-
Clinical, Cosmetic and Investigational... 2023Bowen's disease (BD) commonly occurs in sites of chronic sunlight exposure such as head, neck and extremities. It rarely distributes on the nipple and areola.
INTRODUCTION
Bowen's disease (BD) commonly occurs in sites of chronic sunlight exposure such as head, neck and extremities. It rarely distributes on the nipple and areola.
CASE PRESENTATION
A 59-year-old female presented with crusted plaque on the right breast for over 1 month. Physical examination found an asymptomatic plaque (5 cm × 5 cm) with irregular shape on the right breast. Histopathological examination suggested irregularly acanthotic epidermis and atypical epidermal cells. Dermis showed inflammatory cell infiltration. Immunohistochemical staining showed negative staining for cytokeratin 7 and cytokeratin 20, and positive staining for Ki67 (60%). The mass was excised and no recurrence occurred in the follow-up. Additionally, we reviewed the literature about BD of the breast and summarized the clinical manifestations, histological features, and treatment options.
CONCLUSION
We reported a rare BD case involving nipple and areola. Wide local excision and complete nipple excision are effective for patients with BD of the nipple and areola.
PubMed: 37581009
DOI: 10.2147/CCID.S419059 -
Aesthetic Plastic Surgery Jun 2018Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or...
AIM
Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or roundness. We present a technique of breast reduction combined with augmentation termed "reductive augmentation" to solve this problem. The technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis in the patient who has previously undergone breast augmentation with or without mastopexy.
METHODS
An evolution of techniques has been used to create a breast with more upper pole fullness and anterior projection in those patients desiring a more round, higher-profile appearance. Reductive augmentation is a one-stage procedure in which a breast augmentation is immediately followed by a modified superomedial pedicle breast reduction. Often, the excision of breast tissue is greater than would normally be performed with breast reduction alone.
RESULTS
Thirty-five patients underwent reductive augmentation, of which 12 were primary surgeries and 23 were revisions. There was an average tissue removal of 255 and 227 g, respectively, per breast for the primary and revision groups. Six of the reductive augmentations were performed for gross asymmetry. Fourteen patients had a previous mastopexy, and 3 patients had a previous breast reduction. The average follow-up was 26 months.
CONCLUSIONS
Reductive augmentation is an effective one-stage method for achieving a more round-appearing breast with upper pole fullness both in primary breast reduction candidates and in revisionary breast surgery. This technique can also be applied to those patients with significant asymmetry.
LEVEL OF EVIDENCE IV
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 .
Topics: Adult; Breast; Cicatrix; Cohort Studies; Esthetics; Female; Follow-Up Studies; Humans; Hypertrophy; Mammaplasty; Middle Aged; Nipples; Patient Satisfaction; Retrospective Studies; Surgical Flaps; Suture Techniques; Treatment Outcome; Wound Healing
PubMed: 29124375
DOI: 10.1007/s00266-017-1010-0 -
Dermatologie (Heidelberg, Germany) Nov 2022The nipple region is characterized by special anatomical conditions and from a dermatological perspective can be divided into breast skin, skin of the areola and the... (Review)
Review
The nipple region is characterized by special anatomical conditions and from a dermatological perspective can be divided into breast skin, skin of the areola and the skin of the nipple. In a clinical context the nipples are often altered during lactation by mechanical alteration, changes in the environment with maceration by the milk flow and by microbial pathogens. In addition, there is a risk of developing puerperal mastitis. Outside of pregnancy and lactation, eczema diseases are occasionally found on the mammary skin, often with atopic disposition (atopic nipple eczema) or as irritant contact eczema ("joggers nipple"). More rarely, allergic contact eczema is observed from preservatives in topical preparations or metals (piercings). Also, in the context of a scabies infestation involvement of the nipples, especially in women, is regularly observed. Of great clinical importance are rare preinvasive lesions of breast cancer or Paget's disease of the mamilla of the extramammary type. Due to the special anatomical conditions, it is obvious that specific penetration conditions are also derived from the application of topical substances. Experimental studies on human skin ex vivo suggest that depending on the molecular weight and solubility of the drug as well as the vehicle system used, a significant increase in cutaneous bioavailability, especially on the nipple itself through the transpapillary diffusion pathway, may occur. This should be considered in particular in the topical application of drugs with known potential of dose-dependent side effects (e.g. glucocorticoids); however, there is still no clinical evidence for this.
