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At least 19 recordsLinked to original sources
PubMed1999

Early experience with SPAIR mammaplasty: a useful alternative to vertical mammaplasty.

The short-scar periareolar inferior pedicle reduction (SPAIR) mammaplasty is a recently developed "limited-scar" technique that attempts to combine favorable elements of several well-established mammaplasty operations. Parenchymal resection and nipple transposition are achieved in a manner similar to the standard inferior pedicle reduction. Skin closure is achieved through a combination of periareolar and vertical techniques. Indications, operative technique, and pitfalls of the operation are discussed. Early experience with this technique in 102 breasts in 61 patients has been very favorable.

Female↗
PubMed2000

Secondary reduction mammaplasty: is using a different pedicle safe?

Reduction mammaplasty is a frequently performed procedure and one with consistent patient satisfaction. Few patients present for revisional procedures, and even fewer present for a secondary or repeated reduction mammaplasty. This study defines secondary reduction mammaplasty as performing an additional reduction using a pedicled nipple-areola complex. Few reports of secondary reduction are found in the literature. Operative guidelines for secondary reduction mammaplasty have been published recently. However, the experience of others has differed from these guidelines, and herein is presented another experience with secondary reduction mammaplasty. Ten cases of secondary reduction over a 37-year period were identified and reviewed. The initial reductions were performed using six different techniques. An average of 307 g of tissue per breast (range, 130 to 552 g) was removed at the initial operations. The secondary reductions were performed using four different techniques, and an average of 458 g of tissue per breast (range, 147 to 700 g) was removed at the secondary operations. Three of the 10 patients underwent initial and secondary reduction with the same technique. An average of 4 years (range, 1 to 10 years) separated these surgeries. Seven of the 10 patients underwent initial and secondary reductions with different technique. An average of 15 years (range, 5 to 19 years) separated these procedures. There was an average 5-year follow-up (range, 1 to 20 years) in this series. Four of the 10 patients experienced self-limiting complications after secondary reduction, including delay in wound healing, delay in the return of nipple sensitivity, and mild fat necrosis. Three of the four patients with complications had undergone secondary reduction with a different pedicle technique. No significant or long-lasting skin, pedicle, or nipple-areola complex compromise was found after secondary reduction mammaplasty. In contrast to the recently published guidelines, this study demonstrates that secondary reduction mammaplasty is a safe and viable option when performed with either similar or different technique. This finding allows secondary reduction mammaplasty to be tailored to the individual breast type and to the abilities of the specific surgeon.

Adolescent↗
PubMed2006

The vertical reduction mammaplasty: a prospective analysis of patient outcomes.

BACKGROUND: In the United States, breast reductions based upon a Wise pattern incision remain common. However, dissatisfaction with this procedure, on the part of the patient and the surgeon alike because of unsightly scars and long-term "bottoming out" of the breast, has promoted the search for alternative methods of breast reduction. The purpose of this study was to analyze patient outcomes after vertical reduction mammaplasty utilizing prospectively collected data. METHODS: All patients were given a custom-designed questionnaire designed to evaluate their macromastia-related symptoms and other macromastia-related quality-of-life issues. Patients were then provided the same questionnaire at their final postoperative visit between 3 and 6 months after surgery. RESULTS: A total of 63 patients underwent vertical reduction mammaplasty and 40 patients underwent Wise pattern inferior pedicle reduction mammaplasty. Vertical reduction mammaplasty resulted in significant decreases in all macromastia-related symptoms analyzed, including upper back pain, lower back pain, neck pain, arm pain, shoulder pain, hand pain, breast pain, headaches, rashes and/or itching, and painful brassiere strap grooving (all, p < 0.00001). Furthermore, vertical reduction mammaplasty resulted in significant improvement in all quality-of-life factors analyzed, including difficulty buying clothes and brassieres, difficulty playing sports, and difficulty running (all, p < 0.00001). Minor complications (superficial infection, seroma, or delayed wound healing) occurred in 16 patients (25 percent) in the vertical reduction mammaplasty group. Minor office revisions (scar revision or excision) were performed in four patients (6 percent) in the vertical reduction mammaplasty group. CONCLUSION: The authors' method of vertical reduction mammaplasty offers substantial relief of macromastia-associated symptoms with a low complication/revision rate.

Adult↗
PubMed2000

Long-term outcome of augmentation mammaplasty in male-to-female transsexuals: a questionnaire survey of 107 patients.

