Cases Of Breast Reduction Research Articles

Goldilocks Procedure without a Vertical Incision and a Comprehensive Literature Review.

Background:The Goldilocks technique is a postmastectomy breast reconstruction procedure adopted in 2012, which is performed by preserving and de-epithelializing the residual mastectomy flap to create an autologous tissue breast mound using an anchor, inverted T, or lateral incision. It is utilized in select patients along with the addition of a free nipple graft, fat grafting, and/or tattoo. A novel technique using the Goldilocks procedure offers promising postoperative results as a more aesthetic alternative. The purpose of this study was to perform a literature review on the healing outcomes and patient satisfaction of the Goldilocks procedure along with presenting our approach using a horizontal inframammary incision without a vertical incision.Methods:A retrospective chart review of patients presenting to a single surgeon for breast reconstruction surgery using the Goldilocks procedure without a vertical incision from March of 2018 to October of 2020 was performed. A narrative literature review on surgical techniques and outcomes was also conducted.Results:Three cases of breast reduction using the Goldilocks procedure without a vertical incision are described. From the literature search, 13 articles inclusive of 222 patients were identified.Conclusions:The Goldilocks procedure without a vertical incision can be performed in patients with large breasts for breast reconstruction postmastectomy. It is possible to utilize the superior flap in conjunction with the de-epithelialized inferior flap of the breast and obtain good projection with this method. Furthermore, avoidance of the vertical incision reduces breakdown at the T-junction and is aesthetically beneficial.

Plastic surgery for the serious breast asymmetry

Objective To evaluate mammaplasty for repairing the serious breast asymmetry. Methods Different mammaplasty was used to repair 38 cases of breast asymmetry, including 13 cases of unilateral breast augmentation, 10 cases of breast reduction after different volume resection on each side, 4 cases of unilateral partial breast resection, 5 cases of breast reduction on one side and breast suspended on another side, 4 cases of breast suspension on one side and augmentation on the other side, and 2 cases of only suspension on unilateral breast. The 38 cases were followed up for 3 to 12 months postoperatively to evaluate the results. Results One case had slight ptosis in half a year after breast suspension. Apart from mentioned above, the rest of 11 had favorable and satisfactory results. Conclusions The serious breast asymmetry deformities should be corrected with the method of the simple and minimum injuries to make the best result. Key words: Asymmetry; Breast; Mammoplasty

Banking and use of glycerol preserved full-thickness skin allograft harvested from body contouring procedures

IntroductionThe use of glycerol preserved skin allograft (GPA) became a main stay in burn treatment. However, harvesting of cadaveric skin is not yet legalized in many countries including Egypt. ObjectivesTo estimate the feasibility of using skin harvested from body contouring procedures as a source of GPA and its clinical efficacy. Patients and methodsSkin harvested from body contouring procedures done in Al-Azhar university hospitals was preserved by glycerolization and used in management of burn and complicated wounds. ResultsIn the period between February 2012 and February 2013 skin was harvested from 24 abdomenoplasty cases, 6 bilateral breast reduction cases, and 1 case of thigh lift done in Al-Azhar university hospitals. This yielded about 22,000cm2 of skin preserved by glycerolization. This GPA was used in 15 excised burn wounds, in 9 cases of chronic burn wounds, and in 6 complicated wounds. Partial graft loss occurred in 3 cases and total graft loss occurred in 1 case. ConclusionThe glycerolized full-thickness skin harvested from body contouring procedures is clinically effective in burn and wound management. In the presence of regional coordination, it can serve as an abundant source for skin banking in where cadaveric skin use is not legalized.

