Is Immediate Breast Reconstruction With a Latissimus Dorsi Myocutaneous Flap Safe for Starting Adjuvant Chemotherapy in Patients With Breast Cancer?

INTRODUCTION: Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy. MATERIALS AND METHODS: This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3). RESULTS: A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0. CONCLUSION: Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants.

Combination of Superior and Superomedial Pedicle Techniques in Reduction Mammaplasty: A Modified Approach to Increase Upper Pole Fullness.

OBJECTIVE: Creation of the upper pole fullness is one of the basic goals in reduction mammaplasty. The superior pedicle (S-P) technique brings extra tissue to the upper pole, but folding of a long pedicle can compromise circulation of the nipple-areola complex (NAC). Although the pedicle is not folded in superomedial pedicle (SM-P) technique, it has disadvantage of not bringing extra tissue to the upper pole. We designed a new approach by combining the advantages of S-P and SM-P techniques. Thereby, we aimed to increase upper pole fullness in SM-P or superolateral pedicle (SL-P) mammaplasty. METHOD: We operated 20 female patients (study group) with the modified SM-P/SL-P technique for breast reduction between 2010 and 2022. Preoperatively, mean sternal notch-nipple distance was 32.6 ± 2.5 cm. The upper pole fullness was created by using a superiorly based glandular flap, while the SM-P (17 patients) or SL-P (three patients) was used to carry the NAC. We assessed the success rate of the upper pole fullness, compared with two control groups of 40 patients who underwent conventional SM-P mammaplasty (control group I: 20 patients) and who underwent conventional S-P mammaplasty (control group II: 20 patients). Two plastic surgeons, who do not know which technique was used, assessed before and after photographs of 60 patients regarding success rate of upper pole fullness. To evaluate the success rate, the degree of the difference in the upper pole fullness between before and after photographs has been scored 1-10 for each patient. Below 5 was considered as no difference (unsuccessful), 5-7 as moderate difference (average), 8-10 as significant difference (successful). Photographs of the patients had been taken from five different angles: frontal, right and left oblique views, and right and left sides. RESULTS: Out of 10, mean score was 8.2 ± 1.2 in study group, 7.1 ± 1.8 in control group I, 8.2 ± 1.5 in control group II. Postoperatively, no major complications were observed, such as glandular necrosis, total NAC necrosis, partial (> 50%) NAC necrosis, skin necrosis, or poor NAC sensitivity in none of 60 patients. CONCLUSION: By using this modification, it is possible to increase upper pole fullness in SM-P/SL-P mammaplasty. LEVEL OF EVIDENCE II: 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 https://www.springer.com/00266 .

Superomedial Pedicle Technique and Management of Circulation Problems in Gigantomastia : Treatment of Gigantomastia.

Breast reduction surgeries encompass a wide range of methods that are continuously evolving to discover more reliable and satisfactory techniques. This presentation aims to address the research gap by sharing outcomes and experiences using the superomedial pedicle in gigantomastia, as well as the implemented protocol for managing nipple-areola complex (NAC) ischemia. The Wise pattern and superomedial pedicle reduction mammaplasty method were utilized in treating 19 patients (38 breasts). The average age of the patients was 41.47 years, with a basal mass index (BMI) of 33.27 kg/m2. The mean sternal notch to nipple (SN-N) length for the entire population was found to be 40.97 cm. On both sides, this length was statistically similar at 41.11 cm on the right side and 40.84 cm on the left side. The average weight of resected tissue from all patients was calculated to be 1793.42 g, with slightly higher weight on the right side at 1800 g compared to the left side's weight of 1786.84 g. Postoperative NAC ischemia occurred in three patients, one bilateral case, and two unilateral cases. The study revealed that in both the groups with and without NAC ischemia, the average values were as follows: age, which ranged from 45.33 to 40.75 years; BMI, ranging from 35.01 kg/m2 to 32.95 kg/m2; SN-N distance, which varied from 40 cm to 41.09 cm; and excision material weights, ranging from 1650 g to 1810.29 g. The p-value in the comparisons was found to be greater than 0.05. These results indicate that age, BMI, SN-N distance, and excision material weight did not have an impact on NAC vascularity issues. All NACs were successfully saved through a protocol involving hyperbaric oxygen therapy (HOT) and vacuum-assisted therapy (VAT). The study suggests that utilizing a superomedial flap is a viable option for treating gigantomastia and highlights the effectiveness of their outlined protocol in managing postoperative complications. While acknowledging the need for comparative studies, the study proposes incorporating HOT and VAT into protocols aimed at saving NACs.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 .

