A New Technique for Mastopexy and Reduction Mammaplasty: The Rolling Bilateral Flap Technique

Background: Numerous techniques have been proposed as “gold standard” for mastopexy, as for reduction mammaplasty. The quality of the breast parenchyma should be a primary factor in selecting the most appropriate technique for an individual case. Objective: The article describes a simple technique that can be used either for mastopexy or for reduction mammaplasty, giving optimal breast shape and position. It is appropriate for patients having some degree of ptosis, and especially for those in whom the glandular component of the breast predominates. Methods: The technique entails elevating the entire dome of the breast, rolling it under, and then stitching the two halves of the breast parenchyma together (lateral and medial dermoglandular flaps), while the upper pedicle (a third dermoglandular flap) bearing the nipple areolar complex (NAC) severed from the two inferior flaps is attached as a cap. The result is a new and attractive shape of the underlying supporting “barrel”. The technique can be performed with the T scar or the vertical scar approach. Results: The procedure was applied for various indications on 45 patients aged 20 - 62 years. Good results were only achieved in 36 women with predominant glandular component. Nine patients with fatty breasts achieved unsatisfactory results (6 with T scar, 3 with vertical scar) and very poor breast projection. Conclusions: The best-suited candidates for the proposed technique for mastopexy or reduction mammaplasty are women in whom the glandular component of the breast predominates. This simple technique, applicable with either inverted T scar or vertical scar approaches, carries very low morbidity, affording an attractive profile, long-lasting results, and conserving the patient’s ability to breast feed.

Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update

Breast-conservation surgery(BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty(TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally,it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon's experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.

The Effect of the Moufarrege Total Posterior Pedicle Reduction Mammaplasty on the Erogenous Sensation of the Nipple

Traditional reduction mammoplasties have the simple concern to guarantee the survival of the nipple areola complex after surgery. Little has been done to take care of essential functions in the nipple, especially the erogenous sensation. We have conducted a retrospective study on a cohort of 573 female patients operated using the Total Posterior Pedicle of Moufarrege between 1985 and 1995 to evaluate its effect on the erogenous sensation of the nipple. This study demonstrated the preservation of the erogenous sensation of the nipple in a high proportion of these patients. The physiology of this preservation is explained in regard of the technique details in Moufarrege mammoplasty compared to other techniques. The Moufarrege Total Posterior Pedicle would therefore be a highly reliable reduction technique to ensure the preservation of the erogenous sensation of the nipple.

Modification of Moufarrege Total Posterior Pedicle Mammaplasty: Conical Plicated Central U Shaped (COPCU's) Mammaplasty

Reduction mammaplasty and mastopexy is one of the biggest operation groups which have many techniques and their modifications. Generally accepted that, new modifications are the results of improvements of existing techniques. In this study we present a new modification of Moufarrege total posterior pedicle mammaplasty. We performed central plication to achieve a juvenile look in the superior pole of the breast and to prevent postoperative pseudoptosis and used central U shaped flap to achieve maximum NAC safety and to preserve lactation and nipple sensation. Sixty-nine patients were operated with the above mentioned tech-nique. Out of 69 patients, 52 underwent reduction mammaplasty (11 had gigantomastia), eleven mastopexy, and six oncoplastic. All of the patients were satisfied with functional and aesthetic results and none of them had major complications such as total NAC loss. Only six patients had wound healing problems on the suture line and two patients had minimal hematoma. Since we performed conical plication we would like to evalu-ate long term effects of the plication in the breast parenchyma. Breast parenchyma was visualized with USG in younger patients and mammography in older patient in postoperative 6 months and 1 year. We never observed any problem related with our sutures and retroareolar part of the areola examination for ductal patency was performed and interestingly all the patients had very clear ductal patency. Our modification is a safe, reliable technique which creates the least scar, avoids previously described disadvantages, provides maximum preservation of functions, can be employed in all breasts regardless of their sizes and is appropriate for oncoplastic surgery and revision surgery.

Reduction Mammaplasty as a Treatment Option for Early Breast Cancer

Background: Although reduction mammaplasty is a well-known technique for cosmetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. Mammaplasty combined with breast conservation surgery is an effective treatment of early breast cancer, and leads to better overall results and superior quality of life in patients with previous macromastia or ptosis. Our aim is to analyze both the aesthetic and oncologic outcome of reduction mammaplasty combined with conservative breast surgery reconstruction. Patient and Methods: 25 patients with stage 1 or 2 breast cancer, with a tumor size not more than 3 cmin its greatest dimension, were operated upon by quadrantectomy, and bilateral reduction mammaplasty. Oncologic data on tumor size, location, and axillary lymph node, were assessed, and accordingly the design of the pedicle was chosen. Reconstructed breast and opposite breast reduction were evaluated. Results: Of the total 50 breast reductions techniques, 35 (70 percent) were superomedial pedicle, 4 (8 percent) were superior, 3 (6 percent) were superolateral, and 8 (16 percent) were inferior. The cosmetic result was considered to be good or very good in 18 cases, satisfactory in 6 cases, and poor in 1 case. There were no other complications as regard nipple areola ischemia, heamatoma, seroma, wound problems, fat necrosis, or recurrence in any of the cases. Conclusion: By adding breast reduction and other plastic surgery techniques to breast conservation, patients have the opportunity for an improved cosmetic outcome and overall improved quality of life. Although the combined approach between the oncologic surgeon and the plastic surgeon requires more preoperative planning and intraoperative care, the concept can reduce deformities, favor the oncologic treatment, and optimize the aesthetic outcome in most early-stage cancer patients.

