A unique cause of a rare disorder, unilateral macromastia due to lymphangiomatosis of the breast: a case report

Macromastia and in particular unilateral macromastia is a rare clinical entity. It relates to massive enlargement of the breast in non-obese women. This case report describes an initially mild unilateral asymmetry occurring nine months postpartum in a 33-year-old female. However, following her second pregnancy within 12 months, her left breast became severely enlarged. This did not improve on delivery. No discrete lesion was seen on imaging and no significant abnormalities were seen in her blood chemistry. Surgical treatment was a mammoplasty and 580 g of mammary tissue was removed. Grossly, there was spongiform subcutaneous tissue with diffuse extension. On histology, this consisted of a highly complex and diffuse pattern of infiltration and of cavernous empty channels lined by a delicate attenuated endothelium which was CD34 and D2-40 positive. The appearances were consistent with lymphangiomatosis, more commonly encountered in the limbs, heretofore. Lymphangiomatosis has not been previously described in breast tissue and only a single case report exists for such a lesion in axillary tissue. Treatment of such lesions in the periphery by surgical excision is very difficult and excision without being radical can be impossible. Follow up of our patient, shows no evidence of recurrence in this patient. Our case report describes the clinicopathological features, differential diagnosis to be considered and treatment, in addition to reviewing the relevant literature.     

巨乳症的手术疗效比较

目的探讨不同手术方式对巨乳症的治疗效果. 方法 1993年11月～2003年11月,我科共收治巨乳症患者33例66侧,根据乳腺病变的性质、部位、大小、乳房下垂的程度,选择下述不同的术式:垂直双蒂瓣法6例,无垂直切口的横双蒂瓣法12例,双环形切口乳房缩小术15例. 结果术后外观评价:优良27例53侧,中7例13侧;术后乳房疼痛改善率96.8%(30/31),肩背痛及睡眠明显改善100%(31/31,25/25),乳房下皱襞湿疹、皮炎治愈率100%(15/15),术后着装满意率100%(33/33).结论乳房缩小整形术是治疗巨乳症的首选方法,应根据乳房肥大、下垂的程度选择不同的术式.     

晕周三环形切口乳房缩小悬吊术应注意的美学问题

目的:探讨符合美学要求的晕周三环形切口进行乳房缩小悬吊术中应注意的问题及其可行性。方法:局麻下沿晕周三环形切口切除乳房松垂皮肤,悬吊乳腺腺体,以荷包收拢方式缩小封闭晕周切口。结果:用本方法治疗松垂巨乳畸形8例,效果良好。双侧切除乳腺组织重量约0.5～0.9kg。乳头上移5～11cm。经3个月至2年随访未见并发症发生,晕周瘢痕不明显。结论:该术式由于操作简便,效果确切,乳房外观满意,瘢痕不明显,不失为一种矫正轻、中度巨乳畸形的可取方法,值得推广。     

Introducing a new section for the multimedia age

Abstract

The male or female breast/nipple/areola complex arises from a common mammary stem cell and develops similarly in the foetus and during infancy. At puberty the male's breasts remain rudimentary but the female's develop further, mainly through oestrogen and progesterone stimulation, and become more sensitive. Female breasts serve both nutritive and sexual functions, unlike other primates they develop at puberty before lactation is necessary. Their sexual attraction is through size, shape and their areolae but also, when unrestrained, their jiggling movements. Small breasts are more sensitive than large. Pregnancy and lactation increase their size. Breast feeding releases oxytocin (milk release) and prolactin (milk secretion), other functions have been proposed for the latter. The pigmented areola contains tubercles of Montgomery that secrete a fluid protecting the skin and creating an olfactory signal for baby and possibly lover; areola corrugation immediately after orgasm physically signals that orgasm has occurred. Male and female (non-pregnant) nipple stimulation has been claimed to induce prolactin secretion but confirmation is needed. Young adult women and men report that breast stimulation not only induces their sexual arousal but enhances it when already aroused.     

