ABSTRACT
Resumen El cáncer de mama es la patología maligna más frecuente en la población femenina, su tratamiento ha evolucionado progresivamente en dirección a la conservación del seno a través del desarrollo de la cirugía Oncoplástica de seno, que consiste en manejo conservador con mastectomía parcial y reconstrucción inmediata. Las pacientes que presentan de manera concomitante cáncer de seno y macromastia, representan un reto mayor en el tratamiento debido a la dificultad de generar simetría con el seno contralateral y que además presentan sintomatología específica relacionada con la macromastia que disminuye su calidad de vida. El objetivo de este artículo es reportar el caso de una paciente que se maneja de manera exitosa y simultánea el cáncer de seno y macromastia, mediante cirugía oncoplástica de seno derecho y en el mismo tiempo quirúrgico, mamoplastia de reducción bilateral, obteniendo adecuado control oncológico y mejoría significativa en su calidad de vida medida por cuestionario BREAST-Q. MÉD.UIS.2021;34(3): 93-101.
Summary Breast cancer is the most frequent malignant pathology in the female population. Its treatment has progressively evolved in the direction of breast conservation through the development of oncoplastic breast surgery, which consists of conservative management with partial mastectomy and immediate reconstruction. Patients who present breast cancer concomitantly with macromastia, represent a greater challenge in treatment due to the difficulty of generating symmetry with the contralateral breast; they also present specific symptoms related to macromastia that diminishes their quality of life. The objective of this article, is to report the case of a patient with breast cancer and macromastia, who is successfully and simultaneously managed with oncoplastic surgery of the right breast and bilateral reduction mammoplasty, obtaining adequate oncological control and significant improvement in her quality of life measured by BREAST-Q questionnaire. MÉD.UIS.2021;34(3): 93-101.
Subject(s)
Humans , Female , Adult , Breast Neoplasms , Mammaplasty , Quality of Life , Breast , Conservative TreatmentABSTRACT
Introducción: La mastoplastia de reducción mediante la técnica de pedículo inferior es una de las intervenciones quirúrgicas estéticas más empleadas para corregir la hipertrofia mamaria. Objetivo: Caracterizar a las pacientes con hipertrofia mamaria, a quienes se les practicó mastoplastia de reducción con la técnica de pedículo inferior. Métodos: Se realizó un estudio descriptivo, observacional, transversal y retrospectivo de 185 pacientes entre 10 y 59 años de edad, con diagnóstico de hipertrofia mamaria, atendidas en el Servicio de Cirugía Plástica y Caumatología del Hospital General Docente Octavio de la Concepción y de la Pedraja del municipio de Baracoa, a las cuales se les practicó mastoplastia de reducción por técnica de pedículo inferior, desde enero de 2004 hasta diciembre 2020. Resultados: En la serie predominaron las féminas entre 30-39 años de edad (42,8 %), los resultados estéticos evaluados de buenos (90,3 %), las complicaciones escasas (20,0 %), con primacía de la necrosis de la piel en el punto inferior de unión de los colgajos (7,0 %) y las pacientes satisfechas con el proceder (93,5 %). El tejido glandular resecado varió entre menos de 300 g y más de 1 200, según el grado de hipertrofia. Conclusiones: La técnica de reducción mamaria a pedículo inferior es versátil, segura y aplicable a todo tipo de hipertrofia, con una tasa de complicaciones baja; asimismo ofrece resultados estéticos favorables y alto grado de satisfacción.
