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Journal of Surgical Oncology Jul 2020A modern perspective on the nipple-sparing mastectomy (NSM) looking at current indications as well as the most up-to-date evidence both in the literature and from our... (Review)
Review
A modern perspective on the nipple-sparing mastectomy (NSM) looking at current indications as well as the most up-to-date evidence both in the literature and from our institution. There is an in-depth description of our NSM technique and an overview of alternative approaches, including the robotic technique. The complicated concept of the learning curve is addressed and ideas on how to train other NSM adopters.
Topics: Breast Neoplasms; Contraindications, Procedure; Female; Humans; Mastectomy; Nipples; Organ Sparing Treatments
PubMed: 32219847
DOI: 10.1002/jso.25909 -
Annals of Plastic Surgery Oct 2022Crescent mastopexy is an operation that is often maligned and infrequently used. However, it can be a useful adjunct both in primary augmentation mammaplasty and in...
Crescent mastopexy is an operation that is often maligned and infrequently used. However, it can be a useful adjunct both in primary augmentation mammaplasty and in secondary breast revision cases. The key to achieving good results with this procedure lies in conceptualizing the operation in 3 dimensions rather than 2. Most publications about the surgical technique describe deepithelialization (or at most full-thickness skin resection) of a crescent-shaped area superior to the areola and a single-layer closure of the defect. Improved outcomes are achieved if a full-thickness composite segment of tissue-skin, subcutaneous fat, and a wedge of breast parenchyma-is resected and the resulting defect closed in multiple layers. A more fitting descriptive term for this procedure, one that conveys the 3-dimensional nature of the tissue resection, is "croissant mastopexy." Croissant mastopexy has been used by the author in primary augmentation in women with mild to moderate ptosis, in patients with asymmetrical nipple position and in patients with tuberous breast deformity. The procedure is also applicable in secondary cases, but precautions must be taken to ensure that blood supply to the nipple is not compromised. When properly executed, croissant mastopexy yields good results without undue stretching of the superior half of the areola and with acceptable scars.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Nipples; Retrospective Studies
PubMed: 35703195
DOI: 10.1097/SAP.0000000000003210 -
Aesthetic Plastic Surgery Oct 2021Mastopexy in combination with implant breast augmentation still remains a controversial topic in plastic surgery because of its complexity and its relative high rate of... (Observational Study)
Observational Study
INTRODUCTION
Mastopexy in combination with implant breast augmentation still remains a controversial topic in plastic surgery because of its complexity and its relative high rate of complications. To obviate the need of a breast implant, numerous authors described glandular rearrangement techniques to optimize upper pole fullness and breast projection. More recently, the combination of mastopexy and lipofilling has been described. The aim of this study is to report our experience on one-stage mastopexy-lipofilling in cosmetic breast surgery, describing our surgical technique and focusing on long-term esthetic results and patient-reported outcomes.
MATERIAL AND METHOD
A prospective observational study was performed including all patients underwent cosmetic one-stage mastopexy-lipofilling. Collected data included patient's age and BMI, smoking, preoperative and postoperative cup size and grade of ptosis, preoperative and postoperative distances between the upper part of the nipple areola complex and the inframammary fold and between the upper part of the nipple areola complex and the sternal notch, mean liposuction and fat injection volume, mean operating time and postoperative complications. Cosmetic results and patient satisfaction were evaluated using the 5 points Likert scale considering breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape and global satisfaction.
RESULTS
A total of 21 patients (42 breasts) were included with a mean follow-up of 13.8 months. Mean liposuction and injection volumes were 1070 mL and 230 mL, respectively. With respect to breast size, 11 patients (52.4%) showed an increase in one-cup size, while 10 patients (47.6%) showed a slight increase in volume without changing cup size. The mean NAC-SN and NAC-IMF distances decreased by an average of 3.7 cm and 1.7 cm, respectively. Regarding esthetic outcomes, the mean scores for breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape were 4.1, 4.2, 4.9, 4, 4.6 and 5, respectively. With respect to patient satisfaction, mean scores for breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape were 4.2, 5, 5, 4.7, 5 and 5, respectively. The achievement of a satisfactory outcome (> 4) was obtained in all patients but 1 with a mean score of 4.5 (3-5).
CONCLUSION
The current study suggests that one-stage mastopexy-lipofilling is a safe technique, which leads with satisfactory outcomes allowing breast contouring and breast volume increase.
