Consideraciones acerca de la cirugía plástica en Santiago de Cuba / Considerations on plastic surgery in Santiago de Cuba

El problema de la conformidad del ser humano con las características específicas de su cuerpo puede tener su origen en un problema estético o en un aspecto de carácter puramente físico que limita de manera marcada el desarrollo de sus actividades diarias. Ambos pueden tener solución mediante una cirugía, especialmente la estética. El objetivo de este trabajo es reafirmar que la cirugía plástica estética resuelve verdaderos problemas de salud tanto física como mental al reconocer la labor de los especialistas de cirugía plástica como evaluadores y consejeros de pacientes que acuden a consulta en busca de ayuda en nuestra provincia. Se revisó la literatura nacional e internacional sobre el tema y se concluyó que la cirugía plástica con fines estéticos constituye una solución, al satisfacer las expectativas tanto de las personas que reciben el tratamiento, como de los especialistas que realizan el trabajo.

The problem of dissagrement of the human being with the specific characteristics of his body may have its origin in an esthetical problem or in a purely physical character affair which limits, in a marked way, the development of his daily activities. Both may be solved through a surgery, specially, a esthetic surgery. The objective of this work is to reaffirm that the plastic esthetic surgery solves real physical or mental health problems, so as to recognize the work of plastic surgery specialists as evaluators and advisers of patients visiting the provincial department who look for help. National and international literature on the topic was reviewed and it was concluded that plastic surgery with esthetic aims is a solution, as it satisfies the expectatives either from people searching treatment, as from the specialists who give the service.

Reduction mammoplasty with the modified Benelli round block technique: applied anantomy, technique and long-term follow-up results / 中华医学美学美容杂志

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.

Vertical reduction mammoplasty based on Würinger's horizontal septum / 中华医学美学美容杂志

Objective The vertical mammoplasty which improves the breast morphology and reduces the operative scar has become the first selection of breast reduction.However,the nipple-and-areola complex (NAC) had the risk of necrosis in those severe patients.In this report,we performed the vertical reduction mammoplasty based on Wu'ringer's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejourmosque-dome design was performed.The inferior part of glandular tissue and the skin were excised.The NAC was elevated to normal position based on Wu'ringer's horizontal septum.The breast morphology was modified with vertical scar left.Results 79 patients were operated.4 patients had unilateral breast reduction.4 breasts had partial wound dehiscence.They were treated conservatively with topical dressing.No complete NAC necrosis occurred.Conclusions The vertical reduction mammoplasty based on Wu'ringer's horizontal septum is a safe and effective procedure.The NAC necrosis risk is reduced.This method deserves to be recommended.

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.

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.

Pioderma gangrenoso en mamoplastía de reducción con pedículo inferior / Pyoderma gangrenosum secondary to reduction mammoplasty

Background: Pyoderma gangrenosum (PG) is an uncommon inflammatory and ulcerative disorder of the skin. It may be associated with immune deficiencies. It is usually located in the extremities and its appearance after reduction mammoplasty is exceptional. We report three patients with the disease. A 54 years old female subjected to a bilateral reduction mammoplasty with an inferior pedicle. She developed a pyoderma gangrenosum and was treated with systemic steroids and local application of Dapsone with remission of lesions and healing after one month of evolution. A 23 years old women subjected to the same surgical procedure, which developed a wound dehiscence with ulcerative lesions, was treated with steroids and Azathioprine, reducing the local inflammation but leaving a severe esthetic sequel. A 21 years old woman subjected to the same surgical procedure, develop bilateral wound dehiscence and ulcerative lesions, she was treated with steroids and antimicrobials achieving a secondary healing...

Introducción: El Pioderma Gangrenoso es una enfermedad poco frecuente, de difícil diagnóstico y manejo. Puede estar asociado a otras enfermedades, en donde la alteración de la respuesta inmune es común. Su presentación por lo general corresponde a lesiones ulceradas de la piel ubicadas con frecuencia en las extremidades, siendo su presentación en las mamas excepcional; y mucho más rara su relación post mamoplastía de reducción. Métodos: Se realizó una revisión de pacientes sometidas a mamoplastía de reducción con pedículo inferior, asociadas al desarrollo de pioderma gangrenoso post-quirúrgico, durante un período comprendido entre los años 2000 y 2011. Resultados: Se recolectaron 3 pacientes, se describen sus casos clínicos con respecto a esta ubicación, analizando su presentación, evolución y manejo de la enfermedad. Discusión: La presentación del pioderma gangrenoso post-quirúrgico en relación a la mamoplastía de reducción comparte ciertas similitudes, las cuales deben orientar al diagnóstico precoz y de esta forma evitar manejos erróneos que pueden ser deletéreos, secuelantes e incluso potencialmente mortales...

