The Modified Superomedial Pedicle Breast Reduction Technique for Cases with SN-N Distance Exceeding 33 cm.

BACKGROUND: Symptomatic breast hypertrophy affects the quality of life of a large number of women globally. Many reduction mammoplasty techniques have been described for patients with breast hypertrophy. The aim of this study was to provide our clinic's experience in utilizing the modified superomedial pedicle breast reduction technique in specific patients suffering from breast hypertrophy, with sternal notch-to-nipple distance of more than 33 cm. METHOD: Our study included twenty patients who underwent, from January 2022 to December 2023, the modified superomedial pedicle breast reduction technique due to symptomatic breast hypertrophy with sternal notch-to-nipple distance of more than 33 cm in the Plastic and Reconstructive Surgery Department at Nicosia General Hospital in Cyprus. Patient demographics, comorbidities, pre- and postoperative breast anthropometric measurements and surgical complications were recorded and analyzed. RESULTS: The average age at the time of the reduction was 48 years. The mean preoperative body mass index was 28.52 kg/m2. Patients' comorbidities included one (5%) patient with diabetes, seven (35%) with obesity and three (15%) with hypertension. The mean preoperative sternal notch-to-nipple distance was 35.25 cm for the right breast and 34.90 cm for the left breast, while the mean postoperative was 20.65 cm for both breasts. The total mean resection weight of both breasts was 1643.45 g. Surgical complications were minor including two (10%) cases of local hematoma and one (5%) case of T-Junction wound breakdown. All patients were relieved from their preoperative symptoms and were satisfied with the final result. CONCLUSION: Our modified superomedial pedicle technique is a safe, effective and versatile pedicle to be used with many advantages, in specific patients suffering from breast hypertrophy with sternal notch-to-nipple distance of more than 33 cm, including its shape and rotational abilities, viability of the nipple and excellent outcome of glandular plication and breast reshaping. 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 .

Topographic Analysis of the Nipple-Areolar Complex Sensation in Superomedial Pedicle Breast Reduction.

BACKGROUND: Surgeons meticulously perform breast reductions, while ensuring vascular integrity of the pedicle and Nipple-Areolar complex (NAC) to prevent any complication. It is crucial to remember that loss of sensation is also substantial complication, mainly due to unique characteristic features of the NAC. This study aimed to compare early and long-term sensory results by performing topographic analysis of NAC sensation after superomedial pedicle breast reduction. METHODS: A prospective study was conducted by including nonrandomized female patients who underwent breast reduction surgery with wise pattern excision superomedial pedicle technique between January 2019 and June 2022. Semmes-Weinstein Monofilament (SWM) test performed at preoperatively, 3-6 months and 15-18 months postoperatively. NAC complex was divided into four equal quadrants and nipple: superomedial (SM), inferomedial (IM), inferolateral (IL), superolateral (SL) and Nipple (N). Touch-Test® Sensory Evaluator Chart was used to evaluate sensory results. RESULTS: None of the patients had any loss of sensation during preoperative SWM test. In postoperative 3-6 months, statistically significant differences were observed between N and SL (p = 0.002), SL and IM (p < 0.05), SM and IM (p < 0.05). In postoperative 15-18 months, there was no difference between the quadrants and nipple (p = 0.07). In early and long-term comparisons of the same quadrants, IL less pronounced than other quadrant comparisons (p = 0.034). A statistical difference was observed in overall NAC score (p < 0.05). CONCLUSIONS: It would be beneficial to inform patients overall NAC sensation in the postoperative may not be as good as preoperative, there might be variations in NAC sensation across different quadrants in early period. 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 .

Risk Factors and Complications in Reduction Mammaplasty: A Systematic Review and Meta-analysis.

