Vertical Mammoplasty Research Articles

Application of Liposuction and Superior Pedicle Vertical Mammoplasty for Severe Breast Hypertrophy.

Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction. A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded. Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications. This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair. 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 .

Breast Reduction as a Modality for Treatment of Recurrent Intertrigo: A Study of Ten Cases

Abstract Introduction: Macromastia is associated with physical and psychosocial comorbidities. One such entity which presents to dermatologists is intertrigo which is the infection of intertriginous areas caused by various species of bacteria and fungi. This is the most common presentation in females with large ptotic breasts with involvement of the inframammary region. After exhausting all possible modalities including antibiotics, antifungals, and even anti-inflammatory drugs to exclude secondary eczema, these patients can be offered breast reduction surgery as a last resort. Aim: The aim was to study the efficacy of breast reduction surgery in the management of recalcitrant intertrigo. Methodology: Ten such patients who presented to us with recalcitrant intertrigo in the setting of macromastia and consented to breast reduction surgery were recruited, and after obtaining informed consent, breast reduction was performed by vertical mammoplasty and liposuction. The patients were followed up 3 months for 1 year postsurgery. The treatment outcome was measured by physician assessment by checking the presence of visible dermatitis in the intertriginous region and patient assessment with the help of a novel questionnaire to assess the quality of life with responses on a 4-point Likert scale from 0 to 3. However, due to the small sample size, the questionnaire could not be validated. Results: None of the patients in this study reported recurrence of intertrigo. Furthermore, there was a significant functional improvement with minimal complication rates. A novel questionnaire was devised to assess the quality of life of these patients which showed a significant improvement postsurgery. However, due to the relatively small sample size, the questionnaire could not be validated. Conclusion: There is evidence that reduction mammoplasty is not only effective at decreasing breast-related symptoms such as pain and discomfort but also improves functional limitations and clinical conditions like intertrigo. In our study, we conclusively demonstrate an intent to point out to dermatologists that breast reduction can be a treatment for resistant/ intractable intertrigo only as a last resort in patients with large breast size, as would help in reducing the constant predisposing factors of moisture and friction.

Dual-Layer Rotation: A Versatile Therapeutic Mammoplasty Technique

BackgroundMultifocal or complex breast lesions are a challenge for breast-conserving surgery, particularly surgery in small breasts or those located in the upper inner quadrant. The dual-layer rotation technique exploits the idea of manipulating the skin and glandular tissue in separate layers to fill the resection cavity via vertical mammoplasty if skin excision is not required, except in the central area.MethodsThe authors performed a retrospective review of consecutive breast cancer patients who underwent DLR mammoplasty between 2017 and 2019 at a single institution. Clinical data, reoperations, surgical complications, delays in adjuvant treatments, and the need for late revisional surgery were evaluated. Aesthetic outcomes were evaluated objectively and subjectively from photographs.ResultsThe study included 46 breasts of 40 patients. Tumors were located in the UIQ (30%, 14/46) or in multiple quadrants (22%, 10/46). One third (33%, 13/40) of the patients had a small breast cup size (A–B). Negative margins were primarily achieved in 45 of the 46 breasts. Major complications occurred in three patients, who needed reoperation, and adjuvant therapy was delayed for one of these patients. Late refinement surgery was needed for two patients. The objective and subjective aesthetic outcomes were good or excellent regardless of the tumor position.ConclusionAs a novel oncoplastic approach, DLR mammoplasty offers a one-step procedure to treat selected breast cancer patients with challenging resection defects due to different breast sizes or lesion locations. The technique preserves the breast’s natural appearance.

Evaluation of the Surgical Outcomes of Breast Oncoplastic Techniques Carried Out by a General Surgical Oncologist.

