Application of oncoplastic round block technique in surgical management of idiopathic granulomatous mastitis / 中华医学美学美容杂志

Objective:To explore the efficacy of the oncoplastic round block technique in surgical management of idiopathic granulomatous mastitis (IGM).Methods:From January 2014 to December 2019, a total of 18 patients (24 to 38 years old, 32.2 years in average) with IGM underwent excision of the inflammatory breast mass with oncoplastic round block technique, the postoperative clinical efficacy was summarized and analyzed.Results:All 18 patients with IGM underwent excision of the inflammatory breast mass with oncoplastic round block technique, among them 2 patients underwent round-block reduction surgery of contralateral breast at the same time. The median follow-up duration was 16.1 months (from 6 to 36 months). Incision poor healing occurred in two cases which was cured after dressing change. Recurrence occurred in one case at 6 months after operation, and then cured with conservative measures. No other severe complications occurred. All patients were satisfacted with the results.Conclusions:Application of oncoplastic round block technique in surgical management of IGM may remove more tissue in order to reduce the recurrent rate, and get a better cosmetic results.

Psychological status of transgender group before and after mastectomy / 中华医学美学美容杂志

Objective To explore the difference of psychological state and the change of psycho logical state between mastectomy group for the purpose of changing gender identity and breast reduction surgery group for the purpose of improving physical beauty.Methods The psychological evaluation scale of three layers and twelve dimensions was used to evaluate the psychological status of 24 patients who underwent clinical breast masculine surgery and aesthetic breast reduction before and after operation.The psychological characteristics between the two groups before and after operation were compared and analyzed.Data analysis was carried out through Stata 13.0 software package.Results There were significant differences in depression factor,anxiety factor and obsessive compulsive symp tom factor in the aesthetic breast reduction group before and after operation (t=2.194,2.183,2.090;P=0.039,0.040,0.048,P＜0.05).There were significant differences in depression factor,anxiety factor,obsessive-compulsive symptom factor,bullying factor,psychological self,physical self and social self before and after mastectomy (t=4.188,3.730,2.484,2.570,5.898,3.531,3.162,P=0.000,0.001,0.021,0.018,0.000,0.002,0.005,P＜0.05).There were significant differ ences in depression,anxiety,psychoticism,obsessive-compulsive symptoms,psychological self,physiological self and social self between mastectomy group and aesthetic mastectomy group before operation.(t=2.629,4.081,2.097,4.246,5.419,2.600,2.545;P=0.015,0.001,0.048,0.000,0.000,0.016,0.018,P＜0.05).There was significant difference in postoperative depression,anxiety and obsessive-compulsive symptoms between the mastectomy group and the aesthetic mastectomygroup (t=2.117,2.170,3.764;P=0.046,0.041,0.001,P＜0.05).Conclusions Plastic surgeons should pay attention to the psychological status and personality characteristics of different beauty seekers and give psychological guidance,which is of great significance to improve the medical experience and surgical effect of the beauty seekers.

Application of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy / 中国修复重建外科杂志

Objective: To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. Methods: Between January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m 2, with an average of 30.8 kg/m 2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g). Results: The skin flap necrosis at the "T" trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15). Conclusion: For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.

Research progress in breast blood supply and breast reduction / 中国修复重建外科杂志

Objective: To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years. Methods: The related literatures about the distribution of the nerve and blood supply of breast, the development of breast reduction, and postoperative lactation function in recent years were reviewed extensively. The above aspects were analyzed and summarized in combination with the author's experiences. Results: With the anatomical study of mammary gland, nipple areola complex nerve distribution and blood supply, breast reduction has been developed rapidly, and a variety of surgical methods have been formed. But each has its own advantages and disadvantages, and its indications are different. Through the application and improvement of the auxiliary examination technique, severe complications such as nipple areola complex necrosis reduce obviously after operation. Through the selection of position of the incision and pedicle, the degree of retaining the pedicle glands, the application of auxiliary liposuction technique, and the improvement of suture technique, the scar of incision reduces, the sensation of nipple areola is preserved more, and a more satisfactory breast shape is obtained. Some of the patients who gave birth after breast reduction have lactation function. Conclusion: There are some shortcomings in various surgical methods at present, individualized surgical methods should be adopted according to the characteristics of the patients. Further research is needed on how to preserve more sensation of nipple areola, obtain a good and lasting breast shape, and preserve lactation function of women after operation.