Modified reduction mammoplasty with central pedicle-double circle technique / 中华医学美学美容杂志

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.

Breast Reconstruction Make Use of Contralateral Breast Tissue after Mastectomy

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

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.

Biópsia do linfonodo sentinela em mulheres com câncer de mama e mamoplastia redutora prévia - técnica radioguiada / Sentinel lymph node biopsy in women with breast cancer after reduction mammoplasty - radiogueded technique

A mamoplastia redutora tem sido considerada uma contra-indicação relativa para a biópsia do linfonodo sentinela (LS), porque há possibilidade de que os vasos linfáticos tenham sido interrompidos pelo procedimento cirúrgico. Relatamos 13 mulheres com 14 carcinomas de mama detectados após cirurgia de redução das mamas e que se submeteram à biópsia do LS. As pacientes realizaram linfocintilografia detectou a presença de LS em 92,9% (13/14) dos casos e a taxa de sucesso da biópsia cirúrgica foi de 85,7% (12/14). Verificou-se doenças metastática para o LS em 33,3% (4/12) dos casos e realizou-se linfadenectomia axilar em três dessas quatro pacientes, constatando-se metástases adicionais em linfonodos não-sentinelas em um caso. Não se deve considerar a mamoplastia redutora prévia uma contra-indicação para a biópsia do LS.

Breast reduction surgery is considered a relative contraindication for sentinel node biopsy because the possibility that lymphatics have been interrupted by the procedure. We describe 13 patients with 14 carcinomas who underwent sentinel lymph node biopy after breast reduction surgery. The patients underwent presurgical lymphoscintigraphy and intraoperatively the sentinel lymph node was identified with a handheld gamma probe. Lymphoscintigraphy was successful in 92.9% (13/14) of the cases and sentinel lymph node biopsy was successful in 85.7% (12/14). Sentinel node metastases were found in 33.3% (4 / 12). Axillary dissection was performed in 3 of these patients, and additional metastases were found in one patient. Sentinel lymph node biopsy should not be considered a contraindication after breast reduction surgery.

Medial Pedicle Vertical Reduction Mammoplasty

Most recent breast reduction techniques tend to get natural cone shaped breast with minimal scar. On this purpose, we have performed 7 cases of vertical reduction mammoplasty with medial pedicle from August 2003 to August 2005. The mean age of patient was 29, and the average resection amount was 760 gram per breast. The most of the patient were satisfied with their postoperative size, shape and scar. As compared with classical superior pedicle vertical reduction mammoplasty, by using medial pedicle, this technique could use short and wide-ranging pedicle, avoid skin undermining, evade exposure of pectoralis major fascia and remove the fixation as well. And this technique did not operate liposuction. As descrived above, the advantages of vertical mammoplasty using a medial pedicle are as follows: 1. Limited postoperative scar of incision. 2. More effective preservation of sensation to the nipple-areolar complex and physiological function as breast feeding. 3. More aesthetic shape of breast. 4. The procedure is easy to perform. 5. Shortening the period of postoperative care.

Reduction Mammoplasty-100 Cases by Single Surgeon-MDbP302

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.

Simultaneous Reduction Mammoplasty with Excision of Benign Tumor

The purpose of study was to retrospectively assess the possibility of simultaneous breast reduction and tumor excision in women with benign tumor and mammary hyperplasia. Performance status of the patient, appropriate operation technique and postoperative results were analyzed. Evaluation was made regarding four patients who underwent simultaneous breast reduction and tumor excision with more than 6 months follow up. The types and locations of the tumor, corresponding operation technique, postoperative complication such as flap necrosis, subjective alteration in sensorium around the nipple-areolar complex and esthetic satisfaction were assessed. Preoperative radiologic examinations, histologic findings of the fine needle aspiration, and postoperative biopsy were equivalent. The histologic types revealed were tubular adenoma, leiomyoma and lipoma(2 cases). The tumor was each located in lower lateral quadrant, subpectoral, inframammary fold, and upper lateral quadrant of breast, respectively. Regarding the location of tumor and status of mammary hyperplasia, each breast reduction was done with superior, inferior and medial pedicle(2 cases). There were no postoperative complications and esthetic satisfaction rate was high in all patients. When accurate diagnosis based on preoperative radiologic and histologic evaluation and appropriate selection of operative technique were done, simultaneous breast reduction with excision of benign tumor showed satisfying outcome without postoperative complication even along with esthetic satisfaction.

