Upper Footprint Dependent Nipple Position to Avoid High-Riding Nipple after Reduction Mammoplasty

Introduction: High-riding nipple following reduction mammoplasty is a challenging problem for the plastic surgeons. To avoid such problem, many methods have been described for marking the correct nipple position but still controversial. We aimed in this study to present our experience in preventing excessive nipple elevation after reduction mammoplasty by using the upper footprint to set the new nipple position. Material and Methods: From March 2019 to March 2022, 25 female patients at a mean age of 38.3 years were included in this prospective study. They underwent reduction mammoplasty with inverted T scar and a combination of inferior pedicle and Würinger’s septum techniques. Resection weights, pre- and postoperative anthropometric measures were recorded. All patients were photographed at the follow-up visits and evaluated for complications if any, the nipple-areola complex (NAC) sensation, and subjective patient satisfaction using “The Breast Evaluation Questionnaire”. Results: The mean preoperative midclavicular point to nipple distance was 37.40 and 37.18 cm for the right and left breasts, respectively. The mean resection weight was 1270 and 1242 g from the right and left sides, respectively. None of our patients experienced NAC necrosis, while 2 breasts had minor wound dehiscence treated conservatively. After a mean follow-up period of 12 months, the NAC descended by an average of 1.40 cm, the distance from the IMF to nipple had an average increase of 2.24 cm, and all of patients were satisfied with the esthetic outcomes and convinced with their breast shape. Conclusion: The upper footprint dependent nipple position seems to have a real role in preventing high-riding nipple after breast reduction in hypertrophic and gigantomastic breasts. Moreover, it can be applied easily and allow for more satisfying outcomes than other methods for setting the new nipple position.

A mammometric comparison of modified Robertson versus Wise pattern inferior pedicle reduction mammoplasty

Aim:The advent of 3D photoimaging and mammometrics has allowed for quantitative,volumetric breast analyses.This study uses 3D photoimaging and mammometrics to compare the postoperative morphometric outcomes of the modified Robertson technique to the more traditional Wise pattern inferior pedicle technique.Methods:Inferior pedicle reduction mammoplasty was performed using either a Wise pattern or modified Robertson skin incision.3D photography and analysis were done at 1-3 months and 6-12 months postoperatively.Results:There were 14 breasts in the modified Robertson group(ROB)and 24 breasts in the Wise pattern group(WISE).There were no significant differences in demographic data or amount of tissue resected.At 6-12 months,the modified Robertson cohort demonstrated increased superior pole fullness(62.9%ROB vs.58.3%WISE,P=0.05).The Wise cohort,however,maintained greater maximum breast projection(5.52 cm ROB vs.6.54 cm WISE,P=0.01)and increased medial pole fullness(29.6%ROB vs.46.9%WISE,P<0.01).There was no difference in tissue shifting from the superior pole to the inferior pole over time(+3.36 superior pole%ROB vs.+1.42 superior pole%WISE,P=0.28).Areola surface area increased equally in both cohorts(+3.08 cm2 ROB vs.+2.59 cm2 WISE,P=0.77);however,the final size of the areola was greater in the modified Robertson cohort(26.9 cm2 ROB vs.21.6 cm2 WISE,P<0.01).Conclusion:Using 3D mammometrics,we found increased superior pole fullness in the modified Robertson group while the Wise pattern group demonstrated greater medial pole fullness and maximum breast projection.

Dermatomal Somatosensory Evoked Potentials: An Indicator of Improvement of Breast Sensibility after Reduction Mammaplasty

Introduction: Many women think about reduction mammaplasty for different reasons. The effect of surgery on the beast sensibility is one of the greatest concerns after reconstructive reductive breast surgery through its affect on patient’s social life and psychological health. The dermatomal somatosensory evoked potential (D-SEP) is a new method to quantitatively evaluate breast sensibility. Patients and Methods: Twenty-five women enrolled in this study presenting with breast enlargement, underwent mammary reduction by using the inferior pyramidal breast reduction technique using the same operative technique described by Robbins with some modifications. All D-SEP amplitudes and latencies were calculated preoperatively and then were reassessed six and twelve months post-surgery in each breast. Result: The results revealed that there is a significant difference in the D-SEP latency pre- and post-operatively. The statistically significant decrease in latency and the breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. There is also a significant increase in the D-SEP amplitude pre- and post-operatively. The negative and statistically significant increase in amplitude with the decrease in breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. Conclusion: This study concluded that breast sensibility will improve after breast reduction as indicated by significant reduction of D-SEP latencies and increase of its amplitudes. Our results confirm an inverse relationship between breast size and sensibility, with improvement in sensibility after breast reduction.

Applying the Passot technique in the surgical treatment of severe gynecomastia:A case report and literature review

Gynecomastia is emerging as a major cosmetic and physiological concern among adolescents, especially in relation to obesity, acute weight loss following surgery, and other endocrine illnesses. Surgical treatment involves liposuction(mechanical, power-assisted, or ultrasound-assisted), nipple-conserving subcutaneous mastectomies, or nipple transpositions via various techniques. Unsightly scarring, with visible scar hypertrophy and nipple necrosis, continues to plague postoperative cosmetic outcomes;hence, different techniques of performing nipple transposition have been devised, ranging from free grafts to pedicled flaps. In this case report,we draw attention to an old technique, described by Passot in 1925, that was applied primarily for reduction mammoplasty in women at that time. This technique is still not as frequently used as the Wise pattern mastopexy technique in gynecomastia surgery, and we wish to convey that better cosmesis would be achieved in patients with Simon ⅡB/Ⅲ and ptotic gynecomastia using this technique, avoiding a vertical scar.

A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

Aim:Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population.With the increasing prevalence obesity in the population,it is imperative to understand its effect on postoperative outcomes.The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and non-obese controls.Methods:Between 2005 and 2013,the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up.Patients were divided into obese[body mass index(BMI)of 30 or more]vs.not obese(BMI below 30).Patients were initially analyzed using standard multivariable analysis.Using propensity scores obtained from a logistic regression model,patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes.Outcomes were compared between the matched cohorts using McNemar’s test and the Wilcoxon signed rank test.Results:In unmatched multivariable analysis,rates of overall complications(7.2%vs.5.3%,P=0.0024),wound complications(5.5%vs.3.6%,P=0.0004),superficial surgical site infection(4.1%vs.2.8%,P=0.0050),and wound dehiscence(0.3%vs.1.1%,P=0.0005)were found to be statistically different between obese vs.non-obese,respectively.However,when comparing 1:1 matched obese and non-obese patients,only wound complications(4.6%vs.3.1%,P=0.0334)were significantly increased in the obese cohort.Conclusion:Using the most robust statistical tools available,obesity was determined to affect wound complications after breast reduction without increased detriment on other major complications when compared to the non-obese.Obesity should be a considered with other preoperative comorbidities,rather than an independent contraindication to surgery.Breast reduction appears to be safe in the obese patient who is otherwise healthy.