A Process for Quantifying Aesthetic and Functional Breast Surgery

This article defines a comprehensive process using quantified parameters for objective decision making, operative planning, technique selection, and outcomes analysis in mastopexy and breast reduction, and defines quantified parameters for nipple position and vertical and horizontal skin excess. Future submissions will detail application of the processes for skin envelope design and address composite, three-dimensional parenchyma modification options. Breast base width was used to define a proportional, desired nipple-to-inframammary fold distance for optimal aesthetics. Vertical and horizontal skin excess were measured, documented, and used for technique selection and skin envelope design in mastopexy and breast reduction. This method was applied in 124 consecutive mastopexy and 122 consecutive breast reduction cases. Average follow-up was 4.6 years (range, 6 to 14 years). No changes were made to the basic algorithm of the defined process during the study period. No patient required nipple repositioning. Complications included excessive lower pole restretch (4 percent), periareolar scar hypertrophy (0.8 percent), hematoma (1.2 percent), and areola shape irregularities (1.6 percent). Delayed healing at the junction of vertical and horizontal scars occurred in two of 124 reduction patients (1.6 percent), neither of whom required revision. The overall reoperation rate was 6.5 percent (16 of 246). This study defines the first steps of a comprehensive process for using objectively defined parameters that surgeons can apply to skin envelope design for mastopexy and breast reduction. The method can be used in conjunction with, or in lieu of, other described methods to determine nipple position.

Nipple-Areola Complex Evaluation in Long Pedicled Breast Reductions with Real-Time Fluorescent Videoangiography

Sir: We read with great interest the viewpoint and abstract entitled “Fluorescent Intraoperative Tissue Angiography with Indocyanine Green: Evaluation of Nipple-Areola Vascularity during Breast Reduction Surgery” by Dr. Murray et al.1 In their article, they state that “although intraoperative surgical decisions were not altered based on these images, they nonetheless supported the surgeon's operative evaluation.” In response to their article, we report a case in which laser-assisted indocyanine green angiography identified a decrease in perfusion to the nipple-areola complex that was not apparent to the surgeon intraoperatively. Laser-assisted indocyanine green angiography ultimately proved to be predictive of partial nipple areola loss, and could have been used to positively alter intraoperative decision-making. We present the clinical course of a 45-year-old woman with darkly pigmented skin tone and large breasts who underwent bilateral reduction mammaplasty. Preoperative measurements revealed sternal notch–to-nipple distances of 41 cm on the right and 43 cm on the left, with inframammary fold–to-nipple distances of 19 cm on the right and 20 cm on the left. A Wise-type skin pattern with a superomedial dermal pedicle was selected. A total of 1638 g of breast tissue was removed from the right breast, and 1620 g was removed from the left breast. Because of the patient's long dermal pedicles (20 cm on the right and 21 cm on the left) and dark nipple-areola complex skin tone, we elected to perform laser-assisted indocyanine green angiography to better assess nipple-areola complex vascularity. Intraoperative angiography showed a completely viable right nipple-areola complex and a partial filling of the left nipple-areola complex, with the superior portion showing poor perfusion (Fig. 1). Clinically (color, capillary refill, and bleeding edges), the patient's nipple-areola complex appeared viable. Based on our clinical experience, we elected to loosely inset the nipples and not perform a free nipple graft. On postoperative day 1, clinical assessment was unremarkable. One week postoperatively, however, the patient developed a superficial skin blister in the exact area of concern mapped by laser-assisted indocyanine green angiography. Throughout the following postoperative period, this area progressed to a full-thickness skin loss along the superior one-fourth of the nipple (Fig. 2). This was treated with local dressings and the patient continued to heal and is now satisfied with her results. Retrospectively, the laser-assisted indocyanine green angiographic information could have altered our intraoperative decision-making, to either débride a portion of the nipple or perform a free nipple graft, for example.Fig. 1.: Intraoperative laser-assisted indocyanine green angiographic image of the left breast.Fig. 2.: Appearance of the left breast 2 weeks postoperatively.We have previously demonstrated the ability of fluorescent intraoperative angiography to predict subclinical ischemia in free tissue transfer, in pedicle flap design, and in mastectomy flap analysis.2–4 Intraoperative evaluation of nipple-areola complexes during breast reduction surgery can be challenging as well, and may offer another opportunity to use this technology. In particular, patients with dark skin tone, smokers, and women with long dermal pedicles would be good candidates to undergo laser-assisted indocyanine green angiography. Traditionally, dermal pedicle length, the volume of the reduction needed, history of smoking, and clinical judgment are factors contributing to nipple-areola complex viability and are sometimes used to determine whether free nipple grafting should be performed. We do not routinely perform intraoperative fluorescent angiography on all of our breast reduction cases. However, in patients with these risk factors, we now consider intraoperative angiography to assist with intraoperative planning. We propose that intraoperative fluorescent videoangiography can be used and may alter the surgeon's operative evaluation during breast reduction surgery in challenging cases where patients are at risk for poor nipple-areola complex perfusion. DISCLOSURE Dr. Samson and Dr. Newman are paid consultants and speakers for Novadaq Technologies, Inc. Dr. Newman is a paid consultant and speaker for LifeCell Corp. Louis S. Brunworth, M.D. Michel C. Samson, M.D. Martin I. Newman, M.D. Department of Plastic Surgery Cleveland Clinic Florida Weston, Fla. Jose R. Ramirez, M.D. Department of General Surgery Cleveland Clinic Cleveland, Ohio