Degree of satisfaction of women treated with reconstruction and dermopigmentation of the nipple-areola complex after breast reconstruction.

OBJECTIVE: To evaluate the degree of satisfaction of women treated with dermopigmentation and reconstruction of the Areola-Nipple Complex (ANC) after breast reconstruction, as well as their demographic profile and clinical-evolutionary characteristics. METHODS: Descriptive observational study including 128 women treated with dermopigmentation after oncologic breast reconstruction during 2018. In 2021 they were administered an adapted satisfaction questionnaire, which contains 27 items and categorizes satisfaction from 1-5, in addition other clinical-evolutionary and demographic variables were collected. RESULTS: Mean age was 51 (±9) years, 89.1% had previously undergone PDA reconstruction. Mean satisfaction with dermopigmentation was 4.4 (±0.88) and 3.79 (±1.06) for PDA reconstruction. Complications were rare, but 54.5% (n = 54) of the patients reported that the CAP reconstruction did not offer the expected projection, 91.6% (n = 98) that the color had faded and 51.4% (n = 55) would choose permanent tattooing. It was perceived that, the higher the satisfaction of the CAP, the higher the satisfaction of dermopigmentation, while the older the age and previous chemotherapy treatment the lower the color durability (p value ≤ 0.05). CONCLUSIONS: Patients who underwent reconstructive breast surgery show a high degree of satisfaction with dermopigmentation and surgical reconstruction of the PDA, but reiterate the low projecticity of the dermopigmentation and the surgical reconstruction of the PDA, but reiterate the low degree of satisfaction with the dermopigmentation.

Outcomes of Reduction Mammaplasty in Adolescents vs Average-Age Patients: A 3-Year Single-Center Retrospective Analysis.

Background: The onset of macromastia symptomatology occurs most often at puberty, yet most females undergo breast reduction surgery during the fifth decade of life. Adolescent patients with macromastia may benefit from reduction mammaplasty, yet outcome data are limited to a small number of institutions. Methods: We conducted a retrospective medical records review of all patients who underwent reduction mammaplasty at our institution during the years 2016 to 2019. Patients were divided into 2 cohorts based on age: adolescent (10 to 24 years) and average age (≥44 years). Demographics and outcome measures were collected from follow-up evaluations at 1-week, 1-month, 3-month, 6-month, and 12-month intervals postoperatively. Results: A total of 141 patients met the inclusion criteria for the study. Mean age at surgery was 19 ± 3.2 years in the adolescent group and 53 ± 7.4 years in the average-age group. No significant differences in complications related to wound healing (42.9% vs 50.0%, P=0.418) or total postoperative complications (18.4% vs 19.6%, P=0.863) were found between adolescent and average-age patients, respectively. Conclusion: Complications related to wound healing are common in reduction mammaplasty, although rates of life-threatening complications are rare. In this 3-year review comparing the outcomes of adolescent vs average-age patients who underwent reduction mammaplasty at the same institution, no significant differences in postoperative complication rates were found. Our data suggest that adolescent patients with macromastia should not defer reduction mammaplasty out of concern for higher complication rates because of age alone.

Quality of the Information provided by ChatGPT for Patients in Breast Plastic Surgery: Are we already in the future?