A retrospective survey of long-term postoperative male-to-female transsexual patients has been performed to evaluate how well augmentation mammaplasty addresses their needs. One hundred and seven (65%) out of 164 anonymous questionnaires sent to the patients were evaluated. Average clinical follow-up of these patients was 4.8 years, whereas the average time lapse between mammaplasty and filling out of the questionnaire was 5.5 years (range, 16 months-17 years). The age of the subjects at the time of this survey ranged from 22 to 76 years (average, 41 years). Seventeen of the 107 patients had undergone further augmentation mammaplasty, on average 57 months after the initial mammaplasty. The average size of implanted prostheses was 258 ml (range, 130- 450 ml). Eighty patients (75%) indicated satisfaction with the final outcome of the mammaplasty. The median postoperative cup size in this group was B (range of postoperative bra size, 30B-40D). The remaining 27 patients (25%) were unhappy with the results of mammaplasty. The median postoperative cup size in the 18 patients who still felt their breasts to be too small was also B (range of bra size, 30B-48E). The average size of current prostheses in these 18 patients was 261 ml. For a male-to-female transsexual patient to appreciate the outcome of augmentation mammaplasty, the surgeon should tolerate and address this patient's urge for a distinctly feminine breast configuration.

Adult↗
PubMed2004

[Breast cancer and quality of life--improvement by contralateral breast reconstruction and symmetrical mammaplasty?].

We present the results of a retrospective study on 71 patients who underwent breast reconstruction after uni- or bilateral breast cancer. Quality of life (QoL) was evaluated dependent on whether contralateral mammaplasties to obtain symmetry had been performed or not. We used three standardized questionnaires ("SF-36" and the EORTC-questionnaires "QLQ-C30" and "QLQ-BR23") and compared four groups of patients: Group 1: no contralateral breast cancer, but contralateral symmetrical mammaplasty (n = 31). Group 2: no contralateral breast cancer, no contralateral mammaplasty (n = 22). Group 3: contralateral breast cancer, contralateral symmetrical mammaplasty (n = 9). Group 4: contralateral breast cancer, no contralateral mammaplasty (n = 9). Patients with contralateral mammaplasty for symmetry presented statistically higher levels of QoL than patients who only underwent a surgical reconstruction of the carcinomatous breast without any contralateral mammaplasty. More detailed, group 1 manifested higher levels in 17 out of 31 QoL categories than group 2. Group 3, when compared to group 4, showed higher levels in 15 QoL categories. These objective data demonstrate that the outward appearance of the female breast as a symmetrical created organ plays a pivotal role considering QoL. There is significant need to integrate breast symmetry into our preoperative plastic-surgical planning and conversations with patients.

Aged↗
PubMed1992

Blood flow of the areola and breast skin flaps during reduction mammaplasty as measured by laser Doppler flowmetry.

Blood flow changes during reduction mammaplasty were studied using laser Doppler flowmetry. Twenty-one patients (39 breasts) were entered into the study. Eight patients underwent a modified Skoog mammaplasty, 6 a central glandular pedicle mammaplasty, 2 an inferior pyramidal dermal flap mammaplasty, and 5 a glandular resection with free nipple grafts. Laser Doppler flowmetry was performed preoperatively, immediately postoperatively, 24 hours postoperatively, 48 hours postoperatively, and 2 weeks postoperatively. Laser Doppler flowmetry values (in milliliters per minute per 100 grams) measured at the areola declined by 23% (Skoog), 18% (central pedicle), and 21% (inferior pyramidal), in the immediate postoperative period. Values at 48 hours were 31% below baseline (Skoog), 14% below baseline (central pedicle), and 60% below baseline (inferior pyramidal). Values at 2 weeks postoperatively were 12% below baseline (Skoog), 2% above baseline (central pedicle), and 44% below baseline (inferior pyramidal). The free nipple grafts showed an 89% rise above baseline at 2 weeks. One patient's procedure was changed to a free nipple graft after a 92% Doppler flow reduction during a Skoog mammaplasty. The free nipple graft had the greatest blood flow. The central pedicle mammaplasty showed the least decline in areolar flow. The inferior pyramidal mammaplasty showed the greatest decline. Laser Doppler flowmetry is a clinically useful tool for monitoring intraoperative and postoperative nipple/areolar blood flow.

Adolescent↗
PubMed1997

Reduction mammaplasty: an outcome study.