BACKGROUND: Reduction mammaplasty (RM) has become established as the standard effective method for treating macromastia, but reports on the risk factors that predispose to postoperative complications have been conflicting. This meta-analysis aimed to pool the available data to identify predictors of complications following RM. METHODS: The PubMed, Web of Science, Embase, and Cochrane databases were screened from inception to 1 Jan 2022, and studies were included based on predefined criteria. The perioperative risk factors BMI, smoking, age, diabetes, radiation therapy, and tissue resection weight were extracted and their correlation with complications assessed. RESULTS: A total of 40 studies comprising of 5908 patients were included. BMI ≥ 30kg/m2 (OR = 1.65, 95% CI 1.35-2.02; p < 0.01) and ≥ 40 kg/m2 (OR = 1.97, 95% CI 1.26-3.08; p < 0.01), smoking (OR = 2.57, 95% CI 2.01-3.28; p < 0.01), diabetes (OR = 2.21, 95% CI 1.19-4.07; p < 0.05), a unilateral resection weight ≥ 1000 g (OR = 1.76, 95% CI 1.02-3.05; p < 0.05), and radiation therapy (OR = 11.11, 95% CI 2.01-3.28; p < 0.01) were associated with higher rates of postoperative complications. Obese patients (BMI ≥ 30 kg/m2) were more likely to experience fat necrosis (OR = 3.00, 95% CI 1.37-6.57; p < 0.01) and infection (OR = 1.66, 95% CI 1.15-2.40; p < 0.05). Smokers had a 2.03 times higher risk of infection (95% CI 1.24-3.31; p < 0.01) and 2.34 times higher risk of dehiscence (95% CI 1.38-3.98; p < 0.01). No association between complication occurrence and age 40 or 50 years or total tissue resection weight ≥ 1000 g was identified. CONCLUSIONS: This meta-analysis provides evidence that obesity, smoking, diabetes, unilateral resection weight ≥ 1000 g, and preoperative radiation therapy predispose to complication occurrence in RM. This information can optimize the ability of surgeons to provide preoperative patient education, perioperative assessment, and postoperative care planning. LEVEL OF EVIDENCE III: 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 .

A Systematic Literature Review of the Clinical Presentation, Management, and Outcome of Gestational Gigantomastia in the 21st Century.

BACKGROUND: Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two treatment options for GG, and breast reduction or mastectomy with delayed reconstruction is the only available surgical option. We have conducted this systematic review to summarize and critically analyze all the GG data in the literature. METHODS: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were adhered to in reporting this article. A systematic search was conducted in February 2022 for published case reports and case series on GG using the PubMed, MEDLINE, and Cochrane databases. The following keywords were used: macromastia, gestational gigantomastia, and gestational. RESULTS: A total of 639 articles were searched, and only 66 case reports published between 1962 and 2022 were included. The mean patient's age at presentation was 28.79 years old. The majority of the patients were in their first trimester (n = 23, 47%). The main complaint was rapid bilateral breast enlargement (n = 54, 80.59%). Bromocriptine was the most common medical management used (n = 19/35, 54.28%). Bilateral breast reduction was the most common surgery (n = 24/48, 50%). Most patients had uneventful recovery (n = 40/54, 74.07%). CONCLUSION: Gigantomastia is a difficult condition, in terms of its management. We have found that surgery is the gold-standard among all the cases reported; while Bromocriptine was the most commonly administered medical therapy. This systematic review provides a guideline for plastic surgeons to better facilitate their care of these patients. LEVEL OF EVIDENCE III: 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 .

A Clinical Score For Predicting Complications Following Breast Reduction.

Objectives: To establish a clinical score for morbidity prediction based on patient-related risk factors after breast reduction surgery. Method: The retrospective study was conducted at the Department of Plastic and Reconstructive Surgery, Kafrelsheikh University Hospital, Egypt, and comprised data of female patients with bilateral macromastia who underwent breast reduction, using the inferior pedicle invertedT technique between February 2019 and June 2020. After data retrieval, risk factors and complications were documented and related to the patients'risk factors Data was analysed using SPSS 20. RESULTS: Of the 30 cases, 20(66.7%) were aged ≥35 years, 16(53.3%) had body massindex ≥37kg/m2 and 27(90%) were non-smokers. The mean preoperative haemoglobin level was 12.15±1.115g/dL and the mean weight of tissue resected on both sides was 2074.17±696.12gm. Factors significantly associated with complications included smoking, suprasternal notch to nipple distance ≥38cm, haemoglobin <12.5g/dL, the weight of excised tissue ≥2000gm and a positive family history of macromastia. The total score of the morbidity prediction scale ranged 2-190, with the best cut-off value being ≥93. The scale had 100% sensitivity,specificity, positive predictive value, negative predictive value and 100 percent accuracy. CONCLUSIONS: Ability to predict postoperative surgical-site morbidity may optimise safety as well as outcome after reduction mammaplasty.

Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

INTRODUCTION: The demand for prophylactic mastectomy has increased significantly over the last 10 years. This can be explained by a substantial gain of knowledge about the clinical risk and outcome of patients with high risk mutations such as BRCA1 and 2, the improved diagnostic possibilities for detecting the genetic predisposition for the development of breast cancer and the awareness for those mutations by health care professionals as well as patients. In addition to expander-to-implant reconstruction and microsurgical flap surgery, definitive immediate reconstruction with subpectoral insertion of breast implants is often preferred. The prosthesis is covered at its inferior pole by a synthetic mesh or acellular dermal matrix. In these cases, in addition to the silicone prosthesis, a further foreign body must be implanted. This can be exposed in the event of wound healing disorder or necrosis of the usually thin soft tissue covering after subcutaneous mastectomy, thus calling into question the reconstructive result. In this study, the coverage of the lower pole by a caudal deepithelialized dermis flap, which allows the implant to be completely covered with well vascularized tissue, is compared to coverage by a synthetic mesh or acellular dermal matrix. PATIENTS AND METHODS: From January 2014 to June 2020, 74 patients (106 breasts) underwent breast reconstruction following uni or bilateral prophylactic mastectomy. Reconstruction was performed with autologous tissue (15 breasts), with tissue expander or implant without implant support (15 breasts), with implant and use of an acellular dermal matrix or synthetic mesh (39 breasts) and with implant and caudal dermis flap (37 breasts). In this study, we compared the patients with implant and dermal matrix/mesh to the group reconstructed with implant and dermal flap. RESULTS: In the group with the caudal dermis flap, 4 patients developed skin necrosis, which all healed conservatively due to the sufficient blood supply through the dermis flap. In the group with the use of a synthetic mesh or acellular dermal matrix, skin necrosis was found in three cases. In one of these patients the implant was exposed and had to be removed. DISCUSSION: For patients with excess skin or macromastia, the caudal dermis flap is a reliable and less expensive option for complete coverage of an implant after prophylactic mastectomy. In particular, the vascularized dermis flap can protect the implant from the consequences of skin necrosis after prophylactic mastectomy.

Negative Pressure Wound Therapy for Improved Nipple Survival in Large Volume Reduction Mammaplasty.

BACKGROUND: Large volume breast reductions are at increased risk of nipple ischemia and necrosis due to tenuous blood supply of long pedicles. We adapted incisional negative pressure wound therapy to augment nipple survival in such patients undergoing mammaplasty by inferior pedicle technique. METHODS: Patients with nipple-to-inframammary fold distance >14 cm were informed of increased risk of requiring free nipple graft. All patients underwent inferior pedicle technique with Wise pattern skin incision. Once incisions were closed and the nipple-areolar complex was inset, the complex was assessed for vascularity. In 12 cases there was evidence of compromised arterial inflow or venous outflow. For these patients, incisional negative pressure wound therapy was applied to the bilateral nipple-areolar complexes for 5-7 days. RESULTS: None of the 12 patients (24 breasts) in this series experienced nipple-areolar complex ischemia or necrosis. Only 2 patients experienced delayed wound healing which was successfully managed by local wound care. CONCLUSIONS: This study demonstrates the utility of negative pressure wound therapy in nipple survival for at-risk patients. We believe it augments healing by allowing improved micro-circulation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.

Macromastia: an economic burden? A disease cost analysis based on real-world data in Germany.

PURPOSE: Symptomatic macromastia causes physical and psychological problems that can lead to restrictions in the patients' social and working lives and a reduced quality of life. Associated medical treatments also have a considerable impact on health-care costs. Several studies have assessed these costs, but the total disease costs of macromastia have never been evaluated on the basis of real-world data. METHODS: The data for 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative), as well as the patient files. Topics surveyed, besides demographic data, included physician visits, medical imaging, medical procedures, medical treatments, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before surgery, to calculate the costs per year of conservative treatment of symptomatic macromastia. RESULTS: The mean time from start of symptoms to surgery was 11.82 years. The data for this group of patients with symptomatic macromastia show that costs per patient amount to €1677.55 per year. These costs include medical consultation, radiological imaging, medical treatments and procedures, physical therapy and rehabilitation, medication, special brassieres, exercise classes costs for sick leave due to problems with macromastia, and travel expenses. CONCLUSIONS: These results show that considerable health-care costs arise due to macromastia with conservative treatment. Overall, macromastia costs €1677.55 per patient/year. In particular, lost productivity due to sick days and the costs of physiotherapy are factors driving the high costs.