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: Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Nipples; Prospective Studies; Retrospective Studies; Surgery, Plastic; Surgical Flaps; Treatment Outcome
PubMed: 33982157
DOI: 10.1007/s00266-021-02327-y -
Revista Brasileira de Enfermagem 2021to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance.
OBJECTIVES
to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance.
METHODS
this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied.
RESULTS
Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity.
CONCLUSIONS
the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.
Topics: Nipples; Research Design
PubMed: 34614083
DOI: 10.1590/0034-7167-2021-0051 -
Journal of Plastic, Reconstructive &... Sep 2022Breast reconstructive standards are increasingly high oncologically, aesthetically, and practically. Autologous breast reconstruction remains the gold standard which,...
BACKGROUND
Breast reconstructive standards are increasingly high oncologically, aesthetically, and practically. Autologous breast reconstruction remains the gold standard which, buried, after nipple-sparing mastectomy (where oncologically safe) or wise pattern reduction for large or ptotic patients, with contralateral symmetrisation where required, enables single-stage reconstruction. However, previous series report prohibitively high revision rates. This series prospectively compares a series of buried and non-buried free flaps for breast reconstruction.
METHODS
All breast reconstructions with free autologous tissue transfer, buried or with a cutaneous paddle, conducted over 8 years by a single surgeon were included. Demographic, oncologic and reconstructive details, immediate complications and revision surgeries were recorded and compared between the two groups.
RESULTS
A total of 182 free flaps were performed on 156 patients, 69 buried and 113 with cutaneous paddles. There were no significant demographic or complication differences between the two groups. Of the buried group, 51% did not require further surgery compared to 29% of the paddle group.
CONCLUSIONS
Buried autologous breast reconstruction is a safe and aesthetic option for breast reconstruction, and potentially single stage. This is particularly true where it is combined with nipple-sparing mastectomy (where oncologically safe) or breast reduction mastectomy, and contralateral symmetrisation, where required. Further research could include patient reported outcome measures and cost analysis.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Subcutaneous; Nipples; Retrospective Studies
PubMed: 35643594
DOI: 10.1016/j.bjps.2022.04.033 -
The Surgeon : Journal of the Royal... Oct 2021There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all... (Review)
Review
BACKGROUND
There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature.
METHODS
Systematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction.
RESULTS
Fifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area.
CONCLUSION
There is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Nipples; Patient Reported Outcome Measures; Patient Satisfaction; Retrospective Studies
PubMed: 33423920
DOI: 10.1016/j.surge.2020.11.005 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jul 2019To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years. (Review)
Review
OBJECTIVE
To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Breast; Female; Humans; Mammaplasty; Nipples; Postoperative Period; Sensation; Suture Techniques
PubMed: 31298012
DOI: 10.7507/1002-1892.201902016 -
Annals of Plastic Surgery May 2024After breast surgery, patients experience significant alterations to breast sensation, which can diminish quality of life. Nerve coaptation technique, introduced in the... (Review)
Review
BACKGROUND
After breast surgery, patients experience significant alterations to breast sensation, which can diminish quality of life. Nerve coaptation technique, introduced in the 1990s, has gained traction in recent years. We performed a scoping review of the literature to determine the available outcomes in sensate breast reconstruction.
METHODS
The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews statement guidelines. EMBASE and PubMed databases were queried using standardized terminology. Studies were included if they reported original sensory outcomes following innervation techniques during breast reconstruction and were published from January 1, 1990, to April 18, 2022. Data extraction and analyses were performed on Microsoft Excel.
RESULTS
From 602 screened articles, 27 studies met the inclusion criteria. Innervated autologous reconstructive procedures were described in 24, whereas the remaining 3 (all published after 2019) described direct reinnervation of the nipple-areola complex. Most (88.9%) of the studies comparing innervated versus noninnervated reconstruction reported improved sensory outcomes in at least 1 modality. Two studies investigated patient-reported outcomes using validated questionnaires, both of which reported improvement with innervated reconstruction.
CONCLUSIONS
Sensate breast reconstruction has the potential to improve outcomes for patients. There is a recent progressive increase in studies involving direct nipple-areolar reinnervation. Larger, prospective studies are needed to better characterize the quality-of-life outcome using validated scales, as well as evaluate sensory and patient-reported outcomes with implant and autologous reconstruction.