Background With recent advances in different breast cancer treatment modalities, breast conservation surgery (BCS) has gained popularity and has become the mainstay for the treatment of early breast cancer. The model of dedicated breast surgeons working in breast units is standard in some but not all countries. We have aimed to define surgical outcomes of oncoplastic breast surgery carried out by one general surgical oncologist.Patients and methodsWe have conducted a prospective non-randomised case series analysis to assess the oncologic and aesthetic outcome of tissue displacement oncoplastic breast techniques in managing unifocal early-stage breast cancer from January 2019 to January 2020.One surgical oncologist with 23 years of surgical oncology experience carried out all operations.ResultsWe have included 50 female patients treated with variant oncoplastic volume displacement techniques. We have used the round block technique in 20%, the batwing technique in 18%, lateral mammoplasty in 20%, and medial mammoplasty in 2%. We have also carried out wise pattern therapeutic mammoplasty with inferior pedicle in 20% (10 patients), and vertical mammoplasty with superior pedicle in 20% (10 patients).While 8% of our patients had Clavien-Dindo system grade I Immediate complications, including the surgical site infection and postoperative seroma and haematoma, 2% of patients had grade II complications in the form of partial areola and nipple complex necrosis leading to delayed wound healing requiring secondary suturing. No delayed complications or mortalities were recorded.Eight per cent of patients required re-excision to clear margins, 74% had excellent results, 24% had good results, and 2% had fair results. In addition, 64% were very satisfied with their results, 32% were satisfied, while 4% were not satisfied with aesthetic results.ConclusionBased on our limited number of patients, we have found that tissue displacement oncoplastic techniques carried out by a general surgical oncologist are safe and reliable in providing satisfactory oncological outcomes with a low risk of delaying adjuvant therapy and acceptable aesthetic outcomes.

Oncoplastia, reconstrucción prepectoral inmediata e injerto libre del complejo areola-pezón en paciente BRCA 1. Informe de un caso

Immediate prepectoral reconstruction is an increasingly widespread alternative for patients with a higher genetic susceptibility to breast cancer. The most commonly used technique for mastectomy and prepectoral reconstruction with acellular mesh is a lateral incision approach without changing the characteristics of the skin envelope. Patients with significant breast ptosis can be a limitation in prepectoral reconstruction due to the prosthetic projection in the new breast centre, which will be cranial to the nipple–areola complex. There are no documented cases in the available scientific literature describing immediate prepectoral reconstructions with free grafts of the nipple–areola complex. We present the clinical case of a 34-year-old woman with a family history of breast cancer and a diagnosis of BRCA 1 gene mutation. She underwent subcutaneous mastectomy through a vertical mammoplasty pattern and prepectoral reconstruction with prosthesis and acellular mesh with free grafting of the nipple–areola complex in the new breast centre. We show that it is possible to associate the design of an oncoplastic pattern with free grafting of the nipple–areola complex to an immediate prepectoral reconstruction technique with prosthesis and acellular mesh.

The "Arrow Flap" Technique in Reduction Mammaplasty: Combining Short Scars, Narrow Base, and High and Persistent Breast Projection.

Breast reduction is one of the most common procedures performed by plastic surgeons worldwide. Despite that several techniques have been proposed for management of ptotic or hypertrophic breasts, most of them often deal with too large breast bases, poor breast projection, persistent "dog ears," and a certain percentage of bottoming out. Lower-pole shaping of the breast remains one of the challenge of vertical mammoplasty. The authors report their 5-year-long experience with a modification of the vertical scar technique, the "arrow flap," in which they harvest a double lateral glandular and cutaneous flap, to tighten and better shape the base of the breast and to improve the breast projection with a "double-bra" effect. From April 2015 to February 2019, 75 patients with moderate to severe macromastia/breast ptosis underwent bilateral reduction mammoplasty. Postoperative outcomes showed an overall satisfactory results and low incidence of complications. Two patients presented with an asymmetry between the 2 breasts, and no nipple-areola complex necrosis occurred. One patient reported a wider vertical scar, whereas no bottoming out was observed. All patients reported a stable and durable projection of the breast, with pleasant cosmetic results. By combining short scars and narrow base, we can obtain a pleasant lower pole reshaping of the breast, even in that challenging cases of large and squared breast. The authors believe that this technique provides a useful surgical option, increasing the versatility of the superior pedicle vertical mammaplasty both for mastopexy and breast reduction, even in cases of severe macromastia.