Impacto de la cirugía mamaría en la lactancia materna / The impact of breast surgery on breastfeeding

La lactancia materna para la mujer es un periodo vital, el que es influido por diferentes factores, entre estos, está el antecedente de cirugía mamaria. El propósito de esta revisión es explorar, en la evidencia disponible, el impacto que tienen los implantes mamarios y la reducción mamaria en el amamantamiento. Esto, con el fin de apoyar el trabajo con las mujeres en el proceso de lactancia materna e informar previamente a las usuarias cómo estas cirugías podrían afectar su proceso. Con respecto a las características de la cirugía, hay diferencias en los efectos que puede tener en la producción de leche, según: el tipo de cirugía, tipo de abordaje y el sitio de incisión, que puede afectar a corto y largo plazo. Debido a que existe evidencia heterogénea con respecto al impacto de la cirugía mamaria en la lactancia materna, toma un rol importante considerar en la evaluación este antecedente en la mujer, para realizar un buen diagnóstico. Ante todo, es importante el apoyo y guía educativa, tanto prenatal como en el puerperio, para empoderar a las mujeres en la toma de decisiones y el manejo de su lactancia materna, previo a la cirugía y durante el proceso de lactancia materna. Para lograr esto se necesita personal de salud capacitado, que pueda intervenir en esta realidad, informado, con la mejor evidencia disponible.

Breastfeeding is a vital period for women and it's influenced by different factors such as breast surgery. The purpose of this review is to explore available evidence on the impact that some breast surgeries (breast implants or breast reduction) have on breastfeeding. This is to support the breastfeeding process in this women, and also to inform them how these surgeries could affect on their breastfeeding process. There are several factors related to surgery that can influence on the breastfeeding process, such as the type of approach, the incision siteand, in the case of the implant, where it is located, which may affect short or long term. Because there are not enough studies, and there is also heterogeneous evidence regarding the impact of breast surgery on breastfeeding, it is important the educational support be given both prior to surgery and during the pre and postnatal phases. To achieve this the trained health professionals need to be informed and with the best evidence available related to the breastfeeding process.

¿Qué factores influyen en la satisfacción de los pacientes sometidos a reducción mamaria?: análisis de un estudio de cohorte utilizando el instrumento Breast-Q® / The factors that influence the satisfaction of patients subjected to breast reduction: analysis of a cohort study using Breast-Q® scores

Introducción: El instrumento Breast-Q® se ha ocupado de medir la calidad de vida de las pacientes sometidas a cirugía de reducción mamaria o mastopexia. Se desconocen los factores que determinan la mejoría en la calidad de vida de estas pacientes. El objetivo de este trabajo es identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidas a reducción mamaria. Materiales y métodos: Se estudió una cohorte prospectiva de 41 pacientes sometidas a reducción mamaria o mastopexia sin implantes. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Breast-Q®. Para el análisis estadístico se utilizó estadística descriptiva, modelos de ecuaciones de estimación generalizada y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,0001) y por dominios. Dentro de los factores determinantes, existió una relación positiva entre la magnitud de la resección y la mejoría en la calidad de vida de forma global (p = 0,032) y en el dominio de síntomas físicos (p = 0,012). Destaca además una mejoría del 50% con resecciones de tejido mamario sobre los 300 g. Conclusión: La cirugía de reducción mamaría y mastopexia incrementan significativamente la calidad de vida medida mediante el instrumento Breast-Q® en pacientes con hipertrofia o ptosis mamaria. Los determinantes de esta mejora estarían directamente relacionados con la cantidad de tejido resecado, con una mejoría del 50% con resecciones sobre los 300 g.