Introduction: In recent years, artificial intelligence (AI) has gained popularity, even in the field of plastic surgery. It is increasingly common for patients to use the internet to gather information about plastic surgery, and AI-based chatbots, such as ChatGPT, could be employed to answer patients' questions.The aim of this study was to evaluate the quality of medical information provided by ChatGPT regarding three of the most common procedures in breast plastic surgery: breast reconstruction, breast reduction, and augmentation mammaplasty. Methods: The quality of information was evaluated through the expanded EQIP scale. Responses were collected from a pool made by ten resident doctors in plastic surgery and then processed by SPSS software ver. 28.0. Results: The analysis of the contents provided by ChatGPT revealed sufficient quality of information across all selected topics, with a high bias in terms of distribution of the score between the different items. There was a critical lack in the "Information data field" (0/6 score in all the 3 investigations) but a very high overall evaluation concerning the "Structure data" (>7/11 in all the 3 investigations). Conclusion: Currently, AI serves as a valuable tool for patients; however, engineers and developers must address certain critical issues. It is possible that models like ChatGPT will play an important role in improving patient's consciousness about medical procedures and surgical interventions in the future, but their role must be considered ancillary to that of surgeons.

Flying high?-Exploring the effect of red bull on blood pressure after microsurgical breast reconstruction in a randomized controlled trial.

BACKGROUND: A sufficiently high blood pressure (BP) is essential for flap perfusion after microsurgical breast reconstruction. However, postoperative hypotension is common after these procedures. Perioperative volume overload may increase flap-related complications, and postoperative vasopressor use may be limited depending on institutions. Red Bull has been shown to increase BP in several studies. We aimed to evaluate the effect of Red Bull on perfusion-related variables after microsurgical breast reconstruction. METHODS: We conducted a multicenter, prospective, randomized controlled trial. Female patients undergoing unilateral microsurgical breast reconstruction from June 2020 to October 2022 were randomly assigned to the intervention or control groups. The intervention group received 250 ml of Red Bull 2 h after surgery and twice on postoperative day (POD) 1. The control group received 250 ml still water at the respective intervals. BP was measured using a 24-hour monitoring device. Vasopressor use, fluid balance, and flap outcomes were compared. RESULTS: One hundred patients were included in the study. Both groups were comparable concerning age, body mass index, and caffeine consumption. Mean arterial and diastolic BP were significantly higher in the Red Bull group after the second drink in the morning of POD1 (p-value = 0.03 and 0.03, respectively). Vasopressor use was similar, with a tendency for less postoperative etilefrine in the Red Bull group (p-value = 0.08). No flap loss was observed. CONCLUSIONS: We observed increased mean arterial and diastolic BP in the Red Bull group after the second drink. Red Bull may be a useful adjunct after microsurgical breast reconstruction. LEVEL OF EVIDENCE: I, therapeutic.

Oncologic Outcomes of Immediate Breast Reconstruction in the Setting of Neoadjuvant Chemotherapy: A Long-term Follow-up Study of a Matched Cohort.

PURPOSE: Despite the increasing use of immediate breast reconstruction (IBR), its oncologic safety in the setting of neoadjuvant chemotherapy (NACT) needs to be comprehensively clarified in breast cancer management. The objective of the present study was to analyze the oncologic safety of IBR following NACT. METHODS: In total, 587 patients with breast cancer who underwent a total mastectomy (TM) with IBR after NACT between 2008 and 2017 at a single institution were retrospectively reviewed. The reviewed patients with IBR following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) were matched 1:3 to patients who underwent TM alone after NACT. Matching variables included age, clinical T and N stages before NACT, response to NACT, pathologic T and N stages, and molecular subtypes. RESULTS: After propensity score matching, 95 patients who underwent IBR following SSM/NSM after NACT (IBR group) and 228 patients who underwent TM alone after NACT (TM group) were selected. The median follow-up period was 73 (range, 5-181) months after matching. After matching, there were no significant differences between the two groups in 5-year locoregional recurrence-free survival (88.8% vs. 91.2%, p = 0.516), disease-free survival (67.3% vs. 76.6%, p = 0.099), distant metastasis-free survival (71.9% vs. 81.9%, p = 0.057), or overall survival (84.1% vs. 91.5, p = 0.061) rates. In multivariate analyses, conducting IBR was not associated with increased risks for locoregional recurrence, any recurrence, distant metastasis, or overall death. CONCLUSION: Our findings suggest that IBR following SSM/NSM elicits comparable long-term oncologic outcomes to those of TM alone in the setting of NACT.

Impact of sternal notch-to-nipple distance and resection weight asymmetry on complication rates and patient reported outcomes in reduction mammaplasty.