Superiomedial Pedicle Breast Reduction for Gigantic Breast Hypertrophy: Experience in 341 Breasts and Suggested Safety Modifications.

BACKGROUND: Reduction mammoplasty in patients with gigantic breast hypertrophy runs a high risk of complication. Traditionally, inferior pedicle reductions or free nipple grafting techniques have been recommended for gigantic breasts on the basis of measurements and expected resection weights. The superiomedial pedicle (SMP) technique has been less commonly used, due to concerns of vascular inadequacy. This study examines the outcomes of SMP in large reductions and outlines suggested modifications for enhanced safety. METHODS: This is a retrospective review of all patients who underwent SMP breast reduction in our institution between 2005 and 2016. Included are cases with resection weights greater than 800 g. RESULTS: A total of 173 patients with 341 breasts were included. Mean sternal notch to nipple (SNN) distance was mean 35.0 ± 6.6 cm (range 23-44.5) on the left and 34.9 ± 6.6 cm (range 18-46) on the right. Mean resection weight was 1152.2 ± 368.6 g (range 810-2926) on the left and 1159.4 ± 326.6 g (range 800-2528) on the right. The total complication rate was 22.7%. Minor complications occurred in 63 (18.6%) breasts. Major complications occurred in 12 (4.1%) breasts. NAC congestion and partial necrosis occurred in 1.8% and total NAC necrosis in 0.9%. CONCLUSION: The SMP reduction technique is a safe option for gigantic breast reduction with comparable complication rates to other techniques. Preoperative measurements or resection weights are not reliable risk factors alone. High tissue density may be a significant risk factor. High-risk breasts mandate surgical planning and should be tailored to include technical modifications as described. 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.

Double-Unit Superomedio-Central (DUS) Pedicle Inverted-T Reduction Mammaplasty in Gigantomastia: A 7-year Single-Center Retrospective Study.

INTRODUCTION: Reduction mammaplasty in patients with gigantomastia is challenging. The Double-Unit technique with a Superomedio-Central pedicle and inverted-T incision is the standard technique for reduction mammaplasty in our clinic. The aim of this study was to review our approach in cases with gigantomastia in comparison with the current literature. PATIENTS AND METHODS: From 01/2011 to 12/2017, we performed 831 reduction mammaplasties in 630 patients. The Double-Unit  Superomedio-Central  (DUS) pedicle and inverted-T incision was implemented as a standard procedure for gigantomastia. Patient demographics and the outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensibility, and surgical revision rate were obtained and retrospectively analyzed. RESULTS: In 37 patients, 55 reduction mammaplasties were performed with more than 1000 g per breast. Mean resection weight was 1311 g on right side and 1289 g on left side. Mean age was 52.5 years, mean body mass index was 32.8 kg/m2, mean sternal-notch-to-nipple distance was 38.3 cm. A free NAC graft was necessary in four breasts. Overall complication rate was 14.5%; secondary surgical revision rate was 12.7%. 91% of the patients were "very satisfied" and "satisfied" with the aesthetic result. Nipple sensibility was rated "high" and "medium" in 83%. CONCLUSION: The Double-Unit technique with a Superomedio-Central pedicle and inverted-T incision is very effective to achieve volume reduction and aesthetically pleasing reproducible results with a low complication rate in cases with gigantomastia. LEVEL OF EVIDENCE: Level of Evidence 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 .

Reduction mammoplasty and back pain: a systematic review and meta-analysis.

