Biomedical subjects
Publications and source records attributed to G Letterman.
A nomenclature for the definition, diagnosis, and surgical management of the congenital anomalies of the breast is suggested. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) code numbers pertaining to these anomalies have been tabulated.
The final cosmetic result achieved by a mammaplasty is judged primarily upon the size, shape, and position the breasts assume with the individual in the erect position. For the past thirty-five years we have used the sitting position for certain mammaplasty procedures. It has proved especially advantageous and indeed mandatory for those mammaplasties in which the new nipple-areolar site has not been determined before operation. When we first used this position, complications were encountered. This finding prompted an analysis of the entire problem and the institution of measures to prevent complications. With time, a simple routine for positioning the patient evolved. Special measures are used to ensure the integrity of the cardiovascular, respiratory, and musculoskeletal systems. The peripheral nerves and peripheral soft tissue structures must be protected. If the proper care is taken, the sitting position for mammaplasty is safe, and it can be of real value to the surgeon.
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Women with mammary hypertrophy usually have a number of complaints relating to the skeletal system. Neck strain, headache, aching shoulders, heavy anterior chest, and paresthesias of the little fingers disappear after reduction mammaplasty. Low back pain is either completely eliminated or dramatically improved. Posture may or may not be corrected. It is suggested that muscle reeducation be instituted in patients who do not show spontaneous improvement. Deep brassiere strap furrows may vanish after a long postoperative period, or they may be permanent. In any case, they become asymptomatic. The effects of hypertrophic breast on the skeletal system are many and varied. A few such problems are illustrated. Many more exist.
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Adenomammectomy is an operation for the removal of the glandular element of the female breast with the ultimate goal of reconstruction by prosthesis, by autogenous tissue, or by a combination of the two. Indications, technique, and complications are discussed.
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There are many technics available today for reducing the oversize female breast. The most commonly used operations may be divided into two catergories, depending on treatment of the nipple-areolar complex: (1) free graft or (2) transposition on underlying tissue. According to this division, various methods are outlined and discussed.
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