Topics: Pregnancy; Female; Humans; Nipples; Irritants; Eczema; Breast Neoplasms; Dermatitis, Atopic; Dermatitis, Allergic Contact
PubMed: 35925215
DOI: 10.1007/s00105-022-05031-3 -
Indian Journal of Plastic Surgery :... Apr 2024Surgery to masculinize the chest is a frequently sought-after procedure by transmen who wish to conform their physical appearance to their gender identity. In our...
Surgery to masculinize the chest is a frequently sought-after procedure by transmen who wish to conform their physical appearance to their gender identity. In our study, the outcomes of surgical masculinization comprising subcutaneous mastectomy through a modified elliptical incision, liposuction, reduced inert nipple-areola grafting, and quilting stitches were analyzed. Thirty-two transmen with large breasts and hypertrophied nipples and areolae underwent the above-mentioned masculinizing procedure in this prospective cohort study. Our statistically validated institutional aesthetic outcome assessment score (IAOAS) was used to analyze the outcomes at the end of the follow-up period. The average period of follow-up was 24.5 months. The average final IAOAS was 23.1. The rate of complications was found to be associated with using breast binders. In all, 22 of 32 patients (68.75%) had an excellent outcome score, while 10 patients (31.25%) had a good outcome score ( = 0.025). Top surgery is crucial for transmasculine patients to achieve their desired gender identity as males. It is imperative that this procedure is performed to their complete satisfaction. Our single-staged comprehensive approach of subcutaneous mastectomy and liposuction with reduced inert nipple and areola grafts, which aids in a swift transition to a male role, is a prerequisite for bottom surgery at our institute.
PubMed: 38774737
DOI: 10.1055/s-0044-1779481 -
Plastic and Reconstructive Surgery Dec 2022Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics, and weight loss is a common complaint among women visiting a plastic surgeon. This study...
BACKGROUND
Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics, and weight loss is a common complaint among women visiting a plastic surgeon. This study sought to evaluate the utility, efficacy, and safety of radiofrequency-assisted lipolysis on the breast and nipple-areola complex position in women with breast ptosis.
METHODS
This was a single-center (i.e., Maxwell Aesthetics) study of women desiring tightening of the breast envelope and elevation of the nipple-areola complex. Each patient underwent one treatment with radiofrequency-assisted lipolysis in the operating room. Radiofrequency-assisted lipolysis was applied to each breast with a BodyTite Pro handpiece. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 12 months by means of manual and three-dimensional computer-generated measurements (i.e., Vectra).
RESULTS
Ten female patients were enrolled. Ages ranged from 23 to 54 years. Follow-up was 12 months. Data were captured for seven measurements from the nipple longitudinally at five time points. The sternal notch-to-nipple distance, the nipple-to-inframammary fold distance, and the nipple-to-nipple distance improved statistically at 6-week follow-up, which persisted through the 12-month follow-up ( p < 0.05). Patient questionnaires revealed moderate to excellent satisfaction.
CONCLUSIONS
Radiofrequency-assisted lipolysis with a bipolar device to deliver radiofrequency energy to the breast is an effective modality to moderately improve breast ptosis. This study demonstrates that this treatment improves breast measurements across time, regardless of measurement type (manual versus Vectra). This modality affords a minimally invasive, effective method to improve mild to moderate breast ptosis with minimal scarring and high patient satisfaction.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Female; Humans; Young Adult; Adult; Middle Aged; Nipples; Mammaplasty; Lipolysis; Esthetics; Cicatrix; Breast Neoplasms; Retrospective Studies
PubMed: 36103661
DOI: 10.1097/PRS.0000000000009729 -
Indian Journal of Dermatology,... 2022
Topics: Humans; Hyperplasia; Leiomyoma; Nipples; Sebaceous Glands
PubMed: 35593282
DOI: 10.25259/IJDVL_7_2020 -
Journal of Nippon Medical School =... Jun 2021Various skin incision methods have been reported for reduction mammoplasty and mastopexy. This report describes a new incision method that may improve on conventional...
OBJECTIVE
Various skin incision methods have been reported for reduction mammoplasty and mastopexy. This report describes a new incision method that may improve on conventional methods, particularly with respect to prevention of hypertrophic scars.
METHODS
We developed a comma-shaped incision method that results in fewer scars and less strain on the suture line. We then applied this new method to two cases, namely, one case of breast reduction and one case of breast fixation.
RESULTS
In both cases, we achieved good results. There was no scar at the inframammary fold, and no hypertrophic scar formation. All scars were within the breast area and were not in contact with the brassiere wire; hence, there was less pain after the operation.
CONCLUSIONS
We developed a new incision method for reduction mammoplasty and mastopexy.