PURPOSE: There is anecdotal evidence that many patients who undergo reduction mammoplasty (RM) procedures, to relieve symptoms of large breasts, also report improvement in existing back pain. Given how important back pain is as a healthcare burden, the literature which explores the relationship between RM and back pain is sparse. Thus, we aimed to appraise whether such a correlation exists, through systematic review and meta-analysis. METHOD: Adhering to PRISMA methodology, we used the OVID engine to search the MEDLINE and Embase databases with predefined search terms and inclusion criteria. MeSH terms were not exploded. Statistical analysis was performed using Review Manager 5.3, employing a Mantell-Haenszel method and a fixed-effect model suitable for dichotomous data. RESULTS: The review yielded 13 articles after exclusions, eight of which were suitable for quantitative analysis. The results of the analysis suggested an improvement in back pain following RM across all studies (OR 40.37 [8.09, 201.53] 95% CI, n = 1008). Heterogeneity was high (τ2 = 5.14, χ2 = 230.37, df = 7 (p < 0.00001) i2 = 97%). CONCLUSIONS: Although cursory, the evidence gleaned suggests that RM reduces the prevalence of back pain in patients with large breasts. Furthermore, we highlight the scarcity of studies investigating whether RM is at the clinical threshold of efficacy in treating back pain. Although the evidence is insufficient for recommending RM as a management option aimed at treating back pain, this review does identify the need for prospective data looking at back pain metrics as a specific outcome measure before and after reduction mammoplasty.

Oncoplastic Approach to Giant Benign Breast Tumors Presenting as Unilateral Macromastia.

Benign breast tumors attaining large size constitute an important cause of unilateral macromastia. Their usual treatment involves enucleation or excision with a margin based on pathology and waiting for spontaneous retraction of skin envelope. In very large tumors, this will leave the residual breast deflated and unaesthetic, with spontaneous skin retraction giving unpredictable results. Application of the principles of oncoplastic surgery are helpful in this situation. Here, we present two cases of benign giant tumors-a giant fibroadenoma and a giant lipoma-managed by reduction mammaplasty approach to restore the breast symmetry and aesthetics.

Developmental disorders and malformations of the breast.

Developmental abnormalities and malformations of the breast are rare and encompass a variety of genetic, syndromic, acquired and sporadic conditions. Abnormalities in development may include irregularities in the nipple areolar complex and/or the underlying glandular tissue, resulting in under or overdevelopment of breasts. Age of presentation and clinical severity is dependent on the underlying biologic cause. Abnormalities may involve the entirety of unilateral or bilateral breasts, particularly in association with syndromic conditions or endocrine abnormalities. Disordered development may also be focal, resulting in tumor-like lesions such as hamartomas, pseudoangiomatous stromal hyperplasia and gynecomastia. In this review, we discuss the disorders of breast development including etiologies, clinical presentations and corresponding histopathologic features.

Comparison of Sensory Changes Following Superomedial and Inferior Pedicle Breast Reduction.

BACKGROUND: More attention is focused on sensory outcomes following breast reduction operations. We conducted this prospective, non-randomized study to compare two commonly used breast reduction techniques, superomedial pedicle and inferior pedicle, regarding sensation of the nipple-areolar complex. METHODS: We prospectively assigned 60 patients with macromastia into the superomedial pedicle group (SMP group, n = 30) or the inferior pedicle (IP group, n = 30) group. Six patients who withdrew from the study and another six patients who did not attend return visits were excluded. Algometry was used to measure the sensation of breast skin, cardinal points of the areola and the nipple. Two-point discrimination was also measured on the areola. Measurements were performed before surgery, at 3 weeks, and 6 months postoperatively. RESULTS: There were 20 patients in the SMP group and 28 patients in the IP group. The mean ages of the patients were 43.2 ± 12.7 and 45.9 ± 10.8 years, respectively (p = 0.438). The mean BMI of the patients were 32.4 ± 6.7 and 30.4 ± 5.3 kg/m2, respectively (p = 0.257). The mean weights of resected tissues were 802.5 (280-2180) versus 773.7 (349.5-1425.0) g, respectively (p = 0.900). Although breast sensation did not change in the SMP group, sensation in the upper medial and lower lateral portions of breast skin was reduced in the IP group. Two-point discrimination test results did not change in either group. The amount of changes in algometry and two-point discrimination tests were similar in both groups. CONCLUSION: Both superomedial and inferior pedicle breast reduction techniques are safe and reliable in terms of sensory changes. LEVEL OF EVIDENCE III: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of bilateral breast reduction on peak airway pressure and pulmonary function tests.