Introduction: Breast-Q® instrument has been used for measuring the quality of life of patients undergoing breast reduction or breast lift surgery. The factors that determine the improvement in the quality of life of these patients are unknown. The aim of this work is to identify the determinant factors of improvement in the quality of life in patients undergoing breast reduction. Materials and methods: A prospective cohort of 41 patients undergoing breast reduction or breast lift without implants was studied. Sociodemographic features, anthropometric measurements, variables related to surgery were studied and the Breast-Q® instrument was applied. For statistical analysis it was used descriptive statistics, generalized estimating equations models and linear and logistic regression models. Results: We found improvement in the quality of life, globally (P < .0001) and per domains. Among the determining factors, there was a positive correlation between the extent of resection and improved quality of life globally (P = .032) and in the domain of physical symptoms (P = .012). Also highlights an improvement of 50% with resection of breast tissue above 300 g. Conclusion: Breast reduction and breast lift surgery significantly increases the quality of life measured by the Breast-Q® instrument in patients with breast hypertrophy or ptosis. The determinant factors of this improvement would be directly related to the amount of tissue resected, with a 50% improvement with resections above 300 g.

Las mujeres sometidas a reducción mamaria mejoran su apariencia estética, autoestima, síntomas físicos y vida sexual / Effects of breast reduction surgery on the quality life

Abstract Background: The results of breast reduction surgery are usually reported in terms of anthropometric assessments. However the impact of surgery in quality of life is seldom informed. Aim: To assess the effects of breast reduction surgery on the quality of life of patients. Material and Methods: The "Breast-QReduction and Mastopexy Module" was prospectively applied to all women subjected to breast reductionsurgery in a University Hospital during one year. Results: Twenty women answered the survey in thepreoperative period and 20 in the postoperative period. The most commonly cutaneous pattern employedthat the inverted T in 10 women, followed by the Wise pattern in six patients. The most commonly usedpedicles were superior in 10 patients, followed by superomedial in seven patients. Mean excision weightwas 923 g (range 150-2850). Mean Breast Q score improved from 45 to 65%. Satisfaction with breastappearance improved from 31 to 83%, self-esteem from 39 to 80%, sexuality from 50 to 81% and physicalsymptoms decreased from 48 to 16%. There was a significant association between the magnitude of excision and improvement in physical symptoms. Conclusions: Quality of life improves notably in womenafter breast reduction surgery.

Resumen Objetivo: Tradicionalmente la evaluación de resultados en reducción mamaria se ha limitado a evaluaciones antropométricas, que si bien nos entregan una evaluación objetiva de un aspecto de los resultados, resultan insuficientes para evaluar el impacto global en calidad de vida (CdV) de la cirugía en nuestros pacientes. Es por esto que el objetivo de este trabajo es determinar el cambio en calidad de vida en mujer es sometidas a reducción mamaria y explorar sus factores determinantes. Materiales y Métodos: Se realizó un estudio de cohorte prospectiva con todas las pacientes que ingresaron al Hospital Clínico de la Universidad de Chile (HCUCH) y se sometieron a reducción mamaria por cualquier técnica desde julio de 2013 a abril de 2014. La calidad de vida (CdV) se midió con el instrumento validado Breast-Q Reduction and Mastopex y Module. Se utilizó estadística descriptiva para caracterizar la muestra y analítica para determinar el cambio en CdV y sus factores pronósticos. Resultados: Entre julio de 2013 y abril de 2014 se operaron 25 pacientes, el seguimiento promedio fue de 7 meses. Veinte pacientes contestaron el Breast-Q preoperatorio y 20 el post operatorio. El patrón cutáneo más empleado fue la T acortada (10; 55,6%) seguido por el patrón de Wise (6; 33,3%); el pedículo más usado fue el superior (10; 55,6%) seguido del supero medial (7; 38,9%). La resección promedio total fue de 923 g, variando entre 150 g y 2.850 g. El puntaje promedio del Breast-Q subió de45% a 65% (p = 0,005). Las pacientes mejoraron su satisfacción con la apariencia mamaria desde un 30,8%a un 82,9% (p < 0,001), su autoestima de 38,7% a 80,1% (p < 0,001), síntomas físicos de 47,8% a 15,5% (p= 0,003) y sexualidad de 50,0% a 81,4% (p < 0,001). La magnitud de la resección se asoció a la mejoría de síntomas físicos (Coeff 0,07; p = 0,023). No se encontraron otras asociaciones significativas entre el cambio en parámetros de calidad de vida y variables independientes. Conclusiones: En este reporte preliminar hemos podido objetivar que existe una mejoría significativa en la calidad de vida de las pacientes sometidas a una reducción mamaria tanto en forma global como también en cada uno de los aspectos evaluados, mejorando significativamente su autoimagen, autoestima, vida sexual y síntomas físicos.

