Satisfactory Breast Shape Research Articles

Structural Mastopexy: Volume Displacement in Breast Reshaping.

Although in breast reshaping, the restoration of a suitable mammary cone is the main goal of the procedure, long-lasting upper pole fullness preservation is the most common weak point of all mastopexy. Mastopexy is a challenging procedure, and a surgical procedure to create desirable long-lasting results has not been well standardized. In this paper, the authors report their experiences in structural mastopexy procedures, describing three different adipo-glandular flaps, each repositioned as auto-prosthesis to reshape upper pole contour in patients affected by a severe degree of breast ptosis. A 6-year retrospective iconographic-chart and review was performed on 89 patients undergoing mastopexy between January 2016 and December 2021. Surgical candidates reported grades 2 and 3 of ptosis following Regnault classification. Minimum follow-up was 24 months. Pre- and postoperative data for all patients were collected in the same standard conditions. 89 patients affected with bilateral breast ptosis were included in the study, for a total of 178 breasts. Patients' mean age at the time of surgery was 40.45 years, ranging between 28 and 59 years. Follow-up ranged between 2 and 6 years with an average of 47.13 months. Out of 89 patients, 50 underwent general anesthesia, and the remaining 39 underwent local anesthesia. Among the 178 treated breasts, 10 (17.8%) experienced minor complications: No major complications were reported. Autologous tissue displacement, collecting parenchyma wherever surplus can be recruited, permits the transfer of extra tissue to the lack of volume, recontouring satisfactory breast shape and ensuring long-lasting results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inferior and Medially Based Breast Parenchymal Rotation Flap: A New Mastopexy Technique for Replacing Breast Volume After Breast Implant Explantation.

Recently, a growing number of patients have been opting for the removal of breast implants. This often results in a degree of volume loss that can vary from mild to substantial, contingent on the size of the implant, with many patients requiring a mastopexy. Although autoaugmentation mastopexy serves as the primary surgical approach to restore shape and fill the void left by the implant, the fullness attained with the implant cannot be replicated through autoaugmentation. Our goal was to present the technical details and utilization of an inferomedial pedicle-based breast parenchymal flap, without rotational restriction from the parenchyma, for autoaugmentation after explantation. A retrospective chart review was performed of 12 patients who underwent surgery with this technique between the years of 2019 to 2022, with emphasis on reasons for explantation, early and late complications, and satisfaction scores on a Likert scale. Capsular contracture was the most common reason for explantation, and only 2 patients experienced minor wound dehiscence in the early postoperative period. With a mean follow-up of nearly 2 years, no bottoming out was encountered in any of the patients, and satisfactory breast shape was obtained. Further, postoperative satisfaction was significantly higher than preoperative satisfaction. The inferomedial-based parenchymal rotation flap is a new procedure that can be applied in this patient group because of its wide rotation arc and reliable vascularity. It is also an effective option for creating the desired conical breast shape in patients who do not want breast implants over the long term.

Lateral thoracic adipofascial flaps in the reconstruction of defects after breast-conserving surgery in breasts with ptosis, mild ptosis or without ptosis

ObjectiveTo study the feasibility, safety, and effectiveness of lateral thoracic adipofascial flaps in reconstructing the defects following breast-conserving surgery (BCS) in breasts with either no ptosis or mild ptosis. Methods37 female patients who underwent BCS and lateral thoracic adipofascial flap breast reconstruction between June 2020 and July 2022 were analysed. Surgery-related complications, intraoperative positive margin, local recurrence, and cosmetic outcome were assessed. ResultsThree local complications occurred in patients, all of which were cured by conservative treatment. Additionally, four patients had intraoperative positive margins. After a median follow-up period of 17.5 months, none of the patients showed local recurrence. All patients achieved a satisfactory breast shape. Further, patients without ptosis achieved good volume and symmetry. However, the breast symmetry was not satisfactory for patients with ptosis. ConclusionIt is reliable and effective to use the lateral thoracic adipofascial flaps to reconstruct the defects after BCS when the breast is not ptotic and the lesions are located in the lateral and central quadrants.

