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Seminars in Plastic Surgery May 2015Autologous breast reconstruction is capable of creating a breast that closely resembles a natural breast. Reduction and mastopexy in this type of reconstruction yields...
Autologous breast reconstruction is capable of creating a breast that closely resembles a natural breast. Reduction and mastopexy in this type of reconstruction yields several challenges to the reconstructive surgeon. Revision surgery is common to achieve symmetry; however, reduction, mastopexy, and other revision techniques are sparse in the current literature. Often, these techniques are passed from mentor to student during plastic surgery training or are learned with experience in managing one's own patients. Reviewing anatomical principles unique to this subset of patients is essential. We must also consider factors unique to this group including the effects of delayed reconstruction, radiation, skin paddle size, and flap volume. In this article, the authors describe some of the common principles used by experienced reconstructive surgeons to perform reduction and mastopexy in autologous breast reconstruction to achieve a natural, aesthetically pleasing breast reconstruction. In addition, they have included several case examples to further illustrate these principles.
PubMed: 26528087
DOI: 10.1055/s-0035-1549050 -
The Canadian Journal of Plastic Surgery... 2007A technique using a posteriorly based dermoglandular flap as an augmentation of the superior hemisphere of the breast combined with a periareolar mastopexy and vertical...
A technique using a posteriorly based dermoglandular flap as an augmentation of the superior hemisphere of the breast combined with a periareolar mastopexy and vertical mastopexy is presented. The advantages of combining a periareolar mastopexy, in terms of reducing the length of the vertical scar and preventing areolar distortion, are explained.
PubMed: 19554189
DOI: 10.1177/229255030701500201 -
Plastic and Reconstructive Surgery.... Oct 2020Breast ptosis is a common occurrence following weight loss, pregnancy, and breastfeeding, or as a consequence of normal aging. This results in loss of a youthful shape... (Review)
Review
Breast ptosis is a common occurrence following weight loss, pregnancy, and breastfeeding, or as a consequence of normal aging. This results in loss of a youthful shape and contour of the breast, with a change in the position of the nipple-areolar complex. Mastopexy can restore this youthful appearance and transpose the nipple-areolar complex to a more aesthetic position on the breast. Various techniques exist that address the skin and parenchyma of the breast and are chosen based on the degree of ptosis and skin laxity, as well as the patient's goals. These techniques all differ in scar burden and risk profile. Additionally, this can be done simultaneously or in a staged manner. In this literature review, we aim to provide an overview of mastopexy procedures, with and without augmentation. Further, we aim to detail recent advancements in technical approaches, and delineate common complications in certain patient demographics. To this end, we performed a literature search with a medical librarian, using PubMed/Medline to identify pertinent literature. In the context of the review, we discuss important considerations in patient selection and counseling to set expectations and ultimately, optimize surgical outcome and patient satisfaction.
PubMed: 33173660
DOI: 10.1097/GOX.0000000000003057 -
Gland Surgery Sep 2021This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation,... (Review)
Review
OBJECTIVE
This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage.
BACKGROUND
Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction.
METHODS
Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines.
CONCLUSIONS
Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
PubMed: 34733731
DOI: 10.21037/gs-20-892 -
Gland Surgery Apr 2015The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast... (Review)
Review
The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction and result in better control of tumor margins. This article will detail the approach to evaluating and treating patients undergoing oncoplastic reconstruction. Different oncoplastic approaches will be described and applied to an oncoplastic reconstructive algorithm. Surgical complications, oncologic outcomes and aesthetic outcomes are reviewed.
PubMed: 26005647
DOI: 10.3978/j.issn.2227-684X.2015.03.01 -
Gland Surgery Apr 2017The 'waterfall effect' is a descriptive term to indicate a sliding ptosis of parenchymal breast tissue over a fixed or encapsulated implant. It occurs more frequently... (Review)
Review
The 'waterfall effect' is a descriptive term to indicate a sliding ptosis of parenchymal breast tissue over a fixed or encapsulated implant. It occurs more frequently than surgeons anticipate and especially over the longer term after augmentation. Certain breast implants are more prone to contribute to this problem as are implants placed in submuscular pockets that ride high, especially in women with anatomical musculoskeletal variance or asymmetry. This article describes the aetiology of sliding ptosis in more detail, the relevant anatomy and the surgical correction. Understanding the problem enables the surgeon to plan the appropriate procedure and obtain proper informed consent. It is possible that a two stage procedure is necessary should the upper pole of breast require a debulk, either early (3 to 12 months) or later as the breast may slide with ageing of the tissues. The waterfall effect of breast parenchyma over implants is only apparent when the upper torso of the woman is undressed and she is in an erect posture. A significant number of women are happy with this situation and therefore no further action is required. Those that want an improved appearance in these circumstances can try autologous fat transfer to rebulk the surrounding tissues but generally the most likely solution involves a mastopexy with or without implant exchange. The results are highly rewarding but the scars are the legacy. Mastopexy augmentation is a difficult procedure and should only be performed by experienced surgeons. Many surgeons prefer a two stage approach with either an implant based augmentation first to limit scars and see if the patient is happy with the outcome or a first stage mastopexy to decide whether implants or fat graft are actually required as a secondary procedure.