Seventeen Years of Experience with Reduction Mammaplasty Avoiding a Vertical Scar

It is important to reshape the breast with the least scar possible. This has led us to develop a technique for large breasts where the vertical scar was eliminated. The new nipple is positioned at 19-21 cm. The level of the new inframammary line (IML) is marked 6 cm below the new areola. All the area between the marked IML and the present sulcus is de-epithelialized. The upper flap is undermined beginning from the new IML. The tissue excision is performed medially and laterally leaving a central pedicle that also carries the nipple-areola complex (NAC). The dermoglandular pedicle is shaped conically with breast-shaping sutures. The NAC is passed under the upper apron flap through its new opening. We retrospectively reviewed 145 patients who were operated on over the past 17 years. The mean age of the patients was 41 years. The mean distance preoperatively from midclavicle to nipple was 35.3 cm. The average weight of breast tissue excised was 1073 g per side. Seventeen patients (11%) suffered from minor complications. This technique works especially well in breast reduction cases where a large mass excision is required. The horizontal scar is obvious only when the patient is lying down and cannot be seen by the patient herself. There is no risk of destroying the circular feature of the areola, which is pulled inferiorly by the vertical scar in the other techniques.

Reducing Surgical Site Infections in Breast Reduction Patients: Multiple Interventions, Significant Results

BACKGROUND/OBJECTIVES: In August, 2004, an unusual number of surgical site infections (SSIs) in breast reduction cases was noted. A rate of 10.92 (13/119) was generated for breast reduction cases. The National Nosocomial Infections Surveillance rate for mastectomy is 1.74/100 surgeries. Breast reductions are included in the NNIS definition for mastectomy.

Analysis of esthetic anaplasty for the breast asymmetry

目的 探讨各种不同类型的不对称乳房的手术治疗方法.方法对48例不同类型的不对称乳房者,分别采用不同的乳房成形术进行矫治,其中包括两侧不同容积的乳房假体隆乳术(19例),单侧隆乳术(11例),切除两侧不同体积的乳房组织乳房缩小成形术(9例),单侧乳房部分切除术(2例),单侧乳房脂肪抽吸术(1例),一侧巨乳房缩小成形术,一侧乳房悬吊术(3例),一侧乳房悬吊,一侧隆乳术(2例),单侧乳房悬吊(1例).结果1例因乳房新皱襞下皮肤、皮下组织过多,进行了再次整复术.1例乳房悬吊术后半年,继发轻度下垂.1例因原乳腺组织切除过多且伴有乳房局部较大瘢痕,乳房前外侧稍有凹陷,形态不够满意.其余各例都取得了满意或基本满意的效果.结论对不对称乳房应针对不同的类型采用不同的术式治疗,不对称乳房的检查和测量应力求准确,以便达到尽可能的对称。

Short Scar Periareolar Inferior Pedicle Reduction (SPAIR) Mammaplasty/Mastopexy: How I Do It Step by Step

-Recent advances in the technique of breast reduction have focused on reducing the amount of cutaneous scar. Reported here is a short scar operative strategy, which is applicable to everything from cases of simple breast ptosis requiring mastopexy, to cases of breast reduction of more than 1000 g. The operation bases the blood supply to the nipple and areola on an inferior pedicle, controls shape with aggressive internal suturing, and manages the excess skin envelope with a combined periareolar and vertical pattern. The operative technique is straightforward and the results have been consistent and reproducible. The shape of the breast is rounder and fuller than with other techniques, and the breast is resistant to excessive postoperative settling or bottoming out. It is recommended as an excellent option for management of the excessively large or ptotic breast.