Outcome studies of the value of reduction mammaplasties have only recently appeared in the literature. Medical directors of insurance companies and managed care plans have been reluctant to pay for reduction mammaplasties, citing the uncertainty of the medical necessity of the procedure. They have defended their position by stating that the medical literature is devoid of studies documenting that reduction mammaplasty is medically beneficial to the patient. For this reason, reduction mammaplasty is often excluded from health care benefit plans. Because of the need for outcome studies for this procedure, the charts of 363 consecutive patients who had reduction mammaplasty at the Mayo Clinic from January of 1986 to December of 1993 were reviewed. Questionnaires were sent to all these patients asking them to evaluate their outcome, and 328 responded (90.4 percent response rate). Of the respondents, 94.2 percent believed that the procedure was completely or very successful, and only 1.5 percent believed that it was not very successful or completely unsuccessful. The symptoms most frequently reported by patients preoperatively were as follows: uncomfortable feeling about their body, 97.0 percent: inability to find clothes that fit, 95.7 percent; pain in bra-strap groove, 92.4 percent; shoulder pain, 86.0 percent; inability to run, 79.3 percent; upper back pain, 79.0 percent; inability to participate in sports, 77.4 percent; neck pain, 70.7 percent; lower back pain, 64.0 percent; and intertrigo, 61.0 percent. The symptoms least frequently reported by patients preoperatively were as follows: pain or numbness in the hands, 22.6 percent; headaches, 30.2 percent; arm pain, 35.4 percent; and breast pain, 58.2 percent. These symptoms were either relieved or partially relieved in 88 percent or more of the patients. Of the 328 patients, 97.3 percent responded that they definitely or probably would have the procedure again, and only 1.2 percent definitely or probably would not have the operation again. Evaluation of medical treatment used to relieve symptoms showed a marked decrease in the need for such measures after reduction mammaplasty. Study of the charges for the procedure revealed that the setting of practice parameters for the procedure and the use of an ambulatory surgery center significantly decreased the charges for the procedure. This outcome study supports the hypothesis that reduction mammaplasty is an effective procedure and the treatment of choice for symptomatic mammary hyperplasia.

Adult↗
PubMed1983

Mammaplasty-associated mycobacterial infection: a survey of plastic surgeons.

In a 3 1/2-year period, periprosthetic infections due to Mycobacterium fortuitum complex organisms complicated augmentation mammaplasty in at least 17 women. To determine the magnitude of the problem and to identify possible risk factors for infection, we conducted a questionnaire survey of 2062 members of the American Society of Plastic and Reconstructive Surgeons who had performed approximately 64,00 augmentation mammaplasties in 1978. Information about selected aspects of the procedures and practices in use with augmentation mammaplasty and about patients for whom augmentation mammaplasty had been performed was supplied by 67 percent of those surveyed. The estimated attack rate of wound infection after augmentation mammaplasty caused by all organisms was 0.64 percent. Only 5 cases of mycobacterial wound infection were documented after 39,455 augmentation procedures in 1978. Periprosthetic infection due to Mycobacterium fortuitum complex organisms appears, for the most part, to be a sporadic event that may occur after simple augmentation mammaplasty, subcutaneous mastectomy with augmentation, or reduction mammaplasty.

Breast↗
PubMed2004

Subfascial periareolar augmentation mammaplasty.

Subfascial placement of implants was introduced 3 years ago. Collected data reveal very promising short-term and long-term results in comparison with subglandular and subpectoral positioned implants. The clinical experiences of 69 breast augmentations in the subfascial position are reported. The indications for this technique are proposed. The incidence of complications is described from clinical experiences and compared with that for other methods. From January of 1998 through May of 2002, 328 patients underwent periareolar augmentation mammaplasty; 105 patients had a subglandular mammaplasty, 154 patients had a subpectoral mammaplasty, and from August of 1999 through May of 2002, 69 patients had a subfascial augmentation mammaplasty. The mean postoperative follow-up time was 3.6 years in the subglandular group, 3.5 years in the subpectoral group, and 2.9 years in the subfascial group. In comparing the results of the subglandular augmentation group with those of the subpectoral and subfascial augmentation groups, the total rate of complications diminished significantly. The long-term complications of severe capsular contracture, rippling, and nipple sensation and numbness in subglandular augmentation mammaplasty could be significantly reduced (p < 0.05). The subfascial augmentation mammaplasty unites all the advantages of the subpectoral augmentation mammaplasty but eliminates the disadvantages of increased postoperative discomfort and disturbing muscle movement of the breast.

