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Reduction mammaplasty with the nipple-areola carried on a single, narrow inferior pedicle.

Transposition of the nipple-areola on a narrow, single, inferiorly based breast subcutaneous pedicle in reduction mammaplasty is safe, even in patients with massive macromastia. We report breast reduction performed with the single pedicle in 15 breasts in 10 patients, with bipedicles as long as 51 cm (prior to amputation), with single inferior pedicles as long as 30 cm, and with resections of up to 3,000 gm per breast. We are not proposing resection of the superior pedicle in all vertical pedicle mammaplasties; we are saying, rather, that the superior pedicle may be discarded with the resected breast tissue, and the nipple-areola may be transferred safely on a pedicle that is narrower than previously described by others.

Breast↗

Simultaneous augmentation mammaplasty and correction of inverted nipples.

This case proceeds from a patient of ours complaining both of small breasts and of inverted nipples. A lengthy discussion was held with her regarding simultaneous repair of both deformities and the two basic types of correction available for inverted nipples. The decision was made to undertake the combined procedure. The result shows the feasibility of performing the two procedures in one stage through the same incision. We found no previous report of such an operation.

Adult↗

Inferior flap reduction mammaplasty with pedicled nipple.

A modification of the original inferior flap reduction mammaplasty is presented using a dermal pedicle based on the inferior flap to support the nipple and areola complex. The technique is extremely versatile, and the breast contour is excellent. The nipple shows excellent projection and generally improved sensation over the preoperative state.

Adolescent↗

Nipple reconstruction with four-lobe composite auricular graft.

A new method of nipple reconstruction using a four-lobe free composite graft from the inferior pole of the earlobe in the shape of a clover leaf is described. Invagination of the flaps achieves long-term nipple projection without flattening. Donor deformity has been negligible and ear piercing has been preserved when desired. The transposed grafts have retained the pinkish appearance of the vascular donor sites. Color has blended well with the pigmented areolar grafts.

Breast↗

A simple aid for determination of nipple-areola position.

A simple, inexpensive aid for nipple-areola site determination is the disposable electrocardiographic electrode. Patients participate in positioning of the future nipple-areola complex, and accurate localization can be checked even when the breast is covered with a brassiere.

Breast↗

Convergent nipple-areolar complexes corrected by inferior curved pedicle technique.

We report a case of mammaplasty followed by a marked convergence of the nipple-areolar complex and describe the surgical repair by means of an inferior dermal-fat curved flap. The curve of the inferior pedicle permits one to raise the nipple to its normal position with ease and exceptional viability, even if a breast reduction procedure is associated.

Adult↗

A simple method for the treatment of the inverted nipple.

We introduce a simple method for correcting the inverted nipple in which there is preservation of the lactiferous duct, less surgical invasion, and negligible scar formation. Our method consists of two parts: releasing fibrous tissue around the lactiferous ducts, and keeping the nipple in the everted position with a bolster suture and milk suction pump.

Adolescent↗

Nipple centralization for the correction of breast deformity from segmental mastectomy.

A breast deformed by lateral tissue deficiency and severe lateral displacement of the nipple, caused by the treatment of an early breast cancer with segmental mastectomy and radiotherapy, was corrected by a modification of techniques used commonly for mastopexy. The nipple and areola were moved medially on a central pedicle to create the illusion that the missing lateral tissues had been restored. Simultaneously, the opposite breast was reduced to improve symmetry. The result was a normalization of breast appearance without the need for distant tissue. It is possible that modifications of this approach could be used to treat similar deformities in other quadrants of the breast as well.

Adult↗

Free nipple graft reduction mammoplasty.

Free nipple graft reduction mammoplasty is the procedure of choice in patients with massive breast hypertrophy, or those high-risk patients less able to undergo a more extensive procedure. A major criticism of the technique is that it creates a flat, boxy breast that lacks projection. A technical modification of free nipple graft reduction mammoplasty is presented. In this modification, a central, bulky, superiorly based dermal-parenchymal flap extending from the "key-hole" site to the superior aspect of the areola is designed. After tailoring, this central flap is folded superiorly and secured beneath the medial and lateral flaps to create the bulk of the breast mound. This central flap can be accurately tailored to achieve the desired breast size and projection. The medial and lateral breast flaps do not create the breast mound, and are only contoured over the top of this central flap to complement the final breast form.

