Application of liposuction technique assisted superomedial pedicle with vertical incision in reduction mammaplasty / 中国修复重建外科杂志

Objective: To explore the effectiveness of liposuction technique assisted superomedial pedicle with a vertical incision in reduction mammaplasty. Methods: Between March 2014 and March 2019, 65 patients (127 sides) with breast hypertrophy had undergone breast reduction by using liposuction technique assisted superomedial pedicle with a vertical incision. The patients were 21 to 58 years old, with an average of 42.2 years. Body mass index ranged from 18.8 to 26.5 kg/m 2, with an average of 21.3 kg/m 2. Among them, 62 cases were bilateral operations and 3 cases were unilateral operation. The degree of mastoptosis was rated as degreeⅡ in 73 sides and degree Ⅲ in 54 sides according to the Regnault criteria. Results: The unilateral breast removed 432 g on average (range, 228-932 g); the distance of nipple upward was 4.5-9.5 cm (mean, 6.5 cm); the volume of unilateral liposuction was 50-380 mL (mean, 148 mL). There were 2 sides (1.58%) of unilateral intramammary hematomas after operation, 4 sides (3.15%) of bilateral breast vertical incisions slightly split, and 1 side (0.79%) of the nipple-areola epidermis necrosis. All patients were followed up 6 months to 5 years, with an average of 18 months. During the follow-up, there was no evident re-dropping of the breast and no enlargement of the areola. No patient underwent scar excision. At last follow-up, the effectiveness was evaluated by the surgeons. There were 52 cases with very satisfactory, 10 cases with satisfactory, and 3 cases with unsatisfactory for the breast shape and symmetry. There were 51 cases with very satisfactory, 11 cases with satisfactory, and 3 cases with unsatisfactory for the nipple position and areola diameter. The incision scar was obvious in 25 cases and was not obvious in 40 cases. The results of self-assessment showed very satisfactory for the breast shape in 48 cases, satisfactory in 12 cases, and unsatisfactory in 5 cases; very satisfactory for the incision scar in 40 cases, satisfactory in 17 cases, and unsatisfactory in 8 cases. Overall evaluation of the patient was very satisfactory in 52 cases, satisfactory in 7 cases, and unsatisfactory in 6 cases. Conclusion: The liposuction technique assisted superomedial pedicle with a vertical incision in reduction mammaplasty is a safe and reliable surgical method with a satisfactory result.

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.

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.

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.

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.

Clinicopathologic changes of gigantomastia / 国际外科学杂志

Objective To study the clinical and pathologic changes in gigantomast.Methods Tissue sections were prepared from 180 cases of breast hypertrophy and 45 cases of normal breast tissues.The morphological changes and the expression and localization of ERRγwere evaluated on the HE and immunohistochemistry stained sections between hypertrophy and normal breast tissues.Results Compared with normal breast,hypertrophic breast showed expended ducts and obvious hyperplasia of the duct epithelial papillary.Hypertrophic breast tissues demonstrated strong expression of ERR-γ in ducts and lobules.Conclusions Upregulated expression of ERRγ is identified in hypertrophic breast tissues that may associate with the development of gigantomastia.

Concentric circumareolar approach in treatment of gynecomastia / 中华内分泌外科杂志

ObjectiveTo discuss the method and significance of concentric circumareolar approach in treatment of gynecomastia.MethodsThe incision was designed with the patient in a standing position.The location of the new nipple was determined,around which a outer cycle with the diameter of 5 cm was marked.And then a concentric inner circle with the diameter of 2.5 -3 cm was marked around the original nipple.The bilateral nipple position should be on the same level.A rim of tissue around the nipple-areola complex( NAC )was deepithelialized,excision of excess glandular tissue was performed subcutaneously and vascular network of dermis was preserved as much as possible.The purse string suture was applied in the circumareolar incision.Results 30 patients with gynecomastia were treated with this method.The result of the operation was pleasing with good aesthetic appearance,normal blood supply,and inconspicuous scars.Conclusion As a surgical approach of gynaecomastia,concentric circumareolar incision can remove excess glandular tissues and redundant skin,and has the benefit of concealing incision,simple procedure and satisfactory outcome.