While there are numerous predictive models for estimating resection weight, their accuracy may not be strong. Through institutional data of patients who received reduction mammaplasty, this study demonstrates that preoperative sternal notch-to-nipple distance is not an optimal predictive factor for differences in final resection weight, complication rates, and patient reported outcomes. Our results showed that there is a weak correlation between preoperative sternal notch to nipple asymmetry and final resection weight asymmetry. Additionally, significant breast asymmetry is not tied to an increase in complication rates or poorer patient reported outcomes. There is an indication to reconsider the use of such absolute measures for determining who may benefit from reduction mammaplasty.

Fatores de risco consequentes a complicações no pósoperatório da mastoplastia de aumento primária com implantes de silicone: Estudo retrospectivo / Risk factors resulting from complications in the postoperative period of primary breast augmentation with silicone implants: Retrospective study

Introdução: A mamoplastia de aumento é uma das cirurgias plásticas mais realizadas no mundo. Tendo em vista sua alta aplicabilidade, é fundamental conhecer os fatores de risco relacionados à incidência de complicações pós-operatórias a fim de reduzilas nesse tipo de procedimento. Método: Este estudo é retrospectivo feito por meio da análise dos prontuários de 76 pacientes que realizaram mamoplastia de aumento primária com implantes de silicone durante os meses de janeiro de 2018 a dezembro de 2020. Resultados: Observou-se que a presença de comorbidades aumentou a incidência de complicações pós-operatórias precoces (p<0,001), mas não de complicações pósoperatórias tardias (p=0,8). O maior tempo cirúrgico também aumentou a incidência de complicações pós-operatórias (p=0,005). Conclusão: A presença de comorbidades influencia diretamente na incidência de complicações pós-operatórias da mastoplastia de aumento e por esta razão deve-se realizar uma adequada compensação pré-operatória antes de submeter as pacientes a este procedimento cirúrgico.

Introduction: Breast augmentation is one of the most performed plastic surgeries in the world. Given its high applicability, it is essential to know the risk factors related to the incidence of postoperative complications to reduce them in this type of procedure. Method: This retrospective study analyzed the medical records of 76 patients who underwent primary breast augmentation with silicone implants from January 2018 to December 2020. Results: It was observed that the presence of comorbidities increased the incidence of early postoperative complications (p<0.001) but not of late postoperative complications (p=0.8). Longer surgical time also increased the incidence of postoperative complications (p=0.005). Conclusion: The presence of comorbidities directly influences the incidence of postoperative complications after breast augmentation, and for this reason, adequate preoperative compensation must be carried out before submitting patients to this surgical procedure.

Diferenças no perfil de complicações pós-operatórias em pacientes submetidas a mamoplastia de aumento e mastopexia com prótese / Differences in the profile of postoperative complications in patients undergoing breast augmentation and mastopexy with prosthesis

Introdução: A mamoplastia de aumento é uma dos procedimentos mais realizados em Cirurgia Plástica em todo o mundo. A mastopexia com prótese também é um procedimento amplamente realizado, reservado para outro perfil de pacientes. Muitas complicações podem ser evitadas quando se estudam os fatores de risco para desfechos desfavoráveis. Método: Trata-se de um estudo retrospectivo realizado por meio da análise de prontuários de pacientes submetidas a mamoplastia primária de aumento e mastopexia com implantes mamários no período de janeiro de 2018 a dezembro de 2020. Resultados: Das 112 pacientes submetidas a mamoplastia com implante mamário no período do estudo, 76 foram submetidas a mamoplastia de aumento primária (67,86%) e 36 pacientes a mastopexia com implante mamário (32,14%). As pacientes submetidas a mastopexia apresentaram maior média de idade em relação àquelas submetidas a mamoplastia de aumento (p<0,001) e apresentaram menores volumes de implantes mamários (p=0,002). As complicações mais comuns em ambos os grupos incluem a deiscência da ferida operatória, mais comum após mastopexia com prótese. Conclusão: A mastopexia de aumento realizada em procedimento único apresenta maior índice de complicações quando comparada à mamoplastia de aumento realizada individualmente. No entanto, o maior número de complicações precoces observadas no procedimento combinado é a soma dos dois procedimentos distintamente individuais e não um aumento exponencial.