Reduction Mammoplasty is a Functional Operation, for Improving the Quality of Life in Symptomatic Women - MDbP301 / 한국유방암학회지

PURPOSE: Women with huge breasts suffer cervical, shoulder and back pain, breast pain and limitations of their daily activities, and all of this can create a functional disability and poor quality of life. Many patients with huge breasts need a reduction surgery not only for cosmetic purposes but also for functional improvement. METHODS: Fifty reduction mammoplasty cases that were operated in M.D. Clinic from April 2001 to August 2004 were retrospectively reviewed. Patient's age, the amount of removed breast tissue and the method of operation were evaluated, and 38 of these cases were surveyed by phone concerning the changes of their physical symptoms. RESULTS: The mean age of the cases were 37.3, and the ages ranged from 18 to 57. The amounts of removed tissue ranged from 50 g to 605 g (mean of right side: 275 g, and left side: 271 g). Nine cases of Benneli's circumareolar scar technique, 9 cases of inferior pedicle flap (inverted T scar) and 32 cases of circumvertical bipedicle flap were performed. Among the 38 cases that were surveyed by phone, most of them had suffered physical symptoms preoperatively, including cervical and shoulder pain (31 cases, 81.6%), back pain (35 cases, 92%), breast pain (21 cases, 55.3%), submammary rash (24 cases, 63.2%), fatigue (14 cases, 36.8%), headache (15 cases, 39.5%), numbness in hands (6 cases, 15.8%) and depression or nervousness (29 cases, 76.3%). The majority of survey respondents reported improvement in cervical and shoulder pain (100%), back pain (100%), fatigue (100%), headache (100%), breast pain (90.5%), submammary rash (91.7%), depression or nervousness (82.7%). Furthermore, there were additional gains including increased ability to enjoy physical exercise and social activity, improvement in the fit of their clothing and in their self-esteem. Adverse sequelae included scars (21 cases, 55.2%), asymmetry (11 cases, 28.9%), decrease in nipple sensation (13 cases, 34.2%), infection (1 cases, 2.6%) and hematoma (1 cases, 2.6%). CONCLUSION: Huge breast create physical symptoms including cervical and shoulder pain, back pain, breast pain, submammary rash, and other social and psychological problems. Reduction mammoplasty can improve the majority of these symptoms caused by huge breast, and this is an operation to help mend a functional disability.

Simultaneous TRAM Flap Breast Reconstruction with Contralateral Reduction Mammoplasty

Symmetry is an important parameter for breast reconstruction. Contralateral breast frequently provides model to be reconstructed. But hypertrophic and ptotic breast is aesthetically unacceptable. And if the contralateral breast is large, larger flap which is required to reconstruct the breast including the zone of poor vascularity. Therefore, reduction of hypertrophic breasts may be preferable. Many surgeons prefer to perform contralateral procedures at least several months after reconstruction. However authors performed simultaneous contralateral reduction mammoplasty in 18 patients at the same time as pedicled TRAM flap reconstruction. The expected disadvantages of the simultaneous operation are increased hospitalization time, blood loss, and complications. But according to our result, it showed that there was no significant difference in hopitalization time and hemoglobin-decrease. Furthermore, simultaneous operation showed lower complication rate because of the reduced size of the required flap. Our results revealed that TRAM flap breast reconstruction and simultaneous contralateral reduction mammoplasty is a safe procedure. And the results were aesthetically acceptable.

Long Term Follow Up of Reduction Mammoplasy using Inferior Pyramidal Dermal Technique

The inferior pyramidal dermal technique has many advantages in various reduction mammoplasty procedures. It has been possible to increase the amount of breast tissue removed, which enhances the quality of the final result. However, the main disadvantage of this method is the large and long reverse T scars, particularly in Asian women. Twenty breasts of 10 patients, who underwent an operation by the inferior pyramidal dermal technique with several modification from March 1989 to March 2001 were followed up. The mean age was 35 and the mean follow up period was 5.5 years. The mean resection amount was 692 gm per breast. In order to prevent a boxy breast, the inferior margin of the medial flap had a gentle curve, and the lateral flap had a "lazy S" contour. A small triangle of the skin was leaved with its base on the inframammary fold to relieve the T-junctional tension. In order to ensure nipple projection, the skin was deepithelialized at the recipient site for the relocated nipple-areola complex and 2 cm around areola. Because the vascular supply to the nipple-areola complex of the pyramidal flap was derived from the intercostal perforating vessels, the full-thickness removal of the skin from the pyramidal flap was made to reduce the operation time. A sufficient parenchyma resection beneath the lateral flap was performed to minimize a boxy breast. A postoperative hyperpigmented scar became light after 2 years and was inconspicuous after 3 years. An immediate postoperative boxy breast was noticed. However, it has been observed that there was gradual increase in the distance from the inframammary fold to the areola, because of the descent of the breast parenchyma due to gravity, along with the displacement of the nipple-areola complex superiorly. It is believed that this problem can be overcome by pedicle trimming, medial and superior fixation sutures with the nipple areola complex 1-2cm being situated below the expected position.