Hipertrofia virginal mamaria en niños y manejo quirúrgico

Introducción: La hipertrofia virginal mamaria es un padecimiento en mujeres, principalmente durante su pubertad, que se presenta con un crecimiento rápido de la mama, causando alteraciones psicológicas, estéticas y funcionales. Se trata de una patología mamaria benigna, cuyo diagnóstico clínico puede ser difícil cuando se produce de forma unilateral, y su tratamiento quirúrgico es aún controversial. Métodos: Se presenta los casos clínicos de 5 pacientes con el diagnóstico de hipertrofia virginal mamaria, tratadas en el Hospital Infantil de México Federico Gómez en los años 2009-2011, refiriendo sus características clínicas, tratamiento quirúrgico realizado y resultados obtenidos. Resultados: La mayoría de las pacientes tuvo una reducción mamaria con pedículo superior o inferior, con buenos resultados estéticos al final, y sin necesidad al momento de intervenciones posteriores por recurrencia. Una paciente con sospecha de tumor filoides fue sometida a mastectomía subcutánea. La única complicación presentada fue necrosis del complejo areola pezón en una paciente. Conclusiones: La técnica quirúrgica a emplear debe ser valorada en cada paciente, realizando una evaluación integral sobre las características del paciente, presentación y objetivos personales. Creemos que la técnica de reducción mamaria en los adolescentes con esta patología es una buena propuesta, con buenos resultados estéticos, fácilmente aceptada por el paciente pediátrico, disminuyendo la morbilidad de un segundo procedimiento quirúrgico.

Introduction: Virginal breast hypertrophy is a female condition frequently present during puberty as a fast growing breast that causes psychological, aesthetic and functional alterations. It is a benign breast pathology of difficult clinical diagnosis when present unilaterally, and its surgical treatment is still controversial. Methods: Five clinical cases of virginal breast hypertrophy were treated at Hospital Infantil de México Federico Gómez from 2009-2011. We present their clinical characteristics, surgical treatment, and results obtained. Results: Most patients had either superior or inferior pedicle mammary reduction with favorable results or no re-intervention due to recurrence. A patient had suspicion of phyllodes tumor and subcutaneous mastectomy was performed. The only complication was nipple areola complex necrosis in one patient. Conclusions: The surgical technique should be individualized in each patient according to characteristics, presentation, and personal objectives. Mammary reduction for adolescents with this pathology is a good option, with good aesthetic results, easily accepted by the pediatric patient, lowering morbidity of a second surgical procedure.

A New Design of Vertical Reduction Mammaplasty

Although the technique of vertical reduction mammaplasty has gained major popularity, it is difficult to perform and has the steep learning curve. The authors present a modification of the standard Lejour vertical mammaplasty that simplify the design and make it more reliable and easy to perform. We simplified the design by discarding the Mosque dome. From March 2000 to March 2004, we performed this technique for 40 patients with breast hypertrophy. The apex of the design was marked at the anterior projection of the inframammary fold. After resection of the breast tissue, the medial and lateral pillars were approximated. Then a new nipple- areola position was determined at 4.0-5.0cm from a new inframammary fold. The range of resection amount of breast tissues was from 150 to 750 gram. Most of the patients were satisfied with the results. There was no permanent sensory loss and nipple areola skin necrosis. But there was 1 case of hematoma on the first day after the operation. This technique presents several advantages. It allows shaping and projection without compromising the future nipple position and makes it easier to remove an excessive skin around the areolae. And it may be comfortable to adjust the position of the nipple at the end of the procedure. We believe that this modification helps to improve the results of the vertical reduction mammaplasty.

Reduction mammaplasty with pure liposuction / 中华医学美学美容杂志

Objective With the social and economic advancement, the morbidity of breast hypertrophy is increasing. Inverted T technique was the traditional breast reduction mammaplasty method. It left severe scar after operation. The aim of this study was to introduce our experience about breast reduction with pure liposuction that significantly reduced the operative scar after operation. Methods After using tumescent anesthesia, a small incision about 5 mm was performed at inframammary fold for proper selected patients, The entire breast and subcutaneous fat were thoroughly suctioned with small caliber cannulas for breast reduction. No surgical excision was applied. Compression garment was applied after the operation. Results A total of 11 patients were successfully treated. Only one patient had a unilateral seroma that was responded to multiple aspiration. All the patients were satisfied with the results. The morphology was good. The texture of the breast was improved. Conclusion Reduction mammaplasty with pure liposuction is simple and effective for those who had mild to moderate breast hypertrophy with no severe ptosis and more fatty tissue. The scar is invisible. It deserves to be recommended.