PURPOSE: Surgical reduction due to breast size is not carried out merely for anesthetic concerns but also for such complaints as breast pain belonging to breast and skeletal system, back pain, neck pain, and intertriginous rashes. This study aims to investigate the effect of bilateral breast reduction surgery on maximum inspiratory pressure (Ppeak) and pulmonary functions. This study aims to investigate the effect of bilateral breast reduction surgery on pulmonary function test. METHODS: The study included 50 patients who would undergo bilateral breast reduction. Patients were divided into two groups: group II were given positive end-expiratory pressure (PEEP), which was not administered to the group I. Patients were checked in terms of maximum inspiratory pressures (Ppeak) before surgery, after first and second breasts were removed, and after surgery. Pulmonary function tests were carried out on preoperative, postoperative second and 14th days. As RFT, forced vital capacity (FVC), FEV1 (forced expiratory volume at the first second of FVC), FEV1/FVC and PEF (peak expiratory flow rate) were measured. RESULTS: In both groups, demographic data were not found to statistically significant differences (P > 0.05). When compared both groups in terms of preoperative FVC and FEV1/FVC 14th day, a significant increase was found on the 14th day (P < 0.05). A significant difference was not established between groups in terms of Ppeak values (P > 0.05). Ppeak was found to be significantly higher in group I (22.28 ± 7.56) at the end of intubation compared with group II (19.04 ± 3.73) (P = 0.002, P < 0.05). Similarly, preoperative Ppeak was established to be 21.88 ± 7.51 in group I and it was significantly higher compared with group II (19.44 ± 4.08), (P = 0.002, P < 0.05). When compared Ppeak values at the end of intubation and before operation with entry values a statistically significant difference was not found in either group (P = 0.76, P > 0.05). CONCLUSIONS: Some researchers reported a positive correlation between FVC, FEV1/FVC, and PEF along with the excised tissue mass. We established a positive correlation between the excised tissue weight and FVC and FEV1/FVC and that PEEP application did not have an impact on Ppeak.

The role of oncoplastic breast reduction in the conservative management of breast cancer: Complications, survival, and quality of life.

BACKGROUND AND OBJECTIVES: Reduction Mammaplasty (RM) in breast cancer allows mammary remodeling after wide excisions. We aimed to analyze the complications, survival, and quality of life after RM. METHODS: Retrospective study of women who underwent a surgical intervention for breast cancer between 2000 and 2016. Patients were divided into two groups: RM and tumorectomy. Postoperative complications, survival and quality of life were assessed using the Breast-Q questionnaire. RESULTS: A total of 801 patients were evaluated, with a mean follow up of 84 months. RM patients experienced a longer operating time and hospital stay, and a higher proportion of tissue necrosis compared to tumorectomy patients (P < 0.001). No significant differences were observed regarding rate of re-excision or rate of mastectomy, but the recurrence rate at 10 years was higher for RM patients (P < 0.03). Patients who underwent RM reported optimal satisfaction with the breast and a good quality of life. CONCLUSIONS: RM is a useful approach in breast cancer surgery, with a low rate of re-excision and mastectomy. Overall survival at 10 years is similar to that associated with tumorectomy, though with a higher rate of local recurrence. Patient satisfaction and quality of life appears to be good one year after radiotherapy.

Incidental breast carcinoma in reduction mammoplasty.

AIM: The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed. METHODS: We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented. RESULTS: A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2-73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%). CONCLUSIONS: Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.

Quality of Life Following Symptomatic Macromastia Surgery: Short- and Long-term Evaluation.