Chronic bilateral T1 denervation in women with macromastia

Introduction: The objective of this study was to identify the pattern of neurological deficits and document electrophysiological changes in women with macromastia. Methods: Patients with macromastia and neurological complaints underwent clinical evaluation and electrodiagnostic (EDx) studies of the upper limbs. Results: Findings include low‐amplitude medial antebrachial cutaneous (MACN) sensory nerve action potentials (SNAPs) and median compound muscle action potentials (CMAPs) and chronic denervation changes in the bilateral abductor pollicis brevis (APB) muscles on needle electrode examination (NEE), indicating axonal loss in the bilateral T1 distribution. Conclusions: The EDx data are in keeping with lesions involving bilateral T1 anterior primary rami (APR). Potential sites of compromise of the T1 APR are discussed. Further study of the effect of treatment for macromastia on the clinical and EDx findings is proposed. Muscle Nerve, 2013     

Macromastia as a Factor in Sternal Wound Dehiscence Following Cardiac Surgery: Management Combining Chest Wall Reconstruction and Reduction Mammoplasty

Major sternal wound infection occurs in nearly 2% of patients following coronary artery bypass graft surgery. The relationship of this complication to gender has not been reported in detail, nor has female breast size previously been implicated as a factor increasing the risk of sternotomy dehiscence. We report two cases of sternotomy wound dehiscence in women with large, pendulous breasts undergoing myocardial revascularization surgery and postulate that the weight of large, unsupported breasts produced inferolateral tension on the midline sternotomy incisions, contributing to dehiscence of the wounds. Chest wall reconstruction was accomplished using pectoralis muscle flaps, and the procedures were combined with amputative reduction of the size of the breasts, with subsequently successful healing in each case. Combining sternal reconstruction with breast reduction surgery may lead to improved secondary outcome, and postoperative use of supportive brassieres may reduce the frequency of this complication.     

应用扇形组织瓣治疗乳房肥大

目的:探索一种新的可适合任何程度乳房肥大及乳房下垂的手术方法,术后乳头乳晕复合体感觉良好,外形丰满、自然。方法:在乳房中下部作一横向的弧形切口,切除中央皮肤两侧袪真皮的三角区,形成扇形皮瓣,上提乳头乳晕至新的正常位置,锥体塑形成新乳房。结果:从2001年1月￣2006年5月50例术后效果令人满意,无乳头乳晕血运障碍,3例乳房中线伤口表皮裂开,经2周换药治疗愈合,未影响手术效果。结论:扇形组织瓣可适用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良好,新乳房外形丰满,是一种安全实用手术方式。     

Mckissock法与无垂直瘢痕下蒂瓣法行重度乳房肥大矫正的综合比较

目的：探讨应用Mckissock法及无垂直瘢痕的下蒂瓣法进行乳房缩小整形术的适应证、手术效果及优缺点进行对比分析。方法：2010年6月至2011年7月,我们采用Mckissock法与无垂直瘢痕的下蒂瓣法行乳房缩小整形术15例,术后患者就症状改善,外形改善,瘢痕,乳头敏感性及总体满意度进行问卷调查。结果：①15例患者术后乳房形态及乳头乳晕均较对称且外观良好;②无垂直瘢痕的下蒂瓣法较Mckissock法术后并发症发生率少,瘢痕隐蔽;③两种方法术后发生乳头乳晕血运障碍及感觉障碍无明显差异;④Mckissock法较无垂直瘢痕的下蒂瓣法切除乳腺的量稍多,术后乳房立体感良好;⑤无垂直瘢痕的下蒂瓣法较Mckissock法总体满意度高。结论：无垂直瘢痕的下蒂法及Mckissock法均适用于治疗中、重度乳房肥大症尤其对于重度乳房肥大症两种方法对乳房形态的重塑较好,总体来讲无垂直瘢痕的下蒂法术后瘢痕小且隐蔽而Mckissock法切除乳腺组织量多,两种方法各有利弊具体临床应用需要个体化分析。     

横双蒂加中央蒂真皮帽乳房缩小成形术

目的　介绍横双蒂加中央蒂真皮帽乳房缩小成形术的方法,并探讨其疗效。　方法　对8例(16只)乳房肥大病人施行手术治疗, 采用以乳头为中心的中央蒂真皮帽乳房缩小成形术, 设计双同心圆切口, 保留第4肋间神经径路乳腺组织的完整性, 切除多余乳腺组织, 环形切口缩拢缝合。结果　本组单侧切除组织量平均为(310±150)g,术后第2d查乳头乳晕感觉良好,反射存在,乳头乳晕无坏死,除1例伤口裂开行2期缝合外,余均无感染、血肿等并发症。随访6 (3 ~9)个月,外形满意,切口瘢痕不明显。　结论　横双蒂加中央蒂真皮帽乳房缩小成形术设计合理,形态好,可确保乳头乳晕的感觉及功能。