Introduction: The reduction mastoplasty by means of the inferior pedicle technique is one of the most used cosmetic surgical interventions to correct mammary hypertrophy. Objective: To characterize the patients with mammary hypertrophy to whom reduction mastoplasty was practiced with the inferior pedicle technique. Methods: A descriptive, observational, cross-sectional and retrospective study of 185 patients between 10 and 59 years, with diagnosis of mammary hypertrophy was carried out. They were assisted in the Plastic Surgery and Caumatology Service of Octavio de la Concepción y de la Pedraja Teaching General Hospital from the municipality of Baracoa, to whom reduction mastoplasty by inferior pedicle technique was practiced, from January, 2004 to December, 2020. Results: In the series there was a prevalence of the females between 30-39 years (42.8 %), the cosmetic results with good evaluation (90.3 %), few complications (20.0 %), with primacy of the skin necrosis in the inferior space of the flap union (7.0 %) and the patients satisfied with the procedure (93.5 %). The dried up glandular tissue varied in less than 300 grams and more than 1 200, according to the degree of hypertrophy. Conclusions: The mammary reduction technique to inferior pedicle is versatile, safe and applicable to all types of hypertrophy, with a low rate of complications; also it offers favorable cosmetic results and high degree of satisfaction.
Subject(s)
Breast , Mammaplasty/methods , Plastic Surgery Procedures/methods , HypertrophyABSTRACT
Objective To explore the surgical procedures of reduction and lifting mammaplasty with the short vertical scar and breast lateral fibrous septum vascular pedicle to improve the clinical effect and reduce the complications.Methods Sixty-four patients underwent reduction and lifting mammaplasty:a incision around the areola and under the breast,using the breast lateral fibrous septum vascular pedicle and medial superior dermal pedicle to ensure the blood supply of the nipple.The skin and glands of the lower part of the breast were resected with suspension;upper part was lifting,with skin shaping and sutured.Results There were no postoperative complications such as hematoma,infection,skin and nipple areolar necrosis.The breasts were tall,plump and symmetry with little scar.Conclusions The breast reduction and lifting mammaplasty with breast lateral fibrous septum vascular pedicle and verical incision is effective in the treatment of macromastia and ptosis breast;breast form is satisfied and the complication is less;the operation is simple,safe,effective and worth promoting.
ABSTRACT
Objective To clarify the applied anatomy of Chinese female breasts,to improve the breast reduction mammoplasty,and to compare the quality of life in women with symptomatic macromastia before and after reduction mammoplasty with the modified round block technique.Methods The blood supply and innervation of the nipple-areolar complex were dissected in 6 Chinese adult females (12 breast specimens).Special attention was paid to the Würinger horizontal septum and the medial and lateral ligaments.The specific beneficial effects of reduction mammoplasty were evaluated with the modified round block technique,and a general questionnaire the Short Form-36 Health Survey Questionnaire (SF-36) was used in this study,which has good reliability and validity.The scores of the patients before and after the surgery were collected respectively.Results In 12 breast specimens,there existed Würinger horizontal septum and the medial and lateral ligaments.The blood supply and nerve innervation of nipple-areolar complex went along Würinger horizontal septum.In all the patients enrolled,SF-36 showed significant higher quality of life after the operation with regard to 7 of 8 investigated domains.Role of emotion increased most significantly.Increased self-esteem and increased personal and public self-consciousness after surgery were observed.Conclusions The incidence of postoperative complications is reduced after using the modified round block technique.Patients have a higher degree of satisfaction overall.These data are further evidence that breast hypertrophy is not solely an esthetic problem.The reduction mammoplasty with the modified round block technique is an ideal technique.
ABSTRACT
Objective To review the clinical data of reduction mammoplasty by central pedicle technique,and to summarize all kinds of the complications to modify the technique for improvement of long term aesthetic effects.Methods The postoperative complications were analyzd and then an approach was used to investigate the pattern of the blood supply and the nerve distribution of breast.Based on the anatomical study,a modified double-circle reduction mammoplasty technique was designed to treat patients with hypertrophical breasts. Results With a follow-up for 3 months to 3 years,the patients who underwent this modified central pedicle technique,had an invisible scar,good projection,the better shape of breast and preserved their sensation of nipple-areola complex.Conclusions Modified central pedicle technique is a safe and reliable technique,especially ideal for Chinese women.The blood supply is rich and the sensation of nipple-areola complex is preserved.The fixation of the gland tissue is more important than the dermal-bra.
