplasty of the larger breast, and four of them also underwent augmentation of the smaller-than-normal contralateral breast with a gel-filled implant. A submammary incision was made for reduction mammaplasty, and the natural elasticity of the young skin was put to good use. Results There were no postoperative complications, and all the patients were highly satisfied with the final results. The scars are invisible, concealed in the submammary crease. Conclusions Reduction mammaplasty is feasible for teenagers. The author recommends the procedure for correction of breast asymmetry to avoid emotional and social problems in the adolescent girl.     

Breastfeeding After Reduction Mammaplasty Using Different Techniques

Background This study reviewed mammary glandular function and breastfeeding after reduction mammaplasty performed via four different surgical techniques. Patients who underwent this procedure were asked to answer questions concerning the birth of a child, natural breastfeeding, and the reasons why natural breastfeeding was not performed or was interrupted. Methods Between 1992 and 2001, 368 reduction mammaplasties were performed in the Department of Plastic Surgery at the “La Sapienza” University of Rome. After reduction mammaplasty, 105 patients had a child and were enrolled in the study. Breastfeeding data were compared with data from hospital records at the time of surgery in terms of patient age, reduction mammaplasty technique, sensitivity of the nipple–areola complex after the operation, and proportion of the gland removed. Results Maternal breastfeeding was considered to have occurred if it lasted more than 3 weeks and was not accompanied by any nutritional supplements. Babies were breastfed by 60.7% of the patients who underwent a superior pedicle reduction mammaplasty, by 43.5% of those who underwent an inferior pedicle reduction mammaplasty, by 48% of those who underwent a medial pedicle reduction mammaplasty, and by 55.1% of those who underwent a lateral pedicle reduction mammaplasty. Conclusions The findings demonstrate that conservative reduction mammaplasty techniques supported by medical and paramedical staff permit subsequent breastfeeding. In particular, the best outcomes resulted from superior pedicle reduction mammaplasty. Skilled execution of the surgical technique is mandatory to guarantee adequate vascularization and sensitivity of the nipple–areola complex and to spare as many of the glandular ducts and lobules as possible.     

外上侧真皮腺体蒂皮瓣缩乳术

目的　介绍一种适用于中、重度乳房肥大的矫正术。方法　采用包括乳头乳晕复合体的乳房外上真皮腺体蒂皮瓣 ,切除上、内、下方多余的乳腺组织 ;将真皮腺体皮瓣旋转、调整、固定、重新塑形 ,切除多余的皮肤后缝合切口。结果　本组 4例 8侧乳房 ,术后双乳对称 ,乳头乳晕感觉良好 ,随访病例中 1例婚育者有哺乳功能。结论　乳房外上真皮腺体蒂皮瓣缩乳术是一种能够保持乳房外观及功能的合理术式 ,适用于中、重度乳房肥大。     

竖直切口内上蒂巨乳缩小术的临床应用

目的 根据巨乳缩小术的手术原则,探讨一种既能保证乳房血供和功能,又能保持良好乳房外观的手术方式,并观察其临床疗效.方法 本组共10例乳房肥大症患者,采用竖直切口结合内上蒂法行乳房缩小术.根据术前设计,去除内上蒂表皮,形成腺体蒂,再切除外下象限多余的皮肤及腺体,重塑乳房形态.结果 术后无皮肤坏死、脂肪液化、乳头乳晕感觉减退、血肿和感染等并发症发生,切口均Ⅰ期愈合.术后随访3～12个月,患者对术后乳房外观形态及功能均表示满意,能接受术后瘢痕.结论 竖直切口内上蒂巨乳缩小术操作简单、安全,对轻、中度,特别是中度乳房肥大患者特别适用,术后和远期均能达到满意疗效.     

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.