Four flap suspension technique for prevention of bottoming out after breast reduction

PURPOSE: Bottoming-out deformity is accepted as the most important disadvantage of inferior pedicle breast reduction. For prevention of this deformity, different techniques are used in combination with inferior pedicle. In this study, we aimed to prevent bottoming-out deformity by producing an internal bra effect through combination of inferior pedicle technique with 2 superior and 2 inferior dermal flaps that were raised from each side of the pedicle. METHODS: Thirteen patients whose medical records became available during the follow-up period at Ankara Training and Research Hospital from January 2010 to January 2015 were included in this study. We retrospectively obtained patient medical records including demographic characteristics and clinical data. Superior dermal flaps were planned on both sides of the pedicle 2 cm inferior to the lower border of areola and inferior dermal flaps were planned 6 cm inferior to the superior dermal flaps. The superior and inferior dermal flaps were secured to the periosteum of the 2nd and 4th ribs respectively with permanent sutures. RESULTS: Preoperatively, the average distance between the inframammary fold and areola was 13.9 cm (range, 11-18 cm). The average amount of breast parenchymal resection was 745 g (range, 612-1,496 g). The average distance between the inframammary fold and the lower border of the areola was 7.9 cm (range, 7.5-9 cm) on the postoperative first-year measurements. CONCLUSION: In conclusion, according to our study, suspension technique to prevent bottoming-out deformity is associated with an easier technique without the need for alloplastic or allogenic materials. Since fixation is performed to the ribs instead of soft tissues like the pectoral fascia or muscle, we believe that this fixation is more long lasting and can be an effective alternative to other suspension techniques.

Mamoplastias redutoras e mastopexias realizadas no HC-UNICAMP: análise comparativa entre duas técnicas / Reduction mammoplasties and mastopexies performed at HC-UNICAMP: comparative analysis between two techniques

Introdução: Diferentes técnicas para mamoplastia redutora e mastopexia são descritas na literatura, visando a resultados que reconstituam o polo superior, ofereçam melhor projeção e proporcionem tratamento adequado para a ptose mamária. No entanto, devemos nos atentar para a segurança da técnica, com manutenção da vascularização, inervação dos tecidos e possibilidade de amamentação. Análise comparativa com pacientes operadas pela técnica com retalho de pedículo inferior e pacientes operadas pela técnica com sutura circular em bolsa. Métodos: Análise de 85 pacientes submetidas à mamoplastia redutora ou mastopexia sem implantes, entre janeiro de 2011 e dezembro de 2012, no Hospital de Clínicas da Unicamp. Foram excluídos 31 pacientes, as quais foram submetidas apenas à mamoplastia redutora pela técnica de Pitanguy (sem utilização de retalhos ou sutura circular). Dentre as 54 pacientes restantes, cinco foram posteriormente excluídas devido ao não comparecimento à consulta ou à não realização da ultrassonografia pós-operatória. Foram agrupadas 16 pacientes submetidas à sutura circular contínua e 33 pacientes operadas pela técnica de pedículo inferior. Resultados: Dados demográficos foram semelhantes nos dois grupos. Maior número de pequenas complicações e resultados insatisfatórios foi observado no grupo submetido à técnica de pedículo inferior, bem como maior índice de achados ultrassonográficos relevantes no pós-operatório. Conclusão: A técnica de sutura circular contínua apresentou elevado índice de satisfação, menor número de complicações e resultados mais duradouros quando comparados com a técnica de pedículo inferior, durante o período analisado.