ABSTRACT
PURPOSE: This study was conducted to determine if the body shape of women with small breasts differed from that of women with large breasts. METHODS: Between January 2002 and June 2006, 461 patients with hypomastia and 104 patients with macromastia, who had visited the M.D. Clinic, Seoul, Korea, were evaluated. These two groups were further divided into three groups (Group 1; underweight BMI or =23) according to Body mass index (BMI). RESULTS: The average age of women with hypomastia and macromastia was 32 and 34.5 respectively. The average BMI was 18.88 in the hypomastia group and 22.19 in the macromastia group (p<0.001). In the hypomastia group, the distribution of BMI was as follows: group 1, 44.5% (n=205); group 2, 53.8% (n=248); group 3, 1.7% (n=8). However, in the macromastia group, a higher proportion of overweight individuals were observed, as shown by the following distribution pattern: group 1, 7.7% (n=8); group 2, 71.1% (n=32); group 3, 27.3% (n=3). In the hypomastia group, the proportion of group 3 were 0% in their 20s, 0.9% (n=2) in their 30s, 6% (n=3) in their 40s and 27.3% (n=3) in their 50s, but in the macromastia group, the proportion of group 3 were 17.8% (n=8) in 20s, 32% (n=8) in 30s, 50% (n=12) in 40s and 100% (n=10) in 50s. CONCLUSION: The BMI of women with macromastia was significantly higher than that of women with hypomastia. In addition, although BMI was found to increase as age advanced for both groups, women with macromastia appear to have a strong tendency to become overweight with age.
Subject(s)
Female , Humans , Body Mass Index , Breast , Hypertrophy , Korea , Overweight , ThinnessABSTRACT
PURPOSE: The population of women with macromastia is continuously growing year after year in Korea, and macromastia is a common cause of physical and emotional suffering. This study analyzed the clinical results of 100 cases of reduction mammoplasty by single surgeon. METHODS: The author analysed 100 cases of reduction mammoplasty (200 breasts) operated in M.D. Clinic from Jan 2002 to Sep 2005. The operation techniques were vertical bipedicle flap for 74 cases (74%), inferior pedicle flap for 11 (11%), periareolar round block technique for 9 (9%) and liposuction assisted vertical bipedicle flap for 6 (6%). Patient's age, marital state, number of delivery, weight and height, basal metabolic index (BMI), the amount of removed breast tissue, operation time according to period and operation technique, and complications were studied respectively. Sixty one of cases (61%) were surveyed by phone concerning the improveness of their physical sufferings. RESULTS: The mean age of the cases were 35.8 and the ages ranged from 18 to 57. Forty two of cases (42%) were not married and 48 cases (48%) had not delivered yet. BMI based on body weight and height indicated normal (18.5~23) for 51cases, overweight (23<) for 40 and underweight(<18.5) for 9. The amounts of removed tissue per breast ranged from 85 g to 1,450 g (mean of right side: 305 g, and left side: 301 g). According to operation method, mean amounts of removed tissue were 337 g in vertical bipedicle flap, 540 g in inferior pedicle flap and 145 g in periareolar round block technique. Mean operation time were 4:10, 3:32 in periareolar bound block technique, 3:52 in vertical bipedicle flap and 4:45 in inferior pedicle flap. Because of learning curve and the operation time became shortened. The duration of drainage varied from 1 to 5 days and the mean was 2.5 days. Among the 61 cases that were surveyed by phone, most of them had suffered from physical symptoms preoperatively, and the majority of survey respondents reported improvement in cervical and shoulder pain (92.7%), back pain (89.1%), breast pain (90.5%). Adverse sequelae included infection (3 cases, 3%), hematoma (1 case, 1%), nipple necrosis (2 cases, 2%), decreased nipple sensation (31 cases, 31%), wound dehiscence (5 cases, 5%), hypertrophic scar (11 cases, 11%) and all the cases had a little asymmetry. CONCLUSION: Macromastia becomes common in Korea and we should discuss about reduction mammoplasty for adequate surgery. The cases were varied according to age distribution and marital state. There are several methods for reduction surgery, but the author concluded vertical bipedicle flap method is the best for Korean women.