Research progress in breast blood supply and breast reduction

To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years. The related literatures about the distribution of the nerve and blood supply of breast, the development of breast reduction, and postoperative lactation function in recent years were reviewed extensively. The above aspects were analyzed and summarized in combination with the author's experiences. With the anatomical study of mammary gland, nipple areola complex nerve distribution and blood supply, breast reduction has been developed rapidly, and a variety of surgical methods have been formed. But each has its own advantages and disadvantages, and its indications are different. Through the application and improvement of the auxiliary examination technique, severe complications such as nipple areola complex necrosis reduce obviously after operation. Through the selection of position of the incision and pedicle, the degree of retaining the pedicle glands, the application of auxiliary liposuction technique, and the improvement of suture technique, the scar of incision reduces, the sensation of nipple areola is preserved more, and a more satisfactory breast shape is obtained. Some of the patients who gave birth after breast reduction have lactation function. There are some shortcomings in various surgical methods at present, individualized surgical methods should be adopted according to the characteristics of the patients. Further research is needed on how to preserve more sensation of nipple areola, obtain a good and lasting breast shape, and preserve lactation function of women after operation.

Application of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy

To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. 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). 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). For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.

Reduction mammaplasty with central gland pedicle based on Würinger's horizontal septum

To investigate the method and efficacy of reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum in the treatment of female breast hypertrophy. From Mar. 2009 to Sept. 2011, a series of 21 consecutive patients with mild and moderate hypermastia underwent reduction mammaplasty with central gland pedicle. Only the mammary gland located at cranial portion of septum was resected and the mammary gland located at caudal portion of septum was preserved. In our series, the mean resection weight per breast was (327.8 +/- 148.6) g, the mean nipple-to clavicle midpoint was 20.0 cm (range, 18.0-22.0 cm) and the mean nipple-to-sternal-notch distance was 21.0 cm (range, 19.5-22.5 cm) postoperatively. Nipple was moved upward 6.5 cm on average (range, 4.0-10.0 cm). There was no hematoma and nipple-areolar complex (NAC) necrosis. Minimal wound dehiscence occurred in one case and healed by dressing change. 17 cases were followed up for 3 months to 2 years. Satisfactory breast shape was achieved with good NAC sensibility. The reduction mammaplasty with central gland pedicle based on Würinger' s horizontal septum is a safe and reliable technique for mild and moderate hypermastia. Satisfactory breast contour, as well as NAC viability and sensibility, could be achieved with lower occurrence of hematoma or seroma.

Superficial inferior epigastric artery (SIEA) free flap using perforator vessels as a recipient site: clinical implications in autologous breast reconstruction

Background Breast reconstruction with autogenous tissue is a well-established technique, but there are some limitations related to donor-site morbidity. Among available techniques, the superficial inferior epigastric artery (SIEA) flap is the least invasive procedure because it does not require harvesting or incision of the rectus muscle or the abdominal fascia. Besides adequate flap choice, the proper selection of the recipient vessels is an important factor. Thus, the internal mammary perforator branches (IMPBs) have been an attractive option regarding recipient pedicle morbidity. Methods The investigators reported the use of the free SIEA flap with the IMPBs as a recipient site to reconstruct radical mastectomy. Results Five patients with invasive ductal carcinoma underwent modified radical mastectomy and reconstruction. The IMPBs were selected as the recipient site and a free SIEA flap was used. The donor defect was closed directly without synthetic mesh. Satisfactory breast shape was achieved, and no complications were observed. Conclusions For selected patients, the SIEA flap and IMPBs may constitute a new alternative for immediate breast reconstruction, because of the possibility of large tissue transfer with minimal donor and recipient area morbidity. The SIEA pedicle size and the quality of IMPB vessels should be carefully evaluated.

Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients

Polyacrylamide hydrogel (PAAG) was once widely used in breast augmentation in China. Although it had been banned for augmentation mammaplasty in 2006, a large number of patients whose breasts were augmented with the gel injection have continued to seek medical advice because of its complications. The clinical management of these complications has never been standardised. The data of a total of 235 patients with complications following PAAG-injected breast augmentation have been summarised and the types and causations analysed. Magnetic resonance imaging (MRI) was undertaken in 228 patients with palpable masses, breast pain or tenderness, asymmetry or deformity and functional or psychological problems to eliminate neoplasm, infection and to delineate the diseases. The surgical gel evacuation via periareolar incisions was performed for all patients and immediate silicone breast prostheses were implanted in 108 patients and were delayed in 28 cases by 6 months. Most patients (214/235) of the group were satisfied with the treatment, and symptoms disappeared after removal of the gel. The gel distribution and involved tissue were well defined and neoplasm was ruled out by MRI. Postoperative MRI in 68 patients revealed that no obvious PAAG remaining. In either immediate or delayed reconstructive patients with silicone breast implants, good breast contour presented. A diagnosis and management strategy for these complications is proposed. In conclusion, the breast masses, pain and deformity are major complications after PAAG-injected breast augmentation. Psychological problems should be paid attention to. MRI is a sensitive and accurate method for diagnosis and treatment evaluation. Surgical removal of injected gel is the preferred method for complication management. The implantation of silicone prostheses for breast contour restoration after PAAG evacuation is effective for patients under strict selection. Our strategy for treating PAAG-related complications proved useful.