Introduction: Several reduction mammoplasty and mastopexy techniques are described in the literature, with the aim of reconstituting the upper pole, offering better projection, and providing adequate treatment for breast ptosis. However, particular attention should be devoted to the safety of the technique, with maintenance of vascularization, tissue innervation, and the capability of breastfeeding. Female patients operated on with the inferior pedicle flap technique were compared with those operated on with purse-string circular suturing. Methods: Eighty-five patients who had undergone reduction mammoplasty or mastopexy without implants, between January 2011 and December 2012 at Unicamp's Clinical Hospital, were evaluated. Thirty-one patients who only underwent reduction mammoplasty by Pitanguy's technique (without the use of flaps or circular sutures) were excluded. Of the remaining 54 patients, five were subsequently excluded for not attending medical appointments or failure to have postoperative ultrasonography. A group of 16 patients who had undergone circular suturing and a group of 33 operated on by the inferior pedicle technique were considered. Results: Demographic data were similar for both groups. A higher number of minor complications and unsatisfactory results were observed in the group that underwent the inferior pedicle technique, who also had a higher rate of relevant post-operative ultrasonography events. Conclusion: The circular suturing technique resulted in a high satisfaction rate, lower number of complications, and longer lasting results than the inferior pedicle technique, during the period analyzed in this study.

Clinical application of vertical incision pasty of breast / 中国基层医药

Objective To investigate the clinical effect of vertical incision for breast surgery.Methods According to Lejour method,the first breast shape on the patients who needed operation was designed,and make a mark line corresponding to the breast,and then removal of excess tissue during the operation,operation process should pay attention to the protection of important part of breast of vessels and nerves,to prevent the impact of breast lactation function.Results The operation in 48 patients with breast because of too much too small in patients with 2 cases,1 cases of patients areola was too large,the patients were followed up survey,all the patients were satisfied with the operation of the breast shape,1 cases of operation the scar not satisfied,then the operation scar resection of operation after further results were satisfied,the total satisfaction rate was 98%.Conclusion Breast reconstruction process using vertical incision method for patients with relatively small,less bleeding,almost did not affect the normal function of patients with breast,breast shape is preferred for patients with operation scheme.

Treatment of severe gynecomastia by double-ring supra-medialis pedicle for breast reduction / 中华医学美学美容杂志

Objective To introduce a surgical method for treatment of severe gynecomastia.Methods After designing double rings and ectomizing epidermis between two rings,a supra-medialis derma mammary pedicle of the nipple and areola was formed,most of the gland and fatty tissue was ectomized,the pedicle was fixed with the sarcolemma,and the two rings were sutured together.Resuits There were no severe postoperative complications.Following-up of 9 cases (18 sites) for 6 to 24 months showed symmetrical and satisfactory contour.Conclusions The breast reduction with doublering supra-medialis pedicle can be an effective procedure of severe gynecomastia,in which the supramedialis pedicle can ensure the blood supply of nipple and areola and avoid late mastoptosis.

Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction: A case report / 대한마취과학회지

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 52-year-old female patient complaining of chronic breast neuropathic pain after breast reduction, which was relieved after PRF lesioning of the 4th thoracic spinal nerve and its root.

A Case of Breast Reduction with Pure Tumescent Liposuction / 대한피부과학회지

Patients with macromastia have physical discomfort including head, neck, and shoulder pain, wet skin fold/eczema, intractable mastalgia, and restricted exercise. They also have cosmetic problems and psychiatric discomfort. In Korea, excisional breast reduction is the main treatment option for macromastia, but breast reduction with pure tumescent liposuction is becoming a new treatment option in western society. Breast reduction with pure tumescent liposuction has multiple advantages including safety, no general anesthesia, outpatient procedure, minimal scaring, no loss of nipple sensation and the possibility of breast feeding. We report a case of macromastia treated by pure tumescent liposuction without any sedation. We hope that this article may help Korean dermatologists to understand about breast reduction using pure tumescent liposuction and expand the field of dermatologic surgery in Korean society.

The superior medial pedicle breast reduction in gigantomastia: A report of 2 cases.

Gigantomastia is an uncommon condition that may occur in puberty or during pregnancy. The etiology remains unknown. Since 1989, we had treated only 2 cases with massive breast hypertrophy that was unrelated to pregnancy. To alleviate the discomfort of the patients, the superior medical pedicle breast reduction was performed. The entire breast parenchyma and skin in the lower quadrant and some breast tissue in the upper outer quadrant of the breast was removed. The viability of the nipple-areola complex depended on the perforating branches of the internal mammary artery. The operations were uneventful and there has been no recurrence of the gigantomaatia during the follow-up period to the present.