Reduction Mammoplasty using Modified Round Block Technique

The goals of reduction mammoplasty are to remove the appropriate amount of breast tissue and to make the nice cone-shaped breast. For these goals, various methods have been used and newly introduced. Recently, as women's interest in cosmetic attractiveness increases, surgeons make attempts to minimize postoperative scars. Periareolar approach has an advantage of invisible postoperative scar, but has many disadvantages - flattening of breast shape, recurrence of breast ptosis, hypertrophy and widening of periareolar scar, enlargement and distortion of areola caused by tension. After Benelli introduced Round block technique, this approach became one of the most popular methods. The characteristics of Round block technique are periareolar approach, superiorly based dermoglandular pedicle, criss-cross mastopexy, and Round block suture. Authors modified periareolar Round block technique to adjust to Korean women and have operated on 11 patients since 1997. We focused on medializing the lateral portion of inframammary fold and avoiding asymmetry and protrusion of nipple-areolar complex. Round block suture with uniform thickness and length must be applied at the same time to prevent areolar complications. In design, authors referred to the statistical analysis on Korean female. The results are aesthetically and functionally satisfactory and there has been no significant complication. In conclusion, this method is effective for young woman or mild macromastia with moderate ptosis. Besides, an accurate understanding of each step of operative procedure and enough knowledge of anatomy and physiology of the breast are essential.

Reductive mammoplasty: an approach of periareolar incision with glandular flap suspension and its contour-line circum-contraction suture / 中华医学美学美容杂志

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.

Periareolar Reduction Mammoplasty

The goals of the reduction mammoplasty are to reduce the volume of the breast, to create aesthetic shape that is stable over time, to maintain blood supply and innervation to the nipple-areolar complex, and to make fine limited scars. There are 3 rationales in our reduction mammoplasty. To reduce the scar, we perform the periareolar incision. To make effective reduction of the breast volume, and to preserve blood supply and innervation to the nipple-areolar complex, we use a central or an inferior pedicle technique. To prevent areolar widening, we use a purse-string suture. We performed the periareolar reduction mammoplasty to 36 breasts in 18 patients from Jul. 1998 to Jun. 2000. The mean follow up period was 8 months. The mean age was 41 and mean resection amount was 420 gm per breast. Most patients satisfied with their fine periareolar scars, adequate size of breasts and the innervation of the nipple-areolar complex. We applied this procedure to all kinds of macrostomia. The greatest advantage of the periareolar reduction mammoplasty is the inconspicuous limited scar. Other advantages over conventional technique include preservation of sensitivity to the nipple-areolar complex and shorter operative time. As disadvantages, 10 breasts(28%) showed areolar widening. In 8 of 10 breasts with areolar widening, purse-string suture was not applied in the skin flap margin of the outer circle and reoperation was executed to reduce the areolar size by excision of the widened areola. The application of the purse-string suture was carried out in 6 breasts. Two breasts with purse-string suture showed areolar widening possibly due to loosening of the purse-string suture knot. There were persistent periareolar wrinkles in 4 breasts and poor sensitivity to the nipple-areolar complex in 6 breasts in which more than 500 gm of breast tissue per breast was resected. Periareolar reduction mammoplasty is optimal for patients who require reduction of lesser than 500 grams per breast. In the severe macromastia with or without ptosis, inverted T-incision is preferable to the periareolar incision, and periareolar incision can be modified by adding wedge resection of the outer excess skin flap inferiorly which results in a periareolar and vertical scar below the nipple-areolar complex.

A Case of Macrogynecomastia Treated by Reduction Mammoplasty / 대한소아내분비학회지

Gynecomastia is a proliferation of the glandular component of the male breast. Gynecomastia is the most common variant condition of the male breast and results from the effect of an altered estrogen-androgen balance on breast tissue or from the increased sensitivity of breast tissue to a normal estrogen level. We experienced a case of macrogynecomastia in a 16-year-old boy who had a normal male phenotype and was treated by reduction mammoplasty with breast tissue removal, which was effective and produced good cosmetic and psychologic results.