Reduction Surgery for Giant Breast / 한국유방암학회지

PURPOSE: Women with large breasts suffer from both physical embarrassment and physical discomfort. Recently, partially due to socioeconomic development, growing numbers of woman with large breasts have sought reduction surgery, which previously had not been popular in Korea. At this time, a proper evaluation of the operation is required in order to promote the procedure. METHODS: Case files of 60 reduction operations using the inferior pedicle flap method for the reduction of large breasts were clinically reviewed. RESULTS: The patients were aged 19~65 (mean 34.5) years. The primary reasons for surgery were self-consciousness, shoulder/neck/back pain, wet skinfold/eczema and intractable mastalgia. Breast parenchymal pattern analysis by mammography revealed relatively a high frequency of dysplastic change (DY) among women with intractable breast pain, which was nearly entirely relieved by reduction surgery. The nipple-areolar complex were saved with inferior dermal pedicle flaps without any occurrence of necrosis. An average of 350 (range 50~800) grams of tissue from each breast was removed. There were no blood transfusions and significant postoperative complications were rare, although some patients complained of hypertrophic scars. CONCLUSION: Postoperative results were sufficiently satifactory to consider reduction surgery for inappropriately large breasts as a rehabilitative method.

Reduction Surgery for Giant Breast / 한국유방암학회지

PURPOSE: Women with large breasts suffer from both physical embarrassment and physical discomfort. Recently, partially due to socioeconomic development, growing numbers of woman with large breasts have sought reduction surgery, which previously had not been popular in Korea. At this time, a proper evaluation of the operation is required in order to promote the procedure. METHODS: Case files of 60 reduction operations using the inferior pedicle flap method for the reduction of large breasts were clinically reviewed. RESULTS: The patients were aged 19~65 (mean 34.5) years. The primary reasons for surgery were self-consciousness, shoulder/neck/back pain, wet skinfold/eczema and intractable mastalgia. Breast parenchymal pattern analysis by mammography revealed relatively a high frequency of dysplastic change (DY) among women with intractable breast pain, which was nearly entirely relieved by reduction surgery. The nipple-areolar complex were saved with inferior dermal pedicle flaps without any occurrence of necrosis. An average of 350 (range 50~800) grams of tissue from each breast was removed. There were no blood transfusions and significant postoperative complications were rare, although some patients complained of hypertrophic scars. CONCLUSION: Postoperative results were sufficiently satifactory to consider reduction surgery for inappropriately large breasts as a rehabilitative method.

Reduction Surgery for Giant Breast

PURPOSE: Women with large breasts suffer from both physical embarrassment and physical discomfort. Recently, partially due to socioeconomic development, growing numbers of woman with large breasts have sought reduction surgery, which previously had not been popular in Korea. At this time, a proper evaluation of the operation is required in order to promote the procedure. METHODS: Case files of 60 reduction operations using the inferior pedicle flap method for the reduction of large breasts were clinically reviewed. RESULTS: The patients were aged 19~65 (mean 34.5) years. The primary reasons for surgery were self-consciousness, shoulder/neck/back pain, wet skinfold/eczema and intractable mastalgia. Breast parenchymal pattern analysis by mammography revealed relatively a high frequency of dysplastic change (DY) among women with intractable breast pain, which was nearly entirely relieved by reduction surgery. The nipple-areolar complex were saved with inferior dermal pedicle flaps without any occurrence of necrosis. An average of 350 (range 50~800) grams of tissue from each breast was removed. There were no blood transfusions and significant postoperative complications were rare, although some patients complained of hypertrophic scars. CONCLUSION: Postoperative results were sufficiently satifactory to consider reduction surgery for inappropriately large breasts as a rehabilitative method.