Mondor's disease and aesthetic breast surgery: Report of case secondary to mastopexy with augmentation

Although the etiology of Mondor's disease remains obscure, trauma of some form is the most commonly cited cause. Surgical trauma has frequently been quoted, but references in the literature specifically implicating aesthetic breast surgery are scarce. In this article, we report a case of Mondor's disease secondary to mastopexy with concomitant augmentation mammaplasty.     

隆乳术后再次手术原因分析

目的：分析乳房假体隆乳术后再次手术的原因，探讨提高隆乳术效果和安全性的方法。方法：从假体类型、假体位置和切口选择等方面分析117例乳房假体隆乳术后再次手术的原因。结果：包膜挛缩、假体破裂和心理因素是隆乳术后再次手术的主要原因。结论：严格掌握手术适应症．选择高质量充注式乳房假体植入胸大肌后间隙是减少隆乳术后并发症和提高安全性的有效方法。     

保留皮肤全乳切除术后乳房重建的回顾性研究

【目的】探讨乳腺癌患者行保留皮肤全乳切除术联合一期乳房重建手术（SsM＋IBR）的疗效、安全性和美容效果。【方法】对本院肿瘤科收治的82例行SSM＋IBR的乳腺癌患者进行回顾性研究,观察患者术后局部复发／转移发生情况,进行乳房重建满意度调查问卷,比较放疗组和未放疗组满意度情况。【结果】患者住院平均时间为18．5d,随访9～42个月。在全程辅助治疗下,局部复发患者5例,7例发生远处转移。82例中61例采用扩大背阔肌肌皮瓣进行一期乳房重建,其中18例患者发生背部血肿;5例患者采用单纯假体进行一期乳房重建,1例发生假体包囊挛缩;8例采用背阔肌肌皮瓣联合假体、4例采用带蒂横行腹直肌肌皮瓣、4例采用游离腹壁下动脉穿支皮瓣,5例发生局部皮瓣脂肪坏死。【结论】乳腺癌0～Ⅱa期患者的治疗和重建效果较好,对于局部复发和远处转移的患者可及时发现、早期干预。SSM＋IBR手术对于乳腺癌的复发和转移未有明显影响,且重建后美观度较好,患者较为满意。     

Reduction mammaplasty: A safe and effective outpatient procedure

Traditionally, reduction mammaplasty has been performed on an inpatient basis with a one to two day hospitalization. Many procedures once commonly performed on an inpatient basis have been shown to be safe and effective when performed in an outpatient setting. The purpose of this study was to determine if reduction mammaplasty could be performed safely on an outpatient basis and to compare findings between inpatient and outpatient groups. An outcome based retrospective review of patients who had bilateral reduction mammaplasty from 1989 to 1993 was performed at two centers. Minimum follow-up was nine months. Of 331 patients, 161 were outpatients and 170 were inpatients. Seventy-six percent of the surgeries were performed in the hospital and 24 percent at a free-standing surgical facility. There were no statistical differences between the two groups when comparing age, marital status, preoperative health status, operative technique, and resection weight. Evaluation of patient body weights, use of antibiotics, and complications did reveal statistical differences between the two groups. The inpatients were heavier, more likely to experience a complication, and less likely to receive antibiotics. There was, however, no difference between the two groups for incidence of rehospitalization, return to the emergency department, or reoperation.A patient satisfaction survey was conducted with both out-patient and inpatient groups reporting high satisfaction with their results. Over 95 percent of patients in both groups felt the experience was a positive one. The survey indicated high patient acceptance of breast reduction on an outpatient basis for the outpatient population. The data confirms that reduction mammaplasty is a safe and effective procedure when performed on an outpatient basis. The cost savings associated with outpatient surgery is significant and an important consideration in this era of health care reform.     

Role of pre-emptive analgesia in reduction mammaplasty

Pre-emptive analgesia is an antinociceptive treatment that prevents altered central excitability from high intensity noxious stimuli. The aim of this study was to evaluate the efficacy of pre-emptive analgesia in patients due to have elective breast reduction that usually requires drugs for postoperative pain control. Sixty women, ASA grades I-II, were randomly divided into two groups: 30 patients were given ropivacaine infiltration 1.5 mg/ml plus adrenaline 1/200000 in normal saline 100 ml before the skin incision, and 30 had normal saline 100 ml plus adrenaline 1/200000 infiltrated. Postoperative pain was evaluated by an observer who was unaware of the treatment given, and scored on a visual analogue score (VAS) during the first 72 hours postoperatively. Analgesic requirements were recorded. There was a statistically significant difference between groups in the amount of additional pain control required during the early postoperative period, which suggests that pre-emptive analgesia reduces pain after reduction mammaplasty.     

