Mastopexy

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Mastopexy (mastos "breast" -p? xi? "affix") is a surgical procedure for mammoplasty plastic surgery to remove loose breasts in the woman's chest that; by altering and modifying breast size, contour, and elevation. In breast removal surgery to rebuild aesthetic and proportionate breasts for women, critical corrective consideration is viability of the nipple-areola complex (NAC) complex, to ascertain the functional sensitivity of breast for breastfeeding and breastfeeding.

Breast removal of sagging breasts is a surgical operation that cuts and removes excess tissue (gland, adipose, skin), excessive suspensory ligaments, excess skin from envelope skin, and transposes of the breast-areola higher nipple complex. hemisphere. In surgical practice, mastopection may be performed as a discrete breast removal procedure, and as a subordinate operation in a combined mastopexy-breast enlargement procedure.

In addition, mastopedic surgical techniques are also applied to reduce mammoplasty, which is a correction of the breast that is too large. Psychologically, the mastopection procedure for repairing breast ptosis is not indicated by a medical cause or physical reason, but by the woman's self-image; that is, the combination of physical, aesthetic, and mental health requirements of his Self.

Video Mastopexy

Pasien

Ordinary mastopedic patients are women who want breast recovery (elevation, size, and contour), due to loss of post-partum volume of fat and glandular tissue, and the occurrence of breast ptosis. Clinical indications presented by women - degree of weakness of Cooper suspensory ligaments; and from skin-breast envelopes (mild, moderate, severe, and pseudo ptosis) - determine a restorative surgical approach that can be applied to lift the breast. Class I (mild) breast pdosis can be corrected only with breast, surgical and non-surgical enlargement. Severe breast ptosis may be corrected by breast removal techniques, such as Anchor pattern , incision Reversed-T , and Lollipop pattern , performed with surgical incision circumvertical and horizontal; which produce periareolar scars, at the edges of the nipple-areola (NAC) complex, and vertical scar, down from the NAC's lower margins to horizontal scarring in the infra-mammary fold (IMF), where breasts fill the chest; Such surgical scars are aesthetic losses of mastopasis.

Maps Mastopexy

Breast ptosis

Etiology

Gravity is the most common cause of breast ptosis, or sagging.

• In young women with large breasts, sagging occurs due to volume and weight of the breast disproportionate to the female body type, and because of the large elasticity of thin and thin skin of each breast..
• In middle-aged women, breast ptosis is usually caused by postpartum hormonal changes to the mother's body, which consumes the quantity of adipose fat tissue and shrinks the milk glands, and because of the inelasticity of the skin envelope, which is overwhelmed by the swelling of lactation.
• In postmenopausal women, in addition to gravity, breast ptosis atrophy is exacerbated by excessively long and excessive skin flexibility.

Pathophysiology and presentation

In the course of a woman's life, her breasts change in size and volume when the skin is wrapped in an inelastic, and Cooper's suspensory ligaments - which suspend the high mammary glands in the chest - become loose, and therefore cause to fall forward and relax the breast and nipple-areola complex NAC). Additionally, the addition to tissue prolapse, reduced postpartum (involution) of the thick milk glands in the breast exacerbates the clearance of the suspensory ligaments, and from the inelastic, excess skin envelopes. Mastopexy corrects degenerative physical changes, by removing the parenchymal (internal) tissue, cutting and re-measuring the envelope skin, and transposing the nipple-areola complex higher in the breast hemisphere. The rate of breast ptosis of each breast is determined by the position of the nipple-areola complex (NAC) in the breast hemisphere; breast ptosis was measured on a modified Regnault scale of ptosis scale.

The scale scale of Regnault ptosis

• Grade I: Light ptosis - The nipple is located beneath the infrared (IMF) fold, but remains above the breast under the breast.
• Class II: Moderate ptosis - Putting is located under the IMF; but some of the lower pole breast tissue hangs lower than the nipple.
• Grade III: Advanced ptosis - Putting is located below the IMF, and is at the maximum projection of the breast from the chest.
• Level IV: severe ptosis - The nipple is well below the inframammary fold, and there is no lower polar breast tissue under the nipple.

Laurence Kirwan publishes an alternative classification system for primary or non-augmented breast ptosis that is intended to be more suitable than the Regnault scale for planning operations.

Additional mastopexy considerations

Pseudoptosis - Indications are sagging skins on the lower part of the breast (inferior pole), which show nipples located either at or above the infrared (IMF) fold; thus, pseudoptosis is a common consequence of postpartum gland atrophy. The nipple is located at or above the IMF, while the bottom