Topics: Humans; Mammaplasty; Female; Quality of Life; Breast Neoplasms; Nipples; Mastectomy; Breast
PubMed: 38685499
DOI: 10.1097/SAP.0000000000003832 -
Annals of Plastic Surgery May 2023Nipple-sparing mastectomy (NSM) is emerging as the standard of care for treatment of breast cancer because of its oncologic safety and superior aesthetic outcomes.... (Review)
Review
BACKGROUND
Nipple-sparing mastectomy (NSM) is emerging as the standard of care for treatment of breast cancer because of its oncologic safety and superior aesthetic outcomes. However, ischemia or necrosis of the skin flap and/or nipple-areola complex remain frequent complications. Hyperbaric oxygen therapy (HBOT) has emerged as a potential adjunct for flap salvage, although it is not currently a widely accepted practice. Here we review our institution's experience using a protocol of HBOT in patients with signs of flap ischemia or necrosis after NSM.
METHODS
Retrospective review identified all patients treated with HBOT at our institution's hyperbaric and wound care center because of signs of ischemia after NSM. Treatment parameters consisted of 90-minute dives at 2.0 atmosphere once or twice daily. Patients unable to tolerate dives were considered a treatment failure, whereas those lost to follow-up were excluded from analysis. Patient demographics, surgical characteristics, and treatment indications were recorded. Primary outcomes assessed were flap salvage (no operative revision), need for revision procedures, and treatment complications.
RESULTS
A total of 17 patients and 25 breasts met the inclusion criteria. The mean ± SD time to initiation of HBOT was 9.47 ± 12.7 days. The mean ± SD age was 46.7 ± 10.4 years, and mean ± SD follow-up time was 36.5 ± 25.6 days. Indications for NSM included invasive cancer (41.2%), carcinoma in situ (29.4%), and breast cancer prophylaxis (29.4%). Initial reconstruction included tissue-expander placement (47.1%), autologous reconstruction with deep inferior epigastric flaps (29.4%), and direct-to-implant reconstruction (23.5%). Hyperbaric oxygen therapy indications included ischemia or venous congestion for 15 breasts (60.0%) and partial thickness necrosis for 10 breasts (40.0%). Flap salvage was achieved in 22 of 25 breasts (88.0%). Reoperation was required for 3 breasts (12.0%). Hyperbaric oxygen therapy-related complications were observed in 4 patients (23.5%), which included 3 patients with mild ear pain and 1 patient with severe sinus pressure leading to treatment abortion.
CONCLUSIONS
Nipple-sparing mastectomy is an invaluable tool for breast and plastic surgeons to achieve oncologic and cosmetic goals. However, ischemia or necrosis of the nipple-areola complex or mastectomy skin flap remains frequent complications. Hyperbaric oxygen therapy has emerged as a possible intervention for threatened flaps. Our results demonstrate the utility of HBOT in this population to achieve excellent NSM flap salvage rates.
Topics: Humans; Adult; Middle Aged; Female; Nipples; Breast Neoplasms; Mastectomy; Hyperbaric Oxygenation; Mastectomy, Subcutaneous; Retrospective Studies; Necrosis; Ischemia; Mammaplasty
PubMed: 36913565
DOI: 10.1097/SAP.0000000000003441 -
Journal of Plastic, Reconstructive &... Jun 2020Numerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular...
INTRODUCTION
Numerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular supply and sensitivity of the nipple areola complex (NAC), breast feeding, and an esthetically pleasing result.
OBJECTIVES
In the present preliminary report, we introduce a new technique called the three-block L-wing reduction mammaplasty that addresses the aforementioned difficulties.
MATERIALS AND METHODS
The three-block L-wing reduction mammaplasty with a thick hemispheric superiorly based NAC pedicle and a medial as well as lateral pillar was performed in a total of 60 patients.
RESULTS
Our technique increases both, vascular safety and the sensory supply to the NAC, as it conceptually decreases the need for dissection of breast tissue and skin. The incidence of fat necrosis and wound healing disorders may be reduced with this technique. Because the ducts of the breast-gland underneath the NAC are not dissected, this technique also promises a higher probability of regular breast-feeding. Finally, our technique permits a cosmetically pleasing round-shaped mound of the breast.
CONCLUSION
The three-block modification simplifies the procedure of the superior pedicle L-wing mammaplasty markedly. It may increase the esthetic as well as the functional outcome and decrease postoperative complications.
Topics: Adolescent; Adult; Aged; Breast; Cicatrix; Female; Humans; Mammaplasty; Middle Aged; Nipples; Surgical Flaps; Young Adult
PubMed: 32317232
DOI: 10.1016/j.bjps.2020.01.027