Breast Implantation↗
PubMed2002

Viability and sensation of the nipple-areolar complex after reduction mammaplasty.

Reduction mammaplasty with nipple-areolar transposition on a medial pedicle was designed as an alternative to amputation and free nipple graft for women with severe mammary hypertrophy. The purpose of this study was to review the viability and sensory outcome of the nipple-areolar complex (NAC) in 72 women (133 breasts) after medial pedicle and inferior pedicle reduction mammaplasty between 1996 and 2000. The medial pedicle was used for 41 women (79 breasts) with moderate to severe mammary hypertrophy. An inferior pedicle was used for 31 women (54 breasts) with mild to moderate mammary hypertrophy. Mean follow-up for all patients was 25 months. Total sensation of the NAC was obtained in 68 of 79 breasts (86%) after medial pedicle reduction mammaplasty and in 50 of 54 breasts (92%) after inferior pedicle reduction mammaplasty. Total viability of the NAC occurred in 74 of 79 breasts (94%) after medial pedicle reduction mammaplasty and in 53 of 54 breasts (98%) after inferior pedicle reduction mammaplasty. Quantitative sensory testing of the NAC using the pressure-specified sensory device demonstrated that static and moving sensory thresholds of the NAC are lowest in the inferior pedicle group followed by the control group and the medial pedicle group. It can be concluded from this study that the medial and inferior pedicle techniques are capable of supporting vascularity and innervation to the NAC. The medial pedicle technique for severe mammary hypertrophy is a good alternative to free nipple grafting. The amount of breast tissue removed does not correlate with sensory outcome for both inferior and medial pedicle techniques. The pressure-specified sensory device is an excellent means of assessing sensory outcome.

Adult↗
PubMed2006

Effect of pregnancy and breast-feeding on vertical mammaplasty.

BACKGROUND: A retrospective study was performed to evaluate the effect of pregnancy and breast-feeding on the breasts of women who had undergone vertical reduction mammaplasty. METHODS: The study group consisted of 57 women who had pregnancies after their vertical reduction mammaplasty. Of this group, 24 breast-fed. The control group consisted of 103 women who had vertical mammaplasty but no subsequent pregnancies. An evaluation form was completed that included the age, body mass index, amount of tissue removed per breast, pregnancies after the mammaplasty, history of breast-feeding, and breast measurements. All patients had breast measurements routinely performed postoperatively at 2 weeks and again at 2 years. The following measurements were obtained: mid-clavicle to nipple, and inframammary fold to inferior areola. RESULTS: No significant difference was found between the control and the study group regarding age (27 +/- 12 versus 29 +/- 10), body mass index (26 +/- 5 versus 27 +/- 4), and grams of tissue excised per breast (610 +/- 201 versus 598 +/- 279). The breast measurement from the mid-clavicle to nipple was not significantly altered by pregnancy with or without breast-feeding (p > 0.05). The distance between the inframammary fold and the inferior margin of the areola was significantly (p < 0.05) increased by pregnancy both with breast-feeding (4.1 +/- 2.3 cm) and without (3.5 +/- 2.6 cm) when compared with the control group (1.2 +/- 1.5 cm). CONCLUSION: The vertical mammaplasty has less tendency for pseudoptosis (bottoming out), but the alterations of breast volume brought about by pregnancy and breast-feeding may affect the final outcome of even this good reduction mammaplasty method.

Adolescent↗
PubMed2004

[The lateral fold mammaplasty].

The mammaplasty is characterized by the non-reliability of the shape achieved at the end of the operation: sometimes a conic shape is expected and a relatively flat breast is obtained. The mammaplasty is also characterized by the lateral slipping of the shape with time, cause of the sad aspect of the breast. The purpose of the lateral fold mammaplasty is to facilitate the creation of the desired shape and to stabilize the evolution of this shape with time. The standard mammaplasty technique can determine the sub-mammary fold; the medial contour with its specific shape is already determined. Those inferior and medial folds are stables. But the lateral contour is usually not defined and very rarely stable with time. This procedure creates a well-defined and stable lateral fold, which is the convex junction between the anterior axillary line and the sub-mammary fold. This new fold is designed by attachment with five sutures of the axillary sub-dermal tissues to the lateral border of the pectoralis major muscle and just beneath, to the 5th costal arch. A medial tension is applied to the axillary flap before suturing to improve the axillary region. Consequently, the breast shape is more predictable and more stable because the lateral, inferior and medial folds are definitely determined. The realization is simple with no specific complication. It could be an additional procedure to any mammaplasty technique.