Topics: Adult; Cicatrix, Hypertrophic; Dermatologic Surgical Procedures; Female; Humans; Mammaplasty; Mammary Glands, Human; Mammography; Middle Aged; Nipples; Surgical Wound
PubMed: 32863344
DOI: 10.1272/jnms.JNMS.2021_88-313 -
Korean Journal of Radiology Jul 2023Prospective studies on postoperative residual breast tissue (RBT) after robotic-assisted nipple-sparing mastectomy (R-NSM) for breast cancer are limited. RBT presents an... (Review)
Review
OBJECTIVE
Prospective studies on postoperative residual breast tissue (RBT) after robotic-assisted nipple-sparing mastectomy (R-NSM) for breast cancer are limited. RBT presents an unknown risk of local recurrence or the development of new cancer after curative or risk-reducing mastectomies. This study investigated the technical feasibility of using magnetic resonance imaging (MRI) to evaluate RBT after R-NSM in women with breast cancer.
MATERIALS AND METHODS
In this prospective pilot study, 105 patients, who underwent R-NSM for breast cancer at Changhua Christian Hospital between March 2017 and May 2022, were subjected to postoperative breast MRI to evaluate the presence and location of RBT. The postoperative MRI scans of 43 patients (age, 47.8 ± 8.5 years), with existing preoperative MRI scans, were evaluated for the presence and location of RBT. In total, 54 R-NSM procedures were performed. In parallel, we reviewed the literature on RBT after nipple-sparing mastectomy, considering its prevalence.
RESULTS
RBT was detected in 7 (13.0%) of the 54 mastectomies (6 of the 48 therapeutic mastectomies and 1 of the 6 prophylactic mastectomies). The most common location for RBT was behind the nipple-areolar complex (5 of 7 [71.4%]). Another RBT was found in the upper inner quadrant (2 of 7 [28.6%]). Among the six patients who underwent RBT after therapeutic mastectomies, one patient developed a local recurrence of the skin flap. The other five patients with RBT after therapeutic mastectomies remained disease-free.
CONCLUSION
R-NSM, a surgical innovation, does not seem to increase the prevalence of RBT, and breast MRI showed feasibility as a noninvasive imaging tool for evaluating the presence and location of RBT.
Topics: Female; Humans; Adult; Middle Aged; Breast Neoplasms; Mastectomy; Prospective Studies; Nipples; Robotic Surgical Procedures; Pilot Projects; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 37404106
DOI: 10.3348/kjr.2022.0708 -
Gland Surgery Oct 2021Reconstruction of the nipple-areola complex is the final step in surgical restoration of the breast. Nipple-areola reconstruction was previously done after an interval...
BACKGROUND
Reconstruction of the nipple-areola complex is the final step in surgical restoration of the breast. Nipple-areola reconstruction was previously done after an interval of several months using variable techniques, often resulting in low projection and flattened breast mound over time. We present algorithm of simultaneous nipple reconstruction (SNR) that leaves adequate residual projection and naturally shaped breast mound.
METHODS
Forty patients underwent a skin-sparing mastectomy and nipple excision between October 2016 and December 2020. In the control group, 21 patients underwent delayed nipple reconstruction for 6 months after breast reconstruction. The experimental group of 19 patients underwent nipple and breast reconstruction simultaneously. We collected relevant information and photographs of nipple profiles of both groups in the preoperative, postoperative 6-month, and postoperative 1-year time periods. We also examined the ratio between the reconstructed and contralateral nipples.
RESULTS
Scores regarding patient satisfaction questionnaire averaged higher in experimental groups to every category. The control group's scores gradually declined over time and the experimental group showed lesser decline. At the 1-year postoperative follow-up, the mean projection of the immediately reconstructed nipple was approximately the same as the contralateral nipple at 91%, whereas the delayed reconstructed nipple resulted in a 77% ratio.
CONCLUSIONS
Nipple reconstruction should no longer be considered as a secondary complement to immediate breast reconstruction. The nipple appears to be essential component of breast reconstruction for patient. SNR with immediate breast reconstruction is a simple and reliable technique, giving stable aesthetic results over time.
PubMed: 34804884
DOI: 10.21037/gs-21-338 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Aug 2023To review the advances in methods for reconstructing nipple projection based on tissue graft support. (Review)
Review
OBJECTIVE
To review the advances in methods for reconstructing nipple projection based on tissue graft support.
METHODS
The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results.
RESULTS
Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique.
CONCLUSION
There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.
Topics: Humans; Adipose Tissue; Autografts; Costal Cartilage; Nipples; Transplants
PubMed: 37586806
DOI: 10.7507/1002-1892.202304096