Mastoplastia de reducción con la técnica de pedículo inferior en pacientes con hipertrofia mamaria / Reduction mastoplasty by means of the inferior pedicle technique in patients with mammary hypertrophy

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.

Gigantomastia gravídica / Gestational gigantomastia

Introducción La gigantomastia gravídica es una entidad poco frecuente, de etiología desconocida, con una incidencia de 1 en 100.000 embarazos. Se caracteriza por un crecimiento mamario excesivo e invalidante durante la gestación. El tratamiento durante el embarazo es sintomático, requiriendo resolución quirúrgica en el puerperio. Material y método Reporte de caso clínico de gigantomastia gravídica en el Hospital José María Penna de la Ciudad Autónoma de Buenos de Aires en 2017. Caso clínico Paciente de 22 años, primigesta que, cursando embarazo de 20 semanas, consulta por aumento exagerado del volumen mamario, de dos meses de evolución. Se realiza punción percutánea con aguja gruesa cuyo resultado informa parénquima mamario con ductos y lobulillos preservados. Se instaura tratamiento sintomático, decidiéndose la finalización del embarazo durante la semana 34 de gestación por gran disconfort materno asociado a disnea. Durante el puerperio, se inhibe la lactancia, y evoluciona favorablemente con involución mamaria parcial; actualmente se encuentra en plan quirúrgico. Conclusiones La gigantomastia gravídica es de presentación excepcional. El tratamiento es sintomático durante la gestación siendo la resolución quirúrgica fundamental en el puerperio. El manejo multidisciplinario es indispensable.

Introduction Gestational gigantomastia is an unusual condition of unknown origin, which occurs in approximately 1 out of every 100.000 pregnancies. It is defined as an excessive and invalidating mammary hypertrophy which develops during pregnancy. Supportive care for symptomatic relief is offered during pregnancy, but surgical approach and reduction mammoplasty is usually warranted after childbirth. Materials and method The following is a case report of a patient with gestational gigantomastia who was treated at the Hospital Jose Maria Penna de Buenos Aires in 2017. Clinical vignette This is the clinical case of a 22-year-old primigravida, who presented at 20 weeks of pregnancy. She complained of exaggerated bilateral increase in breast volume over the previous two months. Core needle biopsy informed presence of normal breast parenchyma with normal ducts and lobes. Supportive treatment was initiated for symptom relief. Elective termination of pregnancy at 34 weeks was decided because of great materna discomfort and dyspnea. After childbirth, lactation was suppressed and the patient is currently awaiting surgical correction. Conclusions Gestational gigantomastia is an exceptionally rare condition. The therapeutic goal during pregnancy is usually symptom relief. Surgical correction is essential after childbirth and interdisciplinary management is mandatory.

Mastoplastia reductiva por técnica de Thorek modificada en gigantomastia / Reductive mastoplastyby modified Thorek technique in giant breasts

La gigantomastia es un tipo de hipertrofia mamaria cuando sobrepasa los 1500 g de volumen mamario en cada mama y su corrección se realiza con la técnica de mastoplastia reductiva. Se presentó el caso de una paciente de 42 años de edad con el diagnóstico de gigantomastia; a la cual se le practicó mastoplastia reductiva por técnica de injerto del complejo areola pezón, siendo una adaptación a la descrita por Thorek en 1922, utilizando el molde de Wise. El tejido glandular resecado fue 4 000 g en cada mama, total 8000 g, el cual fue la motivación principal de este trabajo, además, despertar el interés de los médicos al estudio de este padecimiento para el diagnóstico, y conocimiento de este tratamiento. Se obtuvo buen resultado estético y satisfacción de la paciente(AU)

Gigantomasty is a kind of mammary hypertrophy when it surpasses the 1 500 g of mammary volume in each mamma and its correction is made with the mastoplasty reductive's technique. It is presented a case of a 42-year-old patient with a diagnosis of giant breasts; was applied reductive mastoplasty by graft technique of the nipple areola complex, being an adaptation to the one described by Thorek in 1922, using the Wise mold. The gland tissue was resected 4 000 grams in each breast, total 8 000 grams, which was the main motivation of this work, in addition, to obtain the interest of doctors to study this condition for diagnosis and knowledge of this treatment. A good aesthetic result and patient satisfaction were obtained(AU)

Hipertrofia mamaria juvenil: Revisión de la literatura. A propósito de un caso clínico

Se presenta el caso de una paciente de 22 años con hipertrofia mamaria bilateral, de gran tamaño. No presentaba tumor ni alteraciones hormonales. Fue intervenida quirúrgicamente y la evolución fue satisfactoria.