Adult↗
PubMed2003

A retrospective quantitative assessment of breast sensation after lateral pedicle mammaplasty.

Preservation of sensitivity is one of the important objectives in reduction mammaplasty. The lateral or medial pedicle reduction mammaplasty technique aims to maintain superficial innervation of the breast. These superficial nerves are smaller and more variable compared with deep and larger nerve structures, which are excised during this procedure. An assessment of recovery of tactile sensitivity after lateral pedicle mammaplasty was performed retrospectively. One hundred and one women, operated on between the year 1985 and 2000, with a lateral pedicle mammaplasty, were reviewed. Using a standardised questionnaire, women reported on subjective changes in sensation after surgery, including time of recovery and the influence which surgery had on sensual function. Fifty-nine of these women were tested 3-7 years after surgery. Touch sensitivity was measured using a set of 20 Semmes-Weinstein monofilaments. Erectile function was also tested. The mean pressure threshold for the areola region was 19.12 g/mm(2) and for the nipple 16.75 g/mm(2), which is better that in studies on inferior pedicle mammaplasty. In previous studies patients were tested earlier, which may explain this difference.No correlation was found between sensitivity and resected tissue (for the areola p=0.88 and for the nipple p=0.82) or between sensitivity and age of patients (for the areola p=0.73 and for the nipple p=0.80). There were individual differences in the results. It is speculated that variability in anatomy of superficial nerves might explain these differences. Nearly all patients tested regained their erectile function. The majority of patients did not notice any change in their erogenous function. Twelve (12%) reported a post-surgical improvement of sensation. Nipples with partial loss of sensation persisted in 2% of the patients.

Adult↗
PubMed2002

Reduction mammaplasty and the use of dextran against thromboembolism.

A retrospective study was conducted on 98 consecutive patients who had reduction mammaplasty done by different techniques during 1995, to find out the effect of dextran 70 on operative blood loss and postoperative complications. The most common procedure was reduction with a laterally based flap (n = 67) followed by a Lejour vertical mammaplasty (n = 15) and a medially based flap (n = 12). Four had other operations. Dextran 70 was given peroperatively to 64 patients and their median (range) blood loss was 350 (30-1000) ml and drainage volume 80 (10-465) ml. In 33 patients not treated with dextran 70 the median (range) blood loss was 200 (25-650) ml and the drainage volume 40 (0-115) ml. Ten patients developed major complications and 16 minor complications and there was no difference in the complication rate between those given dextran 70 (18/64, 28%) and those who were not (8/33, 24%), p = 0.8. Complications were no more common in smokers, overweight patients or those whose breasts were reduced by more than 1500 g, but there was a tendency to find more complications after the Lejour vertical mammaplasty. In conclusion, the study shows that patients undergoing mammaplasty and given Dextran 70 have an acceptable blood loss and drainage. In patients with a high risk of developing thromboembolism there is a need for a prophylactic agent and this study shows that dextran 70 may safely be used during reduction mammaplasty.

Adolescent↗
PubMed1995

Reduction mammaplasty: an outcome analysis.

Reduction mammaplasty is usually performed to relieve painful symptoms and physical signs of macromastia. Justification for reduction mammaplasty should be based on the probability of relieving these clinical signs and symptoms. This retrospective study involved four surgeons who performed a variety of breast reduction procedures and was designed to determine if preoperative symptoms were resolved after reduction mammaplasty. We surveyed 285 women who had reduction mammaplasties from 1988 to 1993. Data from these surveys and the patients' charts were reviewed. A total of 185 patients (65%) returned completed surveys and were included in this study for analysis. Mean age was 40 years with an average follow-up of 3 years. The most common preoperative complaint was shoulder grooving (90%), followed by back pain (82%), shoulder pain (78%), and neck pain (65%). Average amount of breast tissue removed was 855 gm from each breast. Preoperative complaints were substantially reduced after surgery, regardless of the presurgical body mass. Most patients (97%) had improvement of symptoms, and 59% were asymptomatic. Only 3% had no change in their symptoms and none were worse. The complication rate was 45% with fat necrosis/infection being the most common complication (22%). The majority of patients (95%) were either happy or very happy with the surgery, and 98% would recommend surgery to a friend. Our data indicate that reduction mammaplasty relieves preoperative symptoms associated with macromastia.

Adolescent↗