Adolescent↗

Secure dressing after nipple-areola reconstruction.

Firm contact to the underlying recipient bed and immobilization are necessary for survival of an areolar skin graft, yet compression of the nipple must be avoided when performing nipple-areola reconstruction. A simple dressing technique is described that simultaneously accomplishes both goals and can be carried out with commonly available materials.

Female↗

Long-term experience with nipple-areola tattooing.

Although nipple-areola tattooing is now a well-accepted step in breast reconstruction, little is known about its long-term effectiveness. A retrospective study of our 6-year experience in tattooing 151 patients was thus carried out. Patients were surveyed regarding color match, satisfaction, and complications. Follow-up ranged from 1 to 75 months (mean, 25.2 months). Fifty-seven percent of respondents said their tattoo looked similar to the normal areola. There were five (3%) infections, one rash, and one slough. Ten percent of tattoos needed a touch-up later to correct for excessive fading. Nearly 60% of tattoos were ultimately lighter than the normal. Eighty-four percent of the tattoos were rated as satisfactory, and 86% of the patients said they would repeat the procedure if given the same choice again. Nipple-areola tattooing done with iron oxide and titanium dioxide pigments thus appears to be a reasonably safe and effective procedure in most patients but may require one or more subsequent touch-ups for appropriate color match.

Female↗

Gynecomastia of the male nipple.

Diseases of the male nipple can be responsible for severe problems for the patient. The location of gynecomastia can be restricted to the nipple. Carcinoma should also be considered. The therapy of choice is operative treatment. A subtle microsurgical procedure is helpful to achieve a good functional and cosmetic result.

Adult↗

One-stage breast reduction and nipple-areolar reconstruction.

The authors present an easily designed and accomplished technique of one-stage reduction mammaplasty and nipple-areolar reconstruction for patients with large or medium-size breasts and for patients missing the nipple-areolar complex. The technique has low inherent risks, and the symmetry of the breast is maintained to the maximum. In addition to the cosmetic improvement, using this technique benefits the patient further by avoiding postoperative corrections or adjustments.

Female↗

Nipple-areola tattooing as part of breast reconstruction.

Tattooing of the nipple-areola complex has become standard procedure in reconstruction following a mastectomy. It is generally performed as the final stage of breast reconstruction. We began performing the procedure in 1991 and have treated more than 1,000 patients. The purpose of this article is to report on updated techniques since nipple-areola tattooing was first performed.

Female↗

Bilateral reconstruction of the nipple-areola complex.

We present a method for reconstructing the nipple and areola bilaterally in one stage, one which produces a corrugated, elevated nipple and a glabrous pigmented areola. A satisfactory appearance has been maintained in 4 cases during a follow-up period of up to two years.

Adolescent↗

Reduction mammaplasty: nipple-areola survival on a single breast quadrant.

Nipple viability was retained in 165 breasts undergoing reduction mammaplasty without dermal pedicles--even when 3 quadrants of the breast were excised. This technique adds versatility in shaping the breast and permits resection of the hypertrophied portions of the breast, rather than predetermined segments. It allows one to translocate and reposition the nipple-areola without tension or kinking of the breast parenchyma. It gives the patient esthetically pleasing breasts.

Adolescent↗

Reconstruction of the nipple-areola complex.

We present a technique for nipple-areolar reconstruction, which consists basically of hinging two quadrangular dermafat flaps together after denuding the entire area. Mucosal grafts are then applied over the whole nipple-areolar site.

Adipose Tissue↗

Latissimus dermal-epidermal nipple reconstruction.

Nipple reconstruction by dermal-epidermal advancement flaps from the latissimus dorsi skin island was performed in 10 consecutive patients. There was no tissue loss and the nipples are still prominent 16 months after operation. The technique avoids further donor-site distortion and benefits from the use of available tissues with uninterrupted circulation.

Breast↗