Central/Inferior Pedicle Technique for Reduction Mammaplasty: A Systematic Review

Background: Intention of reduction mammoplasty is to minimize the breast volume and maintain supply of blood and innervations to NAC (nipple-areola-complex), to lift NAC to higher position in mound of breast using any reliable technique like central pedicle technique. Methods: This research selected and observed 15 patients who underwent central pedicle technique for mammaplasty of breast reduction. Age criterium included for this research is 18 years to 60 years for 5 years from Chinese patients. In addition to these, this study systematically reviewed about central pedicle technique for 25 years. Papers were selected from 1996 to 2021. Results: Using central pedicle technique, shape and projection of breast were reduced. Such changes of measurements showed that postoperative technique leads to long-term satisfactory impact. Conclusion: Central pedicle technique was found to be best, reliable and safe technique for reduction mammaplasty. Reduction mammaplasty is used for reducing the ptotic and large breasts. It provides more satisfactory and good aesthetic outcomes. Majority of patients do not have any complications postoperative. Complications rate is minimal when central pedicle technique is used for reduction mammaplasty. Patients with ptotic and large breasts would have huge advantage postoperative.

Breast reconstruction:Review of current autologous and implantbased techniques and long-term oncologic outcome

Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.

A Long Term Review of Surgically Treated Enlarged Breasts

Introduction: Breast hypertrophy (excessive enlargement of breast), a condition though rare, is well pronounced in some females. Surgery either by reduction mammaplasty or sub-cutaneous mastectomy is often employed in treatment of this condition. Aim: This study seeks to find out the long term level of satisfaction of the surgery on these persons after about 10 - 12 years after treatment. Materials and Methods: From January 1994 to December 2000, the Komfo Anokye Teaching Hospital (KATH) carried out surgeries on 43 females who presented with several degrees of breast hypertrophy. Patients were asked to answer questionnaires on their condition pre-operatively and post-operatively during the long term review process. Results: Thirty-four (79.1%) patients out of the 43 were available for the review with the patients stating there was much (100%) improvement in terms of the pain they felt in the neck, upper and lower back regions. There was no re-occurrence of the condition in any of the patients;29 (85.3%) stated they were satisfied and that their new breast size(s) was/were excellent for them. Conclusion: The pre-operative complications experienced by these patients were resolved hence this surgical procedure was good and the quality of life of these persons had been improved.

IMMEDIATE BREAST RECONSTRUCTION WITH LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP: A SUITABLE OPTION FOR CHINESE WOMEN AFTER MASTECTOMY

Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.

Versatility of therapeutic reduction mammoplasty in oncoplastic breast conserving surgery

Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, "therapeutic mammoplasty" or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients(14%). Nine patients(15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.

Magnetic resonance imaging on complications of breast augmentation with injected hydrophilic polyacrylamide gel

The injection augmentation mammaplasty for cosmetic purpose has been popular recently in China. Two kinds of injectable material are used clinically, autologous fat and biomaterial. The fat injection for breast augmentation is in question with the major problems of progressive fat re-absorption, microcalcification, and fat liquefaction. Now, the principal alloplastic biomaterial for injection augmentation mammaplasty in China is hydrophilic polyacrylamide gel （HPAAG）. Although thousands of breasts have been augmented with HPAAG and it seems to be a good biocompatible material, some complications develop after HPAAG injection augmentation mammaplasty.The patients had to undergo surgery to remove the injected HPAAG and associated lesions. Ultrasonography or magnetic resonance imaging （MRI） should be taken preoperatively to demonstrate the distribution of injected HPAAG and associated lesions. In this report, the diagnostic value and clinical significance of MRI on the complications of HPAAG breast augmentation were discussed.

Deep inferior epigastric perforator flap for breast reconstruction:experience with 43 flaps

Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous （TRAM） flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator （DIEP） free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap. Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap （3 patients had bilateral procedures）, 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up. Results The mean age of the patients was 38.6 years （range, 28-50）. The size of the flaps was 11 cm×26 cm in average （height 10-12 cm, width 15-33 cm）. The mean length of the vascular pedicles was 9.3 cm （range, 7-12）. The patients were followed up for a mean of 16 months （range, 6-30 months）. During the follow-up, 2 （5%） patients had total flap loss, 2 （5%） had partial necrosis, 4 （9%） had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal. Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce donor-site morbidity and provide an aesthetic refinement in breast reconstruction.