Oncoplastic Level II Surgical Techniques for Breast Cancer Treatment: Long-Term Outcomes

Background: Problems in patients who could not get adequate surgical margins (SM) and good cosmetic results with breast-conserving surgery (BCS) have been overcome with the introduction of oncoplastic surgery (OPS) methods. The purpose of this study was the documentation of level II techniques and the presentation of long-term survival results. Methods: The data on patients who had been prospectively registered in the database between 2007 and 2017 and who had been treated with level II OPS due to invasive breast cancer were examined. Results: A total of 1,074 patients were included in the study. The most commonly applied level II oncoplastic techniques were performed in the upper outer quadrantectomy with racquet incision in 334 (31%) patients, inferior pedicle flaps in 294 (27.3%), and vertical mammoplasty in 140 (13%). Reexcision was performed in 96 patients (8.9%). Total breast conservation rate was 96%. Five-year disease-free survival (DFS) was 88%, local recurrence-free survival (LRFS) 93.6%, and overall survival (OS) 96%. Ten-year DFS was 72%, LRFS 85.4%, and OS 90.2%. Conclusion: Level II OPS techniques have low reoperation and complication rates and a high rate of breast protection. The success of these techniques has been demonstrated in terms of long-term local control. Awareness of the fact that many patients who undergo OPS will not lose their breasts should be created, and regular training programs for OPS techniques should be conducted especially in developing countries. By revealing these results, it is hoped that the OPS and breast conservation rates will increase.

АБДОМИНОПЛАСТИКА У ЖЕНЩИНЫ ПОСЛЕ ВЫРАЖЕННОЙ ПОТЕРИ ВЕСА

In this paper, we wish to present a case report of a 38-year-old woman who underwent abdominoplasty (AP). Patient history obtained during the preoperative phase of care included sleeve gastroplasty, after which she noted a significant weight loss (about 35 kg). As a result, a saggy skin-fat flap of the abdomen in the form of an apron was formed. In addition, she was worried about the pronounced drooping and sagging breasts. Therefore, the patient was offered AP through combined vertical and horizontal incisions. However, due to the patient's refusal of the combined incisions, AP with a transverse incision and vertical mammoplasty were performed. A year later, dissatisfied with the cosmetic result, the patient insisted on AP through a combined incision, which was performed. At this time, the patient indicated her satisfaction with the aesthetic outcomes. Keywords: Saggy abdomen, abdominal dermatochalasis, bariatric surgery, abdominoplasty, mammoplasty.

Bipedicle Vertical Mammoplasty Associated with Liposuction/Lipotunnelization.

Vertical techniques have become more popular and versatile in breast reduction and mastopexy procedures. The authors introduce a combination of vertical mammoplasty with vertical bipedicle technique, presenting some innovations concerning pedicle design, glandular dissection pattern, and the role of liposuction. In this article, we describe a personal surgical technique and analyze the results on 73 mastopexy and breast reduction patients, operated on between 2012 and 2014 by the senior author. The most important aspects of this technique are as follows: 1. the concept of lipotunnelization, where parenchymal tunnels are made with cannulas without suction; 2. the systematic use of liposuction/lipotunnelization to recreate the inframammary fold and decrease pillars height; 3. the use of a thick and narrow vertical pedicle (bipedicled); 4. no skin undermining. Twenty-five patients underwent mastopexy and 48 breast reduction. Results were evaluated by clinical examination and patient photographs. Good shape and projection of the breast and correct nipple elevation were achieved, correlating with a high level of patient satisfaction. No major complications occurred. This lipomammoplasty technique is a reliable and effective option, suitable for a wide range of symptomatic macromastia/ptosis. Adjunctive use of liposuction/lipotunnelization in vertical breast reduction accomplishes effective contouring of the breast with low associated complications and significantly reduces the revision rates. 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 .

Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

Background: Integration of neoadjuvant chemotherapy (NCT) in early 70s resulted that many LABC tumors become resectable but with total mastectomy especially those with partial response, oncoplastic techniques give better oncological outcome with better cosmetic results. Objective: We evaluate the oncological safety of oncoplastic breast surgery (OS) in LABC showing partial response to NCT. Methods: We prospectively analyzed the data of 32 out of 58 patients with LABC who showed partial response to NCT and could have conservative surgery with advanced oncoplastic techniques rather than total mastectomy. Results: Out of 58 patients with LABC, received neoadjuvant chemotherapy, complete response was observed in 8 patients (13%), partial response reported in 32 (55.1%) cases, 12 patients (20%) had stable disease and 6 patients (10%) showed progressive disease. Data of 32 cases were studied (mean age 44.84 ± 9.10 years; range 26 - 59 years). Inferior pedicle was performed in 9 cases, mini LD flap in 3 patients, 5 had Grissotti technique, 6 with superomedial pedicle, 4 had V mammoplasty and 3 with J mammoplasty and 2 had vertical mammoplasty. Margins were positive in 5 cases (15.6%) with mean margin width 9.63 ± 5.72 (range 0 - 22 mm), and the local recurrence was reported in 2 cases (6.2%). Complications were reported in 3 cases (9.3%). The follow up was 1.67 ± 1.03 (range 0 - 3.3 years). Conclusions: Integration of neoadjuvant chemotherapy together with advanced oncoplastic techniques opens a new way for management of LABC especially those showing partial response with avoidance of total mastectomy, and comparable oncological safety in addition to better aesthetic and psychological outcome.

Lower-pole Shaping of the Breast by Means of a Double Glandular and Cutaneous Advancement Flap: The "Arrow" Flap.

Summary:Lower-pole shaping of the breast is sometimes a difficult challenge when performing vertical mammoplasty. The problems mostly encountered are too large breast bases, persistent dog ears, which require long incision, and poor breast projection. We report a modification of the technique that we use in breast reduction so as to better shape the lower pole and to reduce revision surgery.

Peri-areolar marking in Lejour's mammoplasty—a simple device to aid trainee learning: the flexible curve

We propose the use of a simple device—the flexible curve—to aid trainees with the peri-areolar markings of Lejour's mammoplasty. This cheap and simple, commercially available, wipe clean device can be purchased in any art store and easily adapted for purpose. It assists beginners in the marking of the areola site in vertical mammoplasty and speeds the learning curve needed to make the marks accurately despite great variation in pre-operative breast size and contour. Both authors have found the device incredibly useful in the peri-areolar marking of Lejour's mammoplasty technique. We hope that publication and awareness of the device may assist others to achieve accurate peri-areolar markings with ease.

Another Look at Breast Projection After Breast Reduction

A controversy exists between vertical mammoplasty and the "traditional" keyhole\inferior pedicle method of breast reduction. This article examines factors affecting breast projection by considering the difference in concept between vertical mammaplasty (using the modification proposed by Hall-Findley as an example) and the inferior pedicle\keyhole pattern. This article is not about "how to do" but rather about "why" things are done in a certain way. The emphasis is on understanding what is done and its effects rather than on technique. The breast can be considered a cone. Breast projection then is the ratio between the nipple projection and the breast base. Two key concepts need to be considered: the orientation of the ellipses during excision of breast tissue in breast reduction and the role of the breast base\inframammary fold. Breast projection is not determined by the scars. After an examination of each technique, methods to enhance projection are discussed.

Familial Severe Gigantomastia and Reduction with the Free Nipple Graft Vertical Mammoplasty Technique: Report of Two Cases

: Gigantomastia, characterized by massive breast enlargement during adolescence or pregnancy, is thought to be caused by an abnormal and excessive end organ response to a normal hormonal milieu. The amputation technique with the free nipple-areola graft is the mainstay for severe macromastia, but it has been criticized because it results in a flattened, nonaesthetic breast with poor projection. This report presents two sisters with unusual, excessive breast enlargement. : The measured distance from the sternal notch to the nipple was 50 cm for the first case and 55 cm for the second case. The free nipple graft transplantation based on the vertical mammoplasty technique was used, and an average of 4,200 g of breast tissue per breast was removed. To increase breast projection, superior dermoglandular flaps were used : The follow-up period was 24 months. The patients had long-lasting, pronounced breast mound projection, and the level of satisfaction for both cases was very high. The ideal geometric structure of the breast is rather conical, and the authors believe that reshaping the breast tissue in a vertical plane using the vertical mammoplasty technique may be more effective in the long term and may provide better projection.

Vertical Mammoplasty and Liposuction

Vertical Mammoplasty and Liposuction