PubMed: 28497023
DOI: 10.21037/gs.2016.10.01 -
Aesthetic Surgery Journal. Open Forum 2022Reduction mammaplasty and mastopexy are currently some of the most performed breast procedures. Techniques typically involve deepithelialization of the nipple-areola...
BACKGROUND
Reduction mammaplasty and mastopexy are currently some of the most performed breast procedures. Techniques typically involve deepithelialization of the nipple-areola complex pedicle. Traditionally, scalpel or scissor dissection is performed below the basal skin layer to remove the germinal epithelium but above the subcutis to preserve the subdermal vascular plexus. Deepithelialization thus leaves a strong dermal "leash" for the pedicle while preserving the subdermal blood supply. This process is time intensive and bloody, and often an assistant is required for countertraction. Previously, authors have described laser-assisted breast reduction surgery as an alternative to traditional cold knife techniques. The advent of helium plasma generators offers another option for deepithelialization. This study is a preliminary assessment of the safety and efficacy of this application.
OBJECTIVES
The authors performed a prospective pilot study of 10 patients who underwent outpatient, inferior pedicle, breast reduction mammaplasty, or mastopexy surgery by a single surgeon. Outcomes were assessed for safety and efficacy. Representative tissue samples were evaluated by an independent pathology group.
METHODS
All patients received standard outpatient perioperative care. Deepithelialization was performed using the Renuvion helium plasma device (Apyx Medical, Clearwater, FL), and standard breast reduction or mastopexy was performed.
RESULTS
No major complications occurred in our series. Minor complications occurred in 1 patient (10%). No inclusion cysts were recorded in any patients.
CONCLUSIONS
Helium plasma energy for deepithelialization in breast reduction was found to be safe, efficient, and effective. Decreased operating room time and blood loss suggest that helium plasma is a potential alternative for surgeons who have access to this technology.
PubMed: 35912360
DOI: 10.1093/asjof/ojac041 -
Augmentation-Mastopexy: Analysis of 95 Consecutive Patients and Critical Appraisal of the Procedure.Journal of Clinical Medicine Apr 2023Single-stage mastopexy-augmentation has been demonstrated to be a safe procedure. However, revisions may still be necessary. We evaluate 95 consecutive patients...
Single-stage mastopexy-augmentation has been demonstrated to be a safe procedure. However, revisions may still be necessary. We evaluate 95 consecutive patients undergoing mastopexy-augmentation and introduce a new surgical technique for the procedure: the modified dual plane technique. In this retrospective study, 95 patients (mean age 34 ± 11 years) underwent mastopexy-augmentation between 2009 and 2019. The procedures were classified as subglandular, dual plane, or modified dual plane technique. The outcome measures included major and minor complications. A total of 19 patients underwent a subglandular procedure, 32 patients a dual plane procedure, and 44 patients a modified dual plane procedure. We observed a high overall complication rate in the subglandular group (n = 12, 63%), dual plane group (n = 15, 47%), and modified dual plane group (n = 10, 23%). Complications leading to implant loss/change occurred in seven patients in the subglandular group (37%), six patients in the dual plane group (19%), and no patient in the modified dual plane group. While we observed a high complication rate in patients undergoing mastopexy-augmentations, the modified dual plane technique was associated with a lower complication rate.
PubMed: 37176652
DOI: 10.3390/jcm12093213 -
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 -
Plastic and Reconstructive Surgery.... Nov 2019Augmentation mastopexy is one of the most difficult challenges plastic surgeons face, especially concerning sustainability of upper pole fullness and lower pole ptosis...
UNLABELLED
Augmentation mastopexy is one of the most difficult challenges plastic surgeons face, especially concerning sustainability of upper pole fullness and lower pole ptosis correction. We describe our technique for augmentation mastopexy that provides inferolateral muscular support for the implant and standardizes a sequence of surgical stages to resolve multiple situations and present the outcomes of patients who underwent such an approach.
METHODS
Our technique proposes the following: (a) modified subpectoral pocket, with muscular inferolateral support for the implant; (b) independent approaches to the submuscular (implant) pocket and parenchymal resection/reshaping; and (c) pre-established 4-step surgical sequence. Data from office files of our private practice were collected for 266 patients who underwent the technique from October 2015 to January 2019. Patient perception about esthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed.
RESULTS
Overall mid-term and long-term results (39 months) were positive for lift and augmentation at single time mastopexy; >90% of patients reported satisfaction with their esthetic outcomes, including absence of ptosis. No major complications occurred. The total revision rate was 16%, but it became <5% in 2018 as the learning curve progressed.
CONCLUSIONS
Augmentation mastopexy is complex, and the myriad of approaches and possibilities may cause confusion when selecting the most suitable one. The 4-step sequence provides a reliable option, offering a predefined execution plan, whereas inferolateral muscular support prevents recurrence of lower pole ptosis. Other surgeons' experience with lift and augmentation at single time mastopexy and further studies are necessary to validate these findings.
PubMed: 31942312
DOI: 10.1097/GOX.0000000000002523