UNLABELLED: Mammary hypertrophy or macromastia can cause a wide range of symptoms (physical, psychosomatic or behavioral), which affect patients' quality of life. Breast reduction can, in most of the cases, solve the problem. However, certain factors could have a negative effect on the outcome of surgery. The aims of this study were to discover the degree of patient satisfaction (short- and long-term) and to evaluate results of reduction mammoplasty, and also to ascertain which factors may have a negative role on the effectiveness of breast reduction surgery. We carried out a prospective and longitudinal study of 121 patients who underwent breast reduction surgery. Quality of life, outcome of surgery (complications and sequelae) and degree of patient satisfaction were evaluated at 1 month and at 1 year after reduction mammoplasty. Mean patient age was 40.71 (SD = 12.02). Among them, 35.5% were overweight, 44.6% were obese and 34.7% were smokers. The most common symptom was pain. The mean amount of resected breast tissue was 1785 g (SD = 876). A total of 27.3% of the patients suffered complications and 30.60% suffered sequelae. Our results show an improvement in symptoms (p < 0.001) and quality of life (p < 0.001 to p = 0.002) 1 month after and 1 year after breast reduction compared with the preoperative situation. Neither age, body mass index, smoking habit nor the amount of tissue removed had a negative effect on the results of surgery. One year after surgery, the majority of patients were satisfied with the outcome (96.6%), they would recommend it to others (96.6%), and they would undergo surgery a second time (95.8%). CONCLUSIONS: Breast reduction is highly efficient in resolving symptoms and in improving quality of life. It leads to a high level of short- and long-term satisfaction irrespective of each patient's individual characteristics.

The "Superior Ledge": a Modification of the Standard Superomedial Pedicle Reduction Mammoplasty to Accentuate Nipple-Areola Complex Projection.

BACKGROUND: The superomedial pedicle parenchymal excision pattern for reduction mammaplasty has the benefits of a reproducible breast shape and improved superomedial fullness, but is limited by a susceptibility to nipple retraction. The senior author of this paper has formalized the "superior ledge" modification of the superomedial pedicle technique (SL-SMP) to address these limitations. OBJECTIVE: To describe the technical details of the SL-SMP breast reduction technique and to analyze patient outcomes. METHODS: The technique involves only partial-thickness parenchymal excision superolateral to the pedicle, thereby leaving a "superior ledge" of parenchyma on top of which the nipple-areola complex (NAC) rests in a tension-free manner. Postoperative photographs were recorded; and patient demographics, intraoperative details, complications, and outcomes were recorded and analyzed. RESULTS: One hundred seven patients underwent SL-SMP reduction mammaplasty between 2007 and 2013. Complications included wound-healing complications (9.3 %), infection (2.8 %), seroma (1.9 %), and hematoma (1.9 %). Mean follow-up was 44.6 months (Range: 17-72), and during that period no incidence of clinically relevant NAC retraction was noted by either the patient or surgical team. CONCLUSIONS: Maintenance of a distinct superior ledge underlying the final position of the NAC is an important modification to stress, to prevent nipple retraction. Importantly, the height of the ledge can be personalized for each patient. We feel it is a valuable addition to the plastic surgeon's armamentarium to optimize outcomes for patients seeking relief from excessive breast tissue. LEVEL OF EVIDENCE V: 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 .

Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes.

AIM OF THE STUDY: Despite the increase in studies concerning oncoplastic reduction mammoplasty (ORM), data showing long-term aesthetic and patient satisfaction for ORM in patients with macromastia remain limited. Therefore, this study evaluated the long-term results of tumorectomy and concomitant bilateral ORM for early-stage breast cancer patients with macromastia in terms of cosmesis, patient satisfaction, and functional outcomes. MATERIAL AND METHODS: Retrospective data of patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were examined and evaluated regarding the aesthetic results, patient satisfaction, and functional outcomes. RESULTS: The median age of the 82 patients was 50 years. The median follow-up was 120 months (range: 28-212 months). The median breast volume was 1402 cm(3), and the median weight of the excised breast material was 679 g. A good or excellent evaluation of the cosmetic outcome was as follows: self-evaluation: 84.1% at the early-stage, 80.3% at the later stage; panel evaluation: 75.4% at the late-stage. Median patient satisfaction rates were 9.1% for early-stage disease and 8.8% for late-stage disease. Reduced mobility and intertrigo improved by three-fold during the post-operative period. CONCLUSIONS: ORM for early-stage breast cancer in women with macromastia results in good cosmesis in both the early-stage and long-term, and is quite acceptable for use in patients. Patients reacted favorably to the prospect of having their breast cancer and macromastia treated in a single session, and positive results continued over the long-term.