Subject(s)
Female , Humans , Age Distribution , Back Pain , Body Weight , Breast , Cicatrix, Hypertrophic , Drainage , Hematoma , Korea , Learning Curve , Lipectomy , Mammaplasty , Mastodynia , Necrosis , Nipples , Overweight , Sensation , Shoulder Pain , Surveys and Questionnaires , Wounds and InjuriesABSTRACT
Wilson's disease is an autosomal recessive disorder of copper metabolism in individuals with mutant ATP7B genes. Impairment of normal excretion of hepatic copper results in toxic accumulation of the metal in liver, brain and other organs. Clinical manifestations include hepatic, neurologic or psychiatric disturbances. Penicillamine, as a chelator of copper, is the drug of choice in the treatment of Wilson's disease but after treatment of penicillamine, granulocytopenia, thrombocytopenia, the nephrotic syndrome, Goodpasture's syndrome, pemphigus vulgaris or pleural effusion may supervene. We report a case of macromastia with multiple fibroadenomas in a patient who was treated with penicillamine for Wilson's disease.
Subject(s)
Humans , Agranulocytosis , Anti-Glomerular Basement Membrane Disease , Brain , Copper , Fibroadenoma , Hepatolenticular Degeneration , Liver , Metabolism , Nephrotic Syndrome , Pemphigus , Penicillamine , Pleural Effusion , ThrombocytopeniaABSTRACT
Objective To introduce an improved technique of periareolar incision mammoplasty using gland flap suspending and contour line circum-contraction suturing. Methods Through the periareolar incision, dissection was conducted between the subcutaneous tissue and the glandular tissue to detach the skin flap tent from the gland cone. A vertical glandular flap was formed in the upper portion to suspend the gland, with the gland tissue partially excised medial and lateral to the vertical glandular flap. Continuous contour line circum-contraction suturing was made for 2～3 rounds step by step from the cone bottom to the plateau, i.e. the nipple areola level. The suturing proceeded alternately from the flap tent to the glandular cone. Finally, the skin was sutured along the areolar incision. Results Sixteen breasts of eight patients were operated on using the present technique, including 10 cases of macromastia and 6 of breast ptosis. Satisfactory results were achieved with pretty breast shape and inconspicuous periareolar scar. Conclusion The contour line circum-contraction suturing periareolar incision mammoplasty is an optimal choice for moderate macromastia and breast ptosis.
ABSTRACT
Objective To study the clinica features, diagnosis and surgical treatment of simple and complex macromastia. Methods The clinical and pathological data of 21 patients with macromastia in our hospital from 1990 to 2000 were analysed retrospectively. Simple macromastia in 16 patients with 29 breasts, complex macromastia in 5 patients with 8 breasts. Results The average age of patients was 23 years old. All the 21 patients were treated surgically. Among the 5 patients with complex macromastia, subcutaneous mastectomy and reconstruction were performed on 2 patients with breast fibroadenomatosis; of the 2 patients with giant fibroadenoma, one underwent tumor excision, the others were subjected to tumor excision with reduction mammaplasty; the last one with breast fibrous disease, selective partial breast excision and reduction mammaplasty was performed. All the patients had satisfactory mammary appearance and hadn't recurrrence of the breast disease in follow up period. Conclusions (1) Macromastia often happens in the adolescent and young women. (2) It is necessary to do biopsy during operation for distinguishing the simple from the complex macromastia. (3) The treatment for simple macromatia is reduction mammaplasty; for complex macromatia is dissection of the disease area completely and redution mammaplasty simultaneously. For macromastia with fibroadenomatosis, subcutaneous mastectomy with reconstruction can prevent tumor recurrence and get better mammary appearance.