Anatomy and Clinical Significance of Pectoral Fascia

The submuscular or subglandular plane for breast augmentation is widely used. Recently, the subfascial plane for breast augmentation was reported by some authors who achieved satisfactory results. The anatomy of the pectoral fascia in Chinese female corpses was investigated to explore the possibility for a location of augmentation mammaplasty under the pectoral fascia. The anatomy of 30 side pectoral fascias on 15 corpses was studied. The thicknesses of the pectoral fascias were measured. The pectoral fascia is attached to the clavicle and sternum and covers the pectoralis major muscle. It is continuous inferiorly with the fascia of the abdominal wall. Furthermore, the pectoral fascia extends laterally to be continuous with the fascia of the back. The pectoral fascia, which can be successfully dissected bluntly along the subfascial plane, varies in thickness from 0.2 to 1.14 mm. Perforating branches of vessels and nerves emerging from the pectoral fascia are located mainly at the medial lateral and lower fascias. The pectoral fascias can be dissected bluntly along a subfascial plane with the pectoral fascia intact. The potential pocket between the pectoralis major muscle and the pectoral fascia can be used as a place for breast augmentation. The pectoral fascia may provide the breast implant with more soft-tissue coverage.

Refinements of Vertical Scar Mammaplasty: Circumvertical Skin Excision Design With Limited Inferior Pole Subdermal Undermining and Liposculpture of the Inframammary Crease

Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skepticism, vertical reduction mammaplasty is becoming increasingly popular in recent years because it best incorporates the two concepts of minimal scarring and a satisfactory breast shape. At the moment, vertical scar techniques seem to be more popular in Europe than in the United States. A recent survey, however, has demonstrated that even in the United States, it has surpassed the rate of inverted T-scar breast reductions. The technique, however, is not without major drawbacks, such as long vertical scars extending below the inframammary crease and excessive skin gathering and "dog-ear" at the lower end of the scar that may require long periods for resolution, causing extreme distress to patients and surgeons alike. Efforts are being made to minimize these complications and make the procedure more user-friendly either by modifying it or by replacing it with an alternative that retains the same advantages. Although conceptually opposed to the standard vertical design, the circumvertical modification probably is the most important maneuver for shortening vertical scars. Residual dog-ears often are excised, resulting in a short transverse scar (inverted T- or L-scar). The authors describe limited subdermal undermining of the skin at the inferior edge of the vertical incisions with liposculpture of the inframammary crease, avoiding scar extension altogether. Simplified circumvertical drawing that uses the familiar Wise pattern also is described.

Modification of vertical scar in vertical mammaplasty technique.

Vertical mammaplasty is a simple and safe procedure that relies on an upper pedicle to the areola with lower central breast reduction and glandular shaping. We applied this technique to six patients adding a modification of the vertical scar which distributed skin tension both to the areola and vertical suture line. It prevented an unacceptable puckering vertical scar and enlargement of areola. This modification also provided satisfactory breast shape with a good vertical scar especially at the early postoperative period.

A simple technique to correct “bottoming-out” of the breast after augmentation mammaplasty

We present a straightforward and simple technique for correction of “bottoming-out” of the breast resulting from augmentation mammaplasty. The inframammary line is outlined, and a second line is drawn below the lower border of each areola and joined with the first to form a crescent shape. An incision is made along the superior border of the crescent and carried down to the implant capsule. The implants are removed, capsulotomies performed, and new implants inserted in a subpectoral position. The inferiorly based, de-epithelialized dermal flap is advanced superiorly and sutured to the undersurface of the breast envelope. Postoperative follow-up revealed satisfactory breast shape and contour. This technique corrects nipple-areolar malposition and adds additional cushioning to the lower pole of the breast.

Explantation and Mastopexy: The Vertical Mammaplasty Technique to Optimize Breast Shape

Twenty-seven patients who requested removal of their breast implants underwent simultaneous explantation and mastopexy. The time from implantation to explantation ranged from 4 to 26 years. Follow-up after surgery ranged from 5 months to 3 years. The mastopexy procedure used is a modification of the vertical mammaplasty. The final form of the breast is dependent on parenchymal reshaping rather than the pattern shape of the skin brassiere. The technique produced satisfactory breast shape and projection while limiting the extent of skin scarring. Minimal complications were noted, and patient satisfaction remains high.