Sting Technique: A New Procedure for Hypoplasic Lower Breast Poles.

BACKGROUND: In breast augmentation patients affected by hypoplasic lower poles are a difficult challenge for plastic surgeons. Indeed in these cases it is difficult to create a nice and round contour, especially if a tight thoracic skin is present. Various techniques have been described in the past in order to solve this problem including parenchymal manipulation, fat grafting alone or after subcutaneous release of the stenotic tissue (Rigottomy). Following a large experience with the use of needles to deliver fat grafting in fibrotic tissue of different type of scars the Authors report in this paper their preliminary experience with a new surgical technique consisting of a multiple percutaneous stings of the skin and gland of the inferior breast quadrants associated to an implant to correct a flat, rigid and hypoplasic lower breast pole. METHODS: A total of 24 patients affected by this malformation have been treated during the breast augmentation procedure using the above-mentioned technique. Hypoplasic lower poles (skin and subcutaneous tissues) have been punctured several times using an 18 G needle before inserting the implant. Results have been evaluated by the Authors and patients grading them from 0, extremely poor, to 10, extremely satisfactory outcome. RESULTS: Aesthetic results evaluated by the surgeons group reported a mean outcome of 7.9, whereas the ones of the patients reported a mean value of 8.3. In one case a capsulotomy for monolateral capsular contracture was performed. In another patient the aesthetic result was revised performing a fat grafting in order to further correct the lower pole. In six cases a subcutaneous blood effusion, due to the prick of the skin, was experienced while in two patients with darker skin (Fitzpatrick III) the use of the needle left pigmented spots that completely disappeared after the use of hydroquinone cream 4% for two months. CONCLUSIONS: Even with the limitations of this preliminary study, such as the small number of patients and the short follow-up, the sting technique seems to be an efficacious and safe new tool in the armamentarium of plastic surgeons to treat hypoplasic breasts with stenotic lower poles. 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 .

[Is it legitimate to propose surgery of the breast area before the end of puberty?] / Est-il légitime de proposer une chirurgie de la région mammaire avant la fin de la puberté ?

Breast surgery is usually recommended for women who have completed puberty. Indeed, during adolescence the breast is constantly changing, the patient's weight is often unstable, the risk of inflammatory scars (hypertrophic or keloid) is higher and disturbances of areolar sensitivity can affect the patient's quality of sexual life. In addition, the risk of infection is not negligible, especially during an acne outbreak. In case of early implant placement, iterative changes should be planned. Finally, the result obtained is not always stable but above all the lack of psychological maturity and the legal need to obtain the agreement of both parents are obstacles to early surgery. However, the authors argue for the possibility of surgical correction of the breast around puberty, in particular because of the very clear positive psychological impact. Other arguments are also detailed: to ensure a breast reconstruction in successive stages started early, to limit the repercussions of hypertrophy, to correct thoracic or skin anomalies. These indications are illustrated by numerous clinical cases demonstrating the need for customized surgery on a case-by-case basis.

Male Tuberous Breast: A Rare Variant of Gynecomastia. Clinical Considerations and Personal Experience: Tips and Tricks to Maximize Surgical Outcomes.

INTRODUCTION: Tuberous breast deformity, even rarely, might be observed in the gynecomastia population. It can clinically appear very similar to tuberous breast in females, including a footprint resembling a feminine inframammary fold (IMF). Because of its anatomical characteristics, its correction could benefit from particular surgical measures and therefore it should be careful diagnosed. A clear footprint defining a very feminine inframammary fold is very difficult to correct and renders very difficult the management of the extra skin. Transection of the fibrous constrictions at the level of inframammary fold is not sufficient to obtain a satisfactory result, and adjunctive surgical measurements are required. MATERIALS AND METHODS: From January 2007 to December 2015, twenty-one patients, affected by gynecomastia with tuberous breast deformity, underwent surgical correction consisting of parenchyma debulking and transection of the stenotic fibrous ring of the footprint. The recontouring of the chest profile was optimized using parenchymal flaps which helped to maximize the surgical correction with minimal scarring. RESULT: The mean age at surgery was 28.8 years. The average follow-up period was 32 months. The average hospitalization stay was 1.28 days. Routine laboratory tests and histological examinations did not demonstrate any anomalies. No major complications and no recurrences of the disorders have not been observed. No major complications were reported: one seroma, one skin depression, two scar revisions and three cases of bilateral minimal crescent ptotic skin appearance were observed. CONCLUSION: Although tuberous breast in the gynecomastia population is a rare clinical entity, it should be taken into consideration because it could benefit from some specific surgical measures. The use of glandular flaps showed a satisfactory reshaping of the pectoral area. 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.

Breast asymmetry and pectus excavatum improvement with fat grafting.

BACKGROUND: In women, pectus excavatum malformation can cause modified breast morphology, resulting in mammary asymmetry, which can be increased by placing mammary implants alone. Fat transfer can be an elegant solution to increase the volume and projection of the breast. OBJECTIVES: The authors discuss their experience treating pectus excavatum with fat transfer (lipomodeling) since 2000. METHODS: The charts of 19 consecutive patients with a pectus excavatum breast asymmetry who underwent lipomodeling treatment at the authors' facility between January 2000 and November 2011 were retrospectively reviewed. Patients were separated using the Chin classification (type 1, 2, and 3). Data points for each patient included age and body mass index, number of interventions and volume of fat injected during each session, total volume transferred, and postoperative complications. The clinical result was evaluated by the patient and the surgical team on a 4-point scale: very good, good, fair, or poor. RESULTS: Most (74%) patients in this series had type 3 Chin pectus excavatum. The average age was 28 years, and the average body mass index was 20.3. The average number of lipomodeling sessions was 1.63, and the average volume of fat transferred was 230 mL per session and 375 mL total. The patients and the surgical team were very satisfied or satisfied in 95% of cases and considered the result fair in 5% of cases. There were no complications. CONCLUSIONS: Fat transfer for treatment of pectus excavatum yields very good (natural and stable) results and high patient satisfaction rates, which makes this technique our preferred method for treating thoracomammary malformations in pectus excavatum.