Pectoralis major muscle flap: a new support approach to mammaplasty, personal technique.

Despite the significant evolution of mammaplasty techniques, some undesirable changes on the operated breasts result in evident dissatisfaction for both patients and doctors. The main reason is that the breast has a tendency to resume its previous shape months after the operation. In pursuit of a procedure that would avoid this untoward morphologic evolution, we set to work on the development of a new approach of broad fixation to maintain the breast shape and to avoid ptosis by using the inferior third of the pectoralis major muscle. The authors report their experience with 46 consecutive cases of breast reduction and mastopexy operated between March 1994 and November 1995, studying the surgical procedure employed, its advantages, limitations, and possible complications.

Double Skin Technique with Polyglactine or Mixed Mesh in Mastopexy and Breast Reduction

Introduction: The periareolar approach to breast reduction results in a circumareolar scar without vertical and horizontal components. The problems of this technique are widening of the periareolar scar, difficulty in obtaining proper breast shape, and early appearance of breast ptosis. The double skin technique using polyglactine or mixed mesh through a periareolar approach was utilized to see if the problems of the periareolar approach could be reduced. Materials and Methods: Since 1994, 100 patients have had a periareolar approach utilizing the double skin technique with polyglactine or mixed mesh. Age range was 19 to 49 years. There were 44 cases of mastopexy (breast lift) and 66 cases of breast reduction. The double skin technique is a periareolar pexy that utilizes a central large dermo-glandular pedicle, which is lifted (and eventually reduced) up to the desired new position and fixed at the costal margin. A second layer, represented by a large dermal flap, is utilized for the internal lining. A 910 polyglactine mixed mesh harvests the new breast cone to reinforce the new shaped breast. A round-block continuous nonabsorbable suture contributes to pull and distributes the tension of the internal cutaneous lining, while the areolar skin is sutured with a long-term absorbable continuous suture, in a double layer, leaving two independent elements sutured without tension. Conclusions: The experience of the author with the Goes technique includes a large series of patients with mild to medium ptosis and mild to medium hypertrophies. Having performed breast pexy and reductions with other periareolar techniques, experience shows that the present choice exactly fulfills all the requirements of the operation. Shape, projection of the breast, quality of the areolar scar, and long-term results are all improved in comparison with the techniques utilized in the past.

Breast Reduction—An Analysis of 105 Cases Comparing the Superior- and Inferior-Pedicle Techniques

An analysis of 105 consecutive breast reduction cases carried out by means of either the superior- or inferior-pedicle technique was undertaken in an effort to compare the two techniques and evaluate patient satisfaction. The two techniques were compared on the basis of weight of tissue excised from each breast, upward nipple displacement required, patient age, complications, operating time, and histopathology. A patient questionnaire sent to each subject in the study evaluated satisfaction with the surgery. It is concluded from this study that both the superior- and inferior-pedicle techniques are safe, versatile, and workable surgical options which can be incorporated within a cosmetic surgical practice. Both procedures, when utilized for appropriate indications, serve as means to address all degrees of breast hypertrophy. There was a high degree of patient satisfaction for both surgical techniques, with evidence of significant reduction in the symptoms that often led patients to consider the operation.

A critical review of contemporary procedures for mammary reduction

Summary This series includes patients with mammary hypertrophy treated by operation during the years 1955 to 1963 in this unit, using a variety of techniques. A clinical evaluation of 191 cases of breast reduction is presented. The relative merits of different procedures and their complications are discussed in detail.

Mammaplasty: Indications, technique, and complications

Summary 1.A report of 347 consecutive cases of breast reduction is given as regards classification, type of operations, complications, and results. 2.A modification of the Biesenberger operation is presented in detail. 3.H˦matoma is the most serious complication and is probably responsible for most of the surgical disasters in breast reduction. 4.Controlled hypotension has improved the cosmetic result and reduced the time of operation. It has also decreased the number of complications in this type of surgery.