Reduction Mammaplasty and the Use of Dextran Against Thromboembolism

A retrospective study was conducted on 98 consecutive patients who had reduction mammaplasty done by different techniques during 1995, to find out the effect of dextran 70 on operative blood loss and postoperative complications. The most common procedure was reduction with a laterally based flap ( n = 67) followed by a Lejour vertical mammaplasty ( n = 15) and a medially based flap ( n = 12). Four had other operations. Dextran 70 was given peroperatively to 64 patients and their median (range) blood loss was 350 (30-1000) ml and drainage volume 80 (10-465) ml. In 33 patients not treated with dextran 70 the median (range) blood loss was 200 (25- 650) ml and the drainage volume 40 (0-115) ml. Ten patients developed major complications and 16 minor complications and there was no difference in the complication rate between those given dextran 70 (18/64, 28%) and those who were not (8/33, 24%), p = 0.8. Complications were no more common in smokers, overweight patients or those whose breasts were reduced by more than 1500 g, but there was a tendency to find more complications after the Lejour vertical mammaplasty. In conclusion, the study shows that patients undergoing mammaplasty and given Dextran 70 have an acceptable blood loss and drainage. In patients with a high risk of developing thromboembolism there is a need for a prophylactic agent and this study shows that dextran 70 may safely be used during reduction mammaplasty.     

Mastotrainer new version: realistic simulator for training in breast surgery

The “Mastotrainer” was introduced as a new concept of simulators for use in surgical training. Simulators of this type are critical as the use of cadavers is limited or prohibited in some countries. The Mastotrainer has proved very useful in training various surgical techniques, with the first version of the simulator being focused on breast augmentation and reconstruction following mastectomy.This current project explores use of a new version of the surgical simulator that can facilitate a broader spectrum of procedures in the training of breast surgeons as well as plastic and reconstructive surgeons in order to achieve better outcomes.With this new version of the mastotrainer, larger and ptotic breasts provides hands-on training for preoperative markings, various mammaplasty techniques, including breast conserving surgery, reconstructive lumpectomy and oncoplastic procedures. It is valuable for training oncologic, aesthetic and/or reconstructive breast surgeries.     

A Retrospective Analysis of 3,000 Primary Aesthetic Breast Augmentations: Postoperative Complications and Associated Factors

Background A large retrospective analysis was performed on a homogeneous group of patients undergoing primary aesthetic breast augmentations to define complication rates and find associated factors. Methods Data were collected from the personal databases of two different surgeons working at the Crown House Hospital, Oldbury, Birmingham, United Kingdom. The period considered was January 1996 to December 2001. All patients who received primary breast augmentation with or without associated mastopexy for cosmetic purposes were recorded. Results A total of 3,002 women were included in the study. Hematomas were present in 46 patients (1.5%), infections in 33 patients (1.1%), breast asymmetries in 23 patients (0.8%), rippling in 21 patients (0.7%), and capsular contractures in 14 patients (0.5%). The multivariate analysis found that implant placement and the technique used for pocket creation were variables associated with complications (p < 0.05). Capsular contractures carried a progressive cumulative risk and, in our series, appeared 5 years after surgery. No association was found between contractures and hematomas or infections. Conclusions The overall incidence of complications in our series was relatively high (4.6%). Surgical placement of prostheses and the technique used for pocket creation were associated with complications. However, few patients required reoperation (1.6%), and the overall satisfaction rate was acceptable (visual analog score, 7).     

胸背动脉穿支皮瓣在乳腺癌保乳手术一期乳房部分重建中的应用

目的 评价保乳手术联合应用带蒂胸背动脉穿支(thoracodorsal artery perforator,TDAP)皮瓣行一期乳房部分重建(immediate partial breast reconstruction,IPBR)的皮瓣设计、手术结果、重建乳房外观以及供皮区并发症情况.方法 回顾性分析复旦大学附属肿瘤医院乳腺外科2004年11月-2010年11月13例应用带蒂TDAP皮瓣行BCS+ IPBR手术的乳腺癌患者随访资料.结果 胸背动脉主要穿支的位置位于腋后线、腋皱襞下7.5～9.5 cm(中位距离8.0 cm),穿支术前多普勒超声体表定位与术中解剖的位置符合率为100％.单纯解剖穿支1例,余12例均在穿支周围保留1.0～3.0cm宽度的部分背阔肌.术后随访4～71个月,中位随访时间41个月.所有皮瓣均存活,供区均无血清肿及背阔肌功能障碍.重建乳房的外观以患者自我评价及门诊随访医生评价相结合的方式进行评估,结果9例为优良,3例为一般,1例为差.结论 TDAP皮瓣能满足乳腺癌保乳术后任何象限的局部缺损修复和重建,特别对于肿块局部切除活检后保乳的患者来说,能很好的重塑乳房外形,患者满意度较高.术前应用手持式多普勒超声对胸背动脉的主要穿支进行体表定位,有助于术中快速找寻及解剖穿支,减少血管损伤及血管危象的发生.     

改良垂直上蒂乳房组织瓣乳房缩小成形术

目的探讨应用一种新的可适用于各种程度乳房肥大及乳房下垂的巨乳缩小术。方法在乳房中下部设计1条横向的弧形切口，切口须低于第4肋间水平的高度。切除该切口与乳房下皱襞之间多余的乳房组织，并在乳晕两侧各切除1块三角形的表皮真皮全层皮肤，然后将所余乳房组织塑形成新乳房。结果共行45例手术，术后外观令人满意，组织切除量及乳头提升达到预期要求，未伤及第4肋间神经外侧皮神经前支。除3例乳房伤口轻度裂开，经局部治疗后愈合，未影响手术效果外，无其他并发症发生。结论本手术方法可适用于各种程度的乳房肥大及乳房下垂，术后乳头乳晕复合体感觉正常，乳头勃起状态良好，乳房外形自然饱满，是一种简单、实用、令人满意的手术方法。