ObjectiveTo explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy.MethodsBetween January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m2, with an average of 30.8 kg/m2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g).ResultsThe skin flap necrosis at the " T” trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15).ConclusionFor severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.
ObjectiveTo explore the effectiveness of liposuction technique assisted superomedial pedicle with a vertical incision in reduction mammaplasty.MethodsBetween March 2014 and March 2019, 65 patients (127 sides) with breast hypertrophy had undergone breast reduction by using liposuction technique assisted superomedial pedicle with a vertical incision. The patients were 21 to 58 years old, with an average of 42.2 years. Body mass index ranged from 18.8 to 26.5 kg/m2, with an average of 21.3 kg/m2. Among them, 62 cases were bilateral operations and 3 cases were unilateral operation. The degree of mastoptosis was rated as degreeⅡ in 73 sides and degree Ⅲ in 54 sides according to the Regnault criteria.ResultsThe unilateral breast removed 432 g on average (range, 228-932 g); the distance of nipple upward was 4.5-9.5 cm (mean, 6.5 cm); the volume of unilateral liposuction was 50-380 mL (mean, 148 mL). There were 2 sides (1.58%) of unilateral intramammary hematomas after operation, 4 sides (3.15%) of bilateral breast vertical incisions slightly split, and 1 side (0.79%) of the nipple-areola epidermis necrosis. All patients were followed up 6 months to 5 years, with an average of 18 months. During the follow-up, there was no evident re-dropping of the breast and no enlargement of the areola. No patient underwent scar excision. At last follow-up, the effectiveness was evaluated by the surgeons. There were 52 cases with very satisfactory, 10 cases with satisfactory, and 3 cases with unsatisfactory for the breast shape and symmetry. There were 51 cases with very satisfactory, 11 cases with satisfactory, and 3 cases with unsatisfactory for the nipple position and areola diameter. The incision scar was obvious in 25 cases and was not obvious in 40 cases. The results of self-assessment showed very satisfactory for the breast shape in 48 cases, satisfactory in 12 cases, and unsatisfactory in 5 cases; very satisfactory for the incision scar in 40 cases, satisfactory in 17 cases, and unsatisfactory in 8 cases. Overall evaluation of the patient was very satisfactory in 52 cases, satisfactory in 7 cases, and unsatisfactory in 6 cases.ConclusionThe liposuction technique assisted superomedial pedicle with a vertical incision in reduction mammaplasty is a safe and reliable surgical method with a satisfactory result.
ObjectiveTo explore the application and effectiveness of three-pedicle reduction mammoplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis. Methods The clinical data of 15 breast cancer female patients with hypertrophy and/or moderate-to-severe breast ptosis treated by three-pedicle reduction mammaplasty with inverted T incision between January 2019 and March 2021 were retrospectively analysed. The patients were aged 31-58 years, with a median age of 39 years. The disease duration ranged from 10 days to 9 months (median, 3.4 months). All patients had unifocal tumor, with a maximum diameter of primary tumor of 0.5-3.9 cm (mean, 2.0 cm), of which 12 were diagnosed with invasive carcinoma and 3 carcinoma in situ. Tumor stage: TisN0M0 in 3 cases, T1N0M0 in 4 cases, T1N2M0 in 2 cases, T2N0M0 in 4 cases, and T2N1M0 in 2 cases. The preoperative cup sizes of patients were D cup in 3 cases, DD cup in 1 case, E cup in 2 cases, EE cup in 2 cases, F cup in 2 cases, FF cup in 1 case, and ≥G cup in 4 cases. The distance from nipple to inframammary fold was 8-18 cm (mean, 12.2 cm) before operation. The patients were followed up regularly after operation to evaluate the breast reduction effect and complications; Breast cancer reporting outcome scale (BREAST-Q) was used to assess patients’ satisfaction and quality of life; and ultrasound, chest and abdominal CT, whole-body bone scan were performed to assess local tumor recurrence or distant metastasis. Results The postoperative nipple position was slightly higher than inframammary fold in all patients. Postoperative cup sizes were A cup in 3 cases, B cup in 6, C cup in 4, D cup in 1, and DD cup in 1, which showing significant difference when compared with preoperative cup sizes (Z=3.420, P=0.001). The median follow-up time was 9 months (range, 6-33 months). Postoperatively, 2 cases (13.3%) had wound-site cellulitis, 1 (6.7%) had mild fat liquefaction, 2 (13.3%) had nipple and areola hypoesthesia but recovered after 3 months. No complication such as fat necrosis, papillary areola complex, or flap necrosis occurred. All patients had undergone adjuvant radiotherapy, of which 1 (6.7%) showed mild skin color change after radiotherapy, but no radiotherapy-related complication occurred in all patients. No patient was readmitted, received reoperation, or delayed to adjuvant therapy due to complications. In the BREAST-Q score, breast satisfaction and quality of life scores at 3 and 6 months after operation were significantly better than those before operation and at 1 month after operation (P<0.05); no significant difference was found between at 1 month after operation and before operation (P>0.05). Nipple satisfaction scores at 1, 3, and 6 months after operation were 15.6±2.2, 18.5±1.4, 19.3±0.7, respectively. At discharge after operation, the patient’s satisfaction with the outcome of the operation was scored 84.7±11.4. The score of adverse events of radiotherapy at 6 months after operation was 6.5±0.8. During the follow-up, patient had no local recurrence, distant metastasis, or breast cancer related death. Conclusion For breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis, three-pedicle reduction mammoplasty can not only remove the lesions, but also reduce hypertrophic breasts, accomplish the mammoplasty, reduce the radiotherapy complications, and improve the satisfaction and quality of life of patients.