Introduction: Breast augmentation is one of the most performed procedures in Plastic Surgery worldwide. Mastopexy with prosthesis is also a widely performed procedure reserved for other patient profiles. Many complications can be avoided when studying risk factors for unfavorable outcomes. Method: This is a retrospective study carried out through the analysis of medical records of patients who underwent primary breast augmentation and mastopexy with breast implants from January 2018 to December 2020. Results: Of the 112 patients who underwent mammoplasty with the implant during the study period, 76 patients underwent primary breast augmentation (67.86%), and 36 underwent mastopexy with breast implant (32.14%). Patients undergoing mastopexy had a higher average age compared to those undergoing breast augmentation (p<0.001) and had smaller volumes of breast implants (p=0.002). The most common complications in both groups include surgical wound dehiscence, more common after mastopexy with prosthesis. Conclusion: Breast augmentation performed as a single procedure has a higher rate of complications when compared to breast augmentation performed individually. However, the greater number of early complications observed with the combined procedure is the sum of the two distinctly individual procedures and not an exponential increase.

Qual o impacto da capsulectomia nos sintomas sistêmicos atribuídos às próteses mamárias de silicone? Revisão sistemática da literatura / What is the impact of capsulectomy on systemic symptoms attributed to silicone breast implants? Systematic literature review

Introdução: Diversos estudos têm analisado a possível relação entre a prótese mamária de silicone e sintomas sistêmicos. A remoção das próteses de mama com capsulectomia tem sido indicada na tentativa de melhorar esses sintomas. É necessário que o cirurgião tenha dados embasados na literatura para informar ao paciente se há relação entre retirada de prótese de mama com capsulectomia e melhora dos sintomas, qual a taxa de melhora e por quanto tempo se mantém. Método: Foi realizada pesquisa nos bancos de dados virtuais Cochrane Library e PubMed de janeiro de 1990 até abril de 2023. A busca foi realizada pela combinação de termos livres ("breast implant illness", "breast capsulectomy" e "breast implant explantation") e pelo uso de operadores booleanos para descritores Mesh como [autoimmune diseases (MeSH Terms)] e [breast implant (MeSH Terms)]. Resultados: Foram obtidos 1.203 artigos, sendo 14 selecionados para o estudo, consistindo em 7 artigos de coorte retrospectivo, 3 de coorte prospectivo e 4 caso-controle. A taxa de melhora variou entre 50 e 100% dos casos e o tempo de acompanhamento variou entre 2 meses e 2,7 anos. Diversos tipos de capsulectomia foram realizados nos estudos, com taxas semelhantes de melhora. Conclusão: Há evidências de melhora dos sintomas sistêmicos em pacientes com prótese mamária de silicone submetidas a retirada de prótese de mama com capsulectomia. A melhora dos sintomas persistiu durante o período em que as pacientes foram acompanhadas nos estudos. Estudos mais recentes demonstraram que o tipo de capsulectomia não tem influência na melhora dos sintomas sistêmicos.

Introduction: Several studies have analyzed the possible relationship between silicone breast implants and systemic symptoms. Removal of breast implants with capsulectomy has been indicated in an attempt to improve these symptoms. The surgeon must have data based on the literature to inform the patient whether there is a relationship between the removal of a breast prosthesis with capsulectomy and improvement in symptoms, what is the rate of improvement, and how long it lasts. Method: A search was carried out in the Cochrane Library and PubMed virtual databases from January 1990 to April 2023. The search was carried out using a combination of free terms ("breast implant illness", "breast capsulectomy," and "breast implant explantation") and by using Boolean operators for Mesh descriptors such as [autoimmune diseases (MeSH Terms)] and [breast implant (MeSH Terms)]. Results: 1,203 articles were obtained, 14 of which were selected for the study, consisting of 7 retrospective cohort articles, 3 prospective cohort articles, and 4 case-control articles. The improvement rate varied between 50 and 100% of cases, and the follow-up time varied between 2 months and 2.7 years. Several types of capsulectomies were performed in the studies, with similar rates of improvement. Conclusion: There is evidence of improvement in systemic symptoms in patients with silicone breast implants who underwent breast implant removal with capsulectomy. The improvement in symptoms persisted during the period in which the patients were followed in the studies. More recent studies have demonstrated that the type of capsulectomy does not influence the improvement of systemic symptoms.