We report a case of a 22-year-old patient with massive Juvenile Breast Hypertrophy. No tumor or hormonal changes cause the disease. Was successfully treated with a breast reduction.

Gigantomastia juvenil. Hipertrofia virginal. Presentación de caso clínico / Juvenile macromastia. Virginal mammary hypertrophy. Case report

La gigantomastia juvenil es una afección médica benigna poco frecuente que causa el crecimiento excesivo y discapacitante de las mamas, provocando importantes trastornos físicos y psíquicos a pacientes púberes o adolescentes. Presentamos el caso en una paciente de 23 años, la cual se encontraba en la última etapa de su patología con una importante signosintomatología. Al no existir un tratamiento específico para ella, la mastoplastia reductiva es el procedimiento más efectivo con el que se cuenta. Se realizó una reducción de 9000 g de tejido mamario mediante la técnica de Torek, obteniendo mamas de volumen medio, simétricas, con cicatrices aceptables. La complejidad de esta patología hace que debamos manejarnos con un equipo multidisciplinario, tanto durante su estudio como en su tratamiento, y consideramos muy importante realizar un seguimiento estricto a largo plazo ya que es posible que, después del tratamiento quirúrgico, se presenten recurrencias.

Juvenile gigantomastia is a rare benign medical condition that causes excessive and disabling growth of the breasts and provokes considerable physical and psychological discomfort in patients in their puberty and adolescence. We introduce the case of a 23-year-old patient in the last stage of her condition with considerable signs and symptoms. There is no specific treatment for juvenile gigatomastia; hence breast reduction is the most effective procedure available. A reduction of 9,000 grams of breast tissue was performed using Torek's technique, resulting in medium volume, symmetrical breasts with acceptable scars. The complexity of this disorder requires a multidisciplinary team during the study and therapy stages. A strict long-term follow-up is recommended as relapses are possible after surgery.

Gigantomastia juvenil. Hipertrofia virginal. Presentación de caso clínico / Juvenile gigantomastia. Virginal hypertrophy. Clinical case presentation

La gigantomastia juvenil es una afección médica benigna poco frecuente que causa el crecimiento excesivo y discapacitante de las mamas provocando importantes trastornos físicos y psíquicos a pacientes púberes o adolescentes. Presentamos el caso en una paciente de 23 años de edad, la cual se encontraba en la última etapa de su patología con una importante signosintomatología. No existe un tratamiento especifi co para ella, por lo cual la mastoplastia reductiva es el procedimiento más efectivo con el que contamos. Se realizó una reducción de 9000 g de tejido mamario mediante la técnica de Torek, obteniendo mamas de volumen medio, simétricas, con cicatrices aceptables. La complejidad de esta patología hace que debamos manejarnos con un equipo multidisciplinario, tanto durante su estudio como en su tratamiento, y consideramos muy importante realizar un seguimiento estricto a largo plazo ya que es posible que, después del tratamiento quirúrgico, se presenten recurrencias

Juvenile Gigantomastia is a rare benign medical condition that causes excessive and disabling growth of the breasts and provokes considerable physical and psychological discomfort in patients in their puberty and adolescence. We introduce the case of a 23-year-old patient in the last stage of her condition with considerable signs and symptoms. There is no specifi c treatment for Juvenile Gigatomastia; hence breast reduction is the most eff ective procedure available. A reduction of 9,000 grams of breast tissue was performed using Torek's technique, resulting in medium volume, symmetrical breasts with acceptable scars. The complexity of this disorder requires a multidisciplinary team during the study and therapy stages. A strict long-term follow-up is recommended as relapses are possible after surgery

Perfil e avaliação dos resultados de pacientes submetidas à mamoplastia redutora / Patient profile and results evaluation after breast reduction

INTRODUÇÃO: A hipertrofia mamária é relatada como fonte de sofrimento físico e emocional em mulheres, sendo que diversas técnicas vêm sendo descritas para seu tratamento. OBJETIVO: Demonstrar o perfil e resultados satisfatórios da mamoplastia redutora no tratamento de hipertrofias mamárias pela classificação de Bozola. MÉTODO: Estudo descritivo e retrospectivo, com 94 pacientes submetidas àmamoplastia redutora, entre janeiro de 2011 e outubro de 2013, avaliadas segundo idade, queixa principal, comorbidades, índice de massa corporal (IMC), maternidade prévia, flacidez de pele, contorno e consistência mamária, tumorações, graus de hipertrofia submetidas à mamoplastia com a técnica de Ariê e Peixoto, com pedículo I de Lyacir Ribeiro, e a técnica de Pitanguy. No pós-operatório as pacientes foram avaliadas quanto à satisfação dos resultados observados pela simetria das mamas, tamanho, complicações e sensibilidade do complexo areolopapilar (CAP). RESULTADOS: A média de idade das pacientes foi de 28,5 anos e IMC médio de 27,66. A principal queixa foi de desconforto e quadro doloroso em 73,4%. Média de tecido total ressecado foi de 952,5 g. Foi evidenciado taxa de complicação em 27,6%. O avaliador considerou forma, simetria e sensibilidade do CAP. A satisfação, quanto ao procedimento, foi evidenciada como ótima em 51,1% dos casos, e boa em 35,1%. CONCLUSÃO: As técnicas de Ariê e Peixoto, com pedículo inferior, e de Pitanguy promoveram resultados duradouros com maior prazo de sustentação da mama, além de um polo superior medial desenhado com curvas mais acentuadas.

Introduction: In women, breast hypertrophy is a source of physical and emotional pain; several techniques have been described for its treatment. Objective: To demonstrate the appearance and satisfactory results obtained with reductive mammoplasty for the treatment of breast hypertrophy according to Bozola's classification. Method: This descriptive and retrospective study included 94 patients who underwent reductive mammoplasty between January 2011 and October 2013. The patients were evaluated according to age, chief complaint, comorbidities, body mass index (BMI), history of pregnancy, presence of sagging skin, breast contour and consistency, tumors, and hypertrophy grade. The patients underwent reductive mammoplasty using the technique of Ariê and Peixoto with the type I pedicle of Ribeiro as well as Pitanguy's method. During the postoperative period, patient satisfaction was evaluated according to the outcomes observed and regarding breast symmetry, size, complications, and nipple-areola complex (NAC) sensitivity. Results: The average patient age was 28.5 years and the average BMI was 27.66. The main complaint was discomfort and pain (73.4%). The average weight of resected tissue was 952.5 g. The occurrence of complications was observed in 27.6% of patients. For the evaluation, form, symmetry and NAC sensitivity were considered. The satisfaction rate was great in 51.1% of cases and good in 35.1%. Conclusion: The technique of Ariê and Peixoto as well as Pitanguy's method provided long-term results with durable breast support and enabled the design of a medial upper pole with more pronounced contours.

Mastoplastia redutora associada a implante de silicone: quando indico? / Reduction mastoplasty with silicone implants: When is it indicated?

Introdução: Insatisfação dos pacientes com resultado de mamoplastia redutora pode ser identificado em alguns casos, especialmente quando apresentam ptose acompanhada de flacidez excessive, estrias, e ainda, componente mamário mais gorduroso que glandular. Nesses tipos de pacientes, é muito difícil conseguir bons resultados por longo período. Implantes mamários de pequeno volume, podem ser colocados no mesmo tempo da mamoplastia redutora com o objetivo de se obter melhor forma, contorno e projeção das mamas, com maior satisfação a longo prazo. Método: No período de 1997 a 2012, duzentos e sessenta e quatro pacientes com idade entre 27e 55 anos (idade média de 38), foram submetidas à mamoplastia redutora com imediata colocação de implante mamário. Resultados: Foram obtidos resultados satisfatórios, com adequado preenchimento do pólo superior, mamas firmes e reduzida estatística de ptose pós-operatória. Foram identificados dois casos de carcinoma in sito, como achados no anátomo-patológico. Conclusão: Mastoplastia redutora associada a implantes de silicone é um procedimento seguro para casos selecionados.

INTRODUCTION: Patient dissatisfaction with reduction mammoplasty outcomes can occur, especially in cases of ptosis accompanied by excessive flaccidity, striations, and a higher fat than glandular content. In such cases, achieving long-lasting results is very difficult. Small-volume breast implants can be placed during the reduction mammoplasty with the purpose of obtaining better breast shape, contour, and projection as well as greater long-term satisfaction. METHOD: Between 1997 and 2012, 264 patients aged 27-55 years (mean, 38) underwent reduction mammoplasty with immediate placement of breast implants. RESULTS: Satisfactory results were obtained, with adequate filling of the upper pole, increased breast firmness, and statistical reduction in postoperative ptosis. Two cases of carcinoma in situ were identified in the pathological exam. CONCLUSION: Reduction mastoplasty associated with silicone implants is safe for selected cases.

Hipertrofia mamaria virginal en una adolescente / Virginal mammary hypertrophy in an adolescent

Se presenta el caso clínico de una adolescente de 13 años de edad con antecedentes de buena salud, que acudió a la consulta de endocrinología pediátrica del Hospital Infantil Norte Docente Dr Juan de la Cruz Martínez Maceira de Santiago de Cuba por experimentar un aumento exagerado de ambas mamas, de aparición brusca en una semana y acompañado de enrojecimiento en los senos, elevación de su temperatura, dolor punzante y sensibilidad incrementada, sobre todo en los pezones. Estaba muy afectada psicológicamente; pero se le indicó un tratamiento con antiinflamatorio y diurético antes de ser remitida al Instituto Nacional de Neurología y Neurocirugía para la realización de otra tomografía axial computarizada contrastada, donde no se observaron alteraciones en los hemisferios cerebrales, silla turca, ventrículos y fosa posterior.

The case of a 13 year-old adolescent with a history of good health is reported, who attended the Pediatric Endocrinology Department from Dr Juan de la Cruz Martínez Maceira Northern Teaching Children Hospital of Santiago de Cuba due to an excessive increase of the breasts, which onset was abrupt in a week and accompanied by breast redness, elevated temperature, piercing pain and increased sensitivity, especially in the nipples. She was so psychologically affected, but she was on anti-inflammatory and diuretic before being referred to the National Institute of Neurology and Neurosurgery to perform another contrast CAT scan, where no changes were observed in the cerebral hemispheres, sella, ventricles and posterior fossa.

Evaluación de los resultados quirúrgicos de la mastoplastia por vía periareolar / Evaluation of the surgical results of mastoplasty by periareolar route

INTRODUCCIÓN. La mayor desventaja de la corrección de la hipertrofia mamaria moderada o la normotrofia asociadas a ptosis de grado I y II reside en las cicatrices visibles. Este trabajo buscó evaluar los resultados de una técnica de plastia mamaria de reducción y suspensión, por vía periareolar. MÉTODOS. En el Servicio de Cirugía Plástica del Hospital Clinicoquirúrgico Hermanos Ameijeiras fueron operadas 24 pacientes a las que se les realizó mastoplastia por vía periareolar. La técnica consistió en el diseño de un colgajo dermograso glandular fijado a la aponeurosis clavipectoral, mediante una incisión circular periareolar, de modo que la mama mantuviera su forma, consistencia y posición. RESULTADOS. Los resultados se evaluaron entre el primer, tercer y sexto mes después de la operación y al año de esta. En el 79,2 por ciento de las pacientes se obtuvieron resultados estéticos. Se corrigió la ptosis mamaria en el 95,7 por ciento de los casos y se logró una proyección anterior de la mama adecuada en el 87,5 por ciento de las pacientes. Solo hubo complicaciones en tres casos y consistieron en lipólisis abscedada y necrosis de la piel. CONCLUSIONES. Con la técnica empleada se lograron buenos resultados estéticos en la mayoría de las pacientes, así como la corrección y reducción de la ptosis y volumen mamario respectivamente, con un mínimo de complicaciones leves(AU)

INTRODUCTION. The greatest disadvantages of the correction of moderate breast hypertrophy or normotrophy associated with I and II degree ptosis are the visible scars. This paper is aimed at evaluating the results of a breast reduction and suspension plasty technique by periareolar route. METHODS. 24 female patients underwent mastoplasty by periareolar route at the Plastic Surgery Service of «Hermanos Ameijeiras¼ Clinical and Surgical Hospital. The technique consisted in the design of a glandular dermofat flap fixed to the clavipectoral aponeurosis by a circular periareolar incision in such a way that the breast would maintain its form, consistency and position. RESULTS. The results were evaluated on the first, third and sixth month, and a year after the operation. Aesthetic results were obtained in 79.2 percent of the patients. Breast ptosis was corrected in 95.7 percent of the cases. An adequate anterior projection of the breast was attained in 87.5 percent of the patients. Only three cases presented complications, which were abscessed lypolisis and skin necrosis. CONCLUSIONS. Good aesthetic results were obtained in most of the patients, as well as the correction and reduction of ptosis and breast volume, respectively, with a minimum of mild complications by using this technique(AU)

Resultados inmediatos del tratamiento quirúrgico en las hipertrofias mamarias / Inmediate results of the surgical treatment in breast hypertrophies

Se realizó un estudio observacional descriptivo sobre los resultados inmediatos del tratamiento quirúrgico en 223 pacientes ingresadas en el servicio de cirugía plástica del Hospital General Provincial Dr Antonio Luaces Iraola provincia Ciego de Ávila. Más de la mitad de los casos se encontraba en el rango de 26 a 45 años, y presentaban deformidad mamaria grado-II, la técnica quirúrgica más empleada fue el pedículo interno, seguida del pedículo externo y el superior, el mayor número de casos superaban los 1000g de tejido resecado. La infección, el sangra miento y el hematoma, resultaron las complicaciones más frecuentes. La mayoría de las pacientes se encontraron totalmente satisfechas con los resultados de la operación. Los resultados obtenidos demuestran la versatilidad de las técnicas quirúrgicas aplicadas, logrando obtener buena forma y función así como un elevado nivel de satisfacción en las pacientes aquejadas de hipertrofia mamaria.

A descriptive observational study about the immediate results of the surgical treatment in 223 patients who were into the Provincial General Hospital Dr Antonio Luaces Iraola, Ciego de Avila Province was carried out. More than half of the patients were in the rank of age from 26 to 45, and presented a breast deformity grade –II. The most used surgical technique was the internal pedicule, folowed by the external and upper pedicules. The highest number of cases overcame 1000g of resected tissue, infection, bleeding, and hematoma which were the most frequent complications. The great majority of the patients were satisfied with the surgery results. The outcomes obtained show the versatility of the surgical techniques applied, obtaining good chape and fuction as well as an elevated level of satisfaction in the patients suffering from Breast Hypertrophy.

Cirurgia de redução mamária e o mastologista / Breast reduction surgery and the breast surgeon

O tratamento cirúrgico de neoplasias mamárias benignas e malignas, assim como a abordagem de hipertrofias e assimetrias mamárias, requer do mastologista conhecimentos técnicos anteriormente utilizados apenas na área da cirurgia plástica. As técnicas de mamoplastia redutora utilizadas nos dias atuais derivam de técnicas descritas há muitos anos, com diferentes adaptações, objetivando sempre melhores resultados imediatos e tardios. As alterações estruturais e cicatriciais provocadas por esse tipo de cirurgia devem ser bem conhecidas e acompanhadas quando for empregada na solução de problemas oncológicos. Nesta breve revisão, discutem-se diversos aspectos técnicos e conceituais referentes à mamoplastia redutora com relevância na clínica mastológica atual.

New trends in breast cancer surgery motivated breast surgeons to get acquainted with surgical skills formerly only employed in aesthetic surgery. The modern surgical approach to reduction mammaplasty represents a surgical procedure improvement for better shape and reduced scars. Postsurgical changes, some of which may mimic cancer must be recognized and followed by mammography and clinical examination. In this review, we go through some issues about reduction mammaplasty and its importance for breast surgeons.