A prospective study of scars after breast implantation with different incisions / 中华整形外科杂志

Objective@#To compare the scar condition after breast implantation with axillary, periareolar and inframammary fold (IMF) incisions.@*Methods@#The consecutive patients who were diagnosed as breast hypoplasia and underwent breast implantation surgeries between May 2012 to December 2014 were included in the research. The scars were assessed at 1, 6 and 12 months after surgery with VSS and patient satisfaction scoring. The results were analyzed with Variance and Kruskal-Wallis test based on the data type.@*Results@#The scars of 173 patients were assessed 3 times with the follow-up rate being 82.4%. The VSS scores of every incision declined with time, and the patient satisfaction scores increased gradually. At one month after surgery, the media VSS scores were 6 in axillary group and 4 in periareolar and IMF groups, the differences had statistical significance (P<0.05). The media scores of patients satisfaction were 8 in periareolar group and 7 in axillary and IMF groups. The scores of periareola group were higher than those of axillary with statistical significance(P<0.05). When 6 months after surgery, the media VSS scores were 4 in axillary group and 3 in periareolar and IMF groups. The scores of axillary group were higher than those of IMF with statistical significance(P<0.05). The media scores of patients satisfaction were 8 in 3 groups. When 12 months after surgery, the media VSS scores were 0.5 and 1 in periareolar group (left and right respectively), and 2 in axillary and IMF groups. The media scores of patients satisfaction were 9 in 3 groups. No differences were found in VSS and patients satisfaction scores among three kinds of incisions (P>0.05).@*Conclusions@#The scars of three incisions achieved similar cosmetic effects and patient satisfaction at long-time follow-up.

Tratamiento de la ginecomastia: Diferencias entre la incisión periareolar externa y la incisión periareolar inferior en mastectomía subdérmica / Treatment for gynecomastia: Differences for the external and inferior periareolar incision for subdermal mastectomy

Introducción: La ginecomastia define el aumento benigno del tamaño de la glándula mamaria en el hombre. Existen diversos abordajes quirúrgicos para la resección de la lesión, cada una con resultados diferentes. Material y métodos; Estudio transversal. Se incluyeron pacientes con ginecomastia operados de mastectomía subdérmica mediante incisión periareolar externa e incisión periareolar inferior. Para la aleatorización se tomó en cuenta los grados IIb y III de Simon, distribuyendo uno a uno para cada tipo de incisión. Los resultados estéticos fueron evaluados por un cirujano experimentado, tomando como excelentes cuando hubo una cicatrización correcta sin deformidad del área, buenos cuando la cicatrización fue buena sin deformidad del área y mala cuando hubo deformidad del área operada. Resultados: Fueron operados 24 pacientes, el 50% por incisión periareolar externa y el 50% por incisión periareolar inferior. La edad promedio fue 25,58 y 27,58 años respectivamente, sin diferencias significativas p = 0,513. Todos los pacientes tuvieron características sexuales secundarias normales. La etiología fue idiopática en 23 pacientes (95,83%). El tiempo promedio de evolución fue 32,28 meses y en todos el resultado histopatológico fue ginecomastia. La evaluación del aspecto estético de la incisión y el área afectada en los pacientes operados mediante incisión periareolar externa (n = 12) fue mala en un paciente (8,33%), buena en 2 (16,66%) y excelente en 9 pacientes (75%), mientras que en los pacientes operados mediante incisión periareolar inferior, fue buena en el 100% de los pacientes, y mala y excelente en ningún paciente, con diferencias estadísticamente significativas para ambas incisiones, p = 0,000. Ningún paciente presentó complicaciones. Conclusión: Ambas incisiones son seguras. La incisión periareolar externa ofrece mejores resultados que la incisión periareolar inferior para realizar mastectomía subdérmica en pacientes con ginecomastia en todos los grados Simon.

Introduction: Gynecomastia defines the benign enlargement of the mammary gland in man. There are several surgical approaches for resection of the lesion, each with different results. Material and methods: Cross-sectional study. There were included patients with gynecomastia, operated by means of external and inferior periareolar incision. For randomization was took into account degrees IIb and III of Simon, distributing one to one for each type of incision, the cosmetic results were evaluated by an experienced surgeon, taking as excellent results when there was a proper healing without deformity of the area, good results when healing was good without deformity, and bad results when there was deformity of the operated area. Results: There were 24 patients, 50% operated by external periareolar incision and 50% by lower periareolar incision. The mean age was 25.58 and 27.58 years old for each group, with no significant statistically differences (P = .513). All patients had normal secondary sexual characteristics. The etiology was idiopathic in 23 (95.83%). The average evolution time was 32.28 months, on all histopathological result was gynecomastia. The evaluation of the aesthetic aspect of the incision and the area affected in patients operated by external periareolar incision (n = 12) was bad to 1 (8.33%), good in 2 (16.66%) and excellent in 9 (75%) patients; 100% of the patients operated by inferior periareolar incision presented good results, there were statistically significant differences for both incisions, P = .000. There were no complications. Conclusion: Both incisions are safe, periareolar external incision provides better results than the inferior periareolar incision for patients with gynecomastia in all degrees of Simon.

Treatment for Gynaecomastia in Men. Experience with the Inferior Periareolar Incision in a Single Third Level Medical Facility.

Background: Gynaecomastia is defined as an enlargement of the mammary gland in men. Objective: To evaluate Aesthetic Results of Subdermal Mastectomy by means of Inferior Periareolar Incision. Materials and Methods: Descriptive, cross sectional and prospective study. We evaluate aesthetic results of Subdermal Mastectomy by means of Inferior Periareolar Incision using Analog visual Scale applied by an another Surgeon) and a Questionnaire (Auto Evaluation). Variables: Age, Clinical Symptoms, Evolution time, Complications and Aesthetic Results. Descriptive and Inferencial Statistic was used (Wilcoxon test). Results: Twelve patients, median age 27.5 (18-58) year-old. Nine (75%) patients presented pain, 4 (33.3%) bilateral gynaecomastia, 4 (33.3%) left and 4 (33.3%) right sided gynaecomastia. According to Simon Classification, 3 (25%) patients grade I; 2 (16.6%) IIa; 2 (16.6%) IIb and 5 (41.6%) III. No patient presented concomitant disease, 12 (100%) had normal secondary sexual characteristics. Six (50%) had hyperesthesia. The Aesthetic Evaluation made by a distinct Surgeon was as it follows, 10 (83.3%) had a ≤ 6 punctuation and 2 (16.6%) had ≥ seven (0 - 10, Analogue Visual Scale). Ranks for Aesthetic Aspect Evaluation made by the patients, before and after surgery were 2.54 (average after surgery) and 0.00 (average before surgery), Z -1.857, p=0.0063 (p<0.05, Wilcoxon). Conclusion: Subdermal Mastectomy should be in lower case by Inferior Periareolar Incision, it does not present severe complications however aesthetic results are undesirable.

Advances in the treatment of breast fibroadenoma surgery / 国际外科学杂志

Breast fibroadenoma is the most common benign tumor of female mammary gland,which is tend to occur in young women under the age of 30.The main treatment is surgical removal.The option of the method and timing of the surgery is effected by ages,fertility requirements,tumor size,location,and so on.Considering the young women of beauty and nursing requirements in the future,combined with medical cosmetology technology progress,the way to do surgery is particularly important.There are various surgical methods whose effects and applicable objects are different in clinic.In this article,the type of operation on breast fibroadenoma and timing of surgery were reviewed.

Periareolar incision in treatment of gynecomastia / 中国基层医药

Objective To investigate the feasibility and safety of periareolar incision in treating gynecomastia, and whether it produces good cosmetic effects. Methods A total of 42 patients with gynecomastia treated by micro-incision of areola were retrospectnely anslyzed. Results The operation was successfully performed in all the 42 patients. Follow-up was done for 3 to 24 months, the surgical scars were obscure, and the sensation of nipple or areola were good. No operation-related complications were observed. Conclusion The periareolar incision in the treatment of gynecomastia was feasible and recommendable in terms of cosmetic maintenance and safety.

Application of Periareolar Approach to Diverse Mammoplasty

Augmentation mammoplasty can be performed through various ways such as transaxillary, inframammary, periareolar and transumbilical approaches according to the patient's breast contour, body shape, and patient's and physician's preference. Each approach has unique pros and cons. From March, 2000 to October, 2002, we have applied periareolar approaches for augmentation mammoplasties in 69 patients, 134 breasts. Periareolar approach has several advantages. It is easy to access to the subpectoral space technically because of shorter distance and direct visualization. It requires smaller incision and leaves inconspicuous scar. Using endoscope, precise dissection of subpectoral space and hemostasis during operation could be achieved. We have kept fill-tube attached to the saline implant even after the surgery in selective cases. On the following day after the surgery, patients could check her breast contour, size, and symmetry by themselves in front of the mirror. Additional adjustment of implant volume was possible in the range of 10 to 15 per cent and it would decrease patient's complaint about the final result. We have introduced endoscope in periareolar augmentation mammoplasty in some cases. It allows us direct visualization of the subpectoral space and the origin of the pectoralis major muscle, and more accurate manipulation and hemostasis were possible. We have applied periareolar approach to various situations such as primary procedures in hypoplastic breasts, asymmetric breasts and secondary procedures in capsular contracture, rupture of mammary implant and combined operation with breast cancer or inverted nipple. Periareolar approach can be applied for diverse cases of mammoplasty, whether it is primary or secondary procedure, successfully because of its easiness, convenience, safety, economical efficacy and positive effect for doctor-patient relationship.