Single and double injection paravertebral block comparison in reduction mammaplasty cases: a randomized controlled study.

BACKGROUND: This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty. METHODS: After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3-T4) or double (Group D: T2-T3 & T4-T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3-T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2. RESULTS: Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001). CONCLUSIONS: The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive.

Visual representation of diversity in online patient education materials for reduction mammaplasty.

Online patient education materials play an important role in plastic surgery, and surgeons should ensure that materials accurately reflect their patient population. This study compared the skin tone of images in online materials from the American Society of Plastic Surgeons (ASPS), academic plastic surgery programs, and private groups to the demographics of the United States (US) reduction mammaplasty population. Images within patient education materials and embedded photo galleries were assessed and skin tones were categorized using the Fitzpatrick Skin Scale (FSS). Two reviewers evaluated 616 images. Scores of 1-3 were categorized as White, while scores of 4-6 were classified as non-White. The proportion of images categorized as White and non-White were compared to the demographics of the reduction mammaplasty population in the US. Of 616 images, 82% were classified as White, while 18% were non-White. This distribution differed significantly from the racial demographic distribution of patients undergoing reduction mammaplasty in the US in 2020, where 48% identified as White and 52% as non-White (p < 0.001). There was also a statistically significant difference in the distribution of FSS scores between the materials from the ASPS, academic programs, and private surgeon groups, with private groups having a lower percentage of non-White images (p = 0.028). These findings suggest that implicit bias may impact the creation of patient education materials for reduction mammaplasty and highlights the need for improvement in distributing patient education materials that accurately represent the diverse reduction mammaplasty population.

Superomedial-Posterior Pedicle-Based Reduction Mammaplasty: Evaluation of Effectiveness and BREAST-Q Outcomes of a Rapid and Safer Technique.

INTRODUCTION: Breast hypertrophy, a common pathological condition, often requires surgical intervention to alleviate musculoskeletal pain and improve patients' quality of life. Various techniques have been developed for breast reduction, each with its own advantages and complications. The primary aim of this study is to evaluate the efficacy, safety, and patient-reported outcomes of the authors technique: the Superomedial-Posterior Pedicle-Based Reduction Mammaplasty. MATERIAL AND METHODS: A prospective study was conducted on 912 patients who underwent breast reduction surgery between November 2012 and July 2020. The surgical technique involved preserving all glandular tissue from the areola to the pectoralis major muscle using the superomedial-posterior pedicle. The patients' demographic data, operative details, complications, breast-related quality of life (measured using the Breast-Q questionnaire), and nipple-areola complex sensitivity were analyzed. RESULTS: The average operative time was 62.12 ± 10.3 minutes. Complications included minor wound dehiscence (4.05%) and hematoma (1.2%), with no cases of nipple-areola complex necrosis. Nipple-areola sensitivity was fully restored in all patients at the 2-year follow-up. Patient satisfaction with the procedure was high with a statistically significant difference observed between pre- and postoperative scores (p < 0.001) of the Breast-Q questionnaire. CONCLUSION: Authors technique offers reliable vascularization and innervation of the nipple-areola complex and achieves satisfactory aesthetic outcomes. It is associated with shorter operative times compared to other techniques reported in the literature. The Superomedial-Posterior Pedicle-Based Reduction Mammaplasty represents a safe and effective method for breast reduction surgery, providing significant benefits to patients with breast hypertrophy. LEVEL OF EVIDENCE I: 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 .

Breastfeeding Ability After Breast Reductions: What does the Literature Tell us in 2023?

INTRODUCTION: Reduction mammaplasties are routinely performed on women of child-bearing age, yet there still exists some uncertainty regarding a patient's ability to breastfeed following the procedure. This is due to inconsistent definitions of "successful" breastfeeding, a variety of pedicles implemented, and inadequate follow-up in the published literature. Our aim was to summarize the current data and provide clear recommendations for counseling patients on expected breastfeeding outcomes following reduction mammaplasty. METHODS: A systematic review and meta-analysis in accordance with the PRISMA guidelines was conducted. We included papers that reported proportion of breastfeeding ability following reduction mammaplasty. RESULTS: We identified 33 papers that met our inclusion criteria. We found that women who undergo reduction mammaplasty are at a 3.5 times increased odds of not being able to breastfeed compared to controls. Overall, reduction mammaplasty patients have a breastfeeding success rate of 62%. The breastfeeding success rate for patients with inferior pedicles was 64%, superior pedicles was 59%, and lateral pedicles was 55%. No conclusions could be drawn regarding medial, central, vertical, and horizontal pedicles on breastfeeding ability. CONCLUSION: Current data suggest that women undergoing reduction mammaplasty have an increased odds of unsuccessful breastfeeding when compared to similar women who have not undergone the procedure. Based on the current literature, pedicle type does play a role in rate of breastfeeding success, although there is a need for further research on the aforementioned pedicles. Physicians should be aware of the likelihood of successful breastfeeding following reduction mammaplasty so that patients can be more thoroughly counseled prior to a decision for surgery. LEVEL OF EVIDENCE I: 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 .

Horizontal pillar technique: A single pedicle septum-based approach in reduction mammaplasty with a twist.

Breast reduction surgery has proven to be a successful treatment for various conditions such as postural disorders, anxiety, dermatological problems, and body image disorders, and is tailored to accommodate each patient's needs and anatomical variations. The author presents a modified approach for reduction mammaplasty using a septum-based superomedial pedicled nipple-areola complex (NAC) flap combined with horizontal dermoglandular pillars. This adjustment enhances desired breast projection, potentially eliminating the need for alternative pedicles in most cases. The limitations and disadvantages of this new technique are discussed. Between July 2015 and July 2021, 85 patients underwent surgery using the horizontal pillar reduction mammaplasty. Clinical data obtained during follow-up visits were recorded. Patients were asked to answer the local version of the Breast-Q, version 2.0, reduction module postoperative scale questionnaire to evaluate breast shape contentment and patient satisfaction at the 1-year follow-up. Necrosis of the NAC was not observed in any patient. The most common complaints in the early postoperative period were pain along the inframammary fold and swelling that extended into the axillary region. The mean values and standard deviations of the postoperative Breast-Q scores were calculated. The postoperative satisfaction with breasts scale mean value was 84.11 ± 12.86, and the postoperative satisfaction with outcomes scale mean value was 81.08 ± 9.97. The horizontal pillar reduction mammaplasty technique is safe, reliable, and easy to perform in breast reduction. Although the initial findings are encouraging, future anatomical and clinical studies are necessary to fully explore this modified technique's functional limitations and long-term outcomes.

Quantitative assessment of inframammary fold in Asians: an MRI study.

Background: The inframammary fold (IMF) is a critical structure affecting the aesthetics of the breast, yet the anatomy and location of the IMF remain controversial. The purpose of this study was to quantitatively evaluate the thickness and location of IMF utilizing magnetic resonance imaging (MRI). Methods: The MRI images of 240 breasts from 120 Asian women were analyzed. The quantitative measurements consisted of breast width, breast projection, nipple to inframammary fold, breast volume, IMF tissue thickness, and IMF position. The IMF position was evaluated by referring to the ribs, as well as measuring the distance between IMF and the inferior of the fifth rib. Results: The mean values of central thickness, medial thickness, and lateral thickness were 1.50±0.59, 1.46±0.60, and 1.76±1.04 cm, respectively. IMF central thickness demonstrated a moderate positive correlation with breast projection (r=0.559, P<0.001) and breast volume (r=0.523, P<0.001). The proportions of IMF located at the fourth intercostal, the fifth rib, the fifth intercostal, the sixth rib and the sixth intercostal were 5.8%, 29.2%, 43.3%, 20.4% and 1.3%, respectively. The average distance between IMF and the inferior of the fifth rib was 0.69±1.40 cm. 60.0% of women had near-symmetrical IMF, while 17.5% had left higher IMF and 22.5% had right higher IMF. Conclusions: This study used MRI to quantitatively assess the anatomy of IMF. The detailed knowledge of IMF would facilitate the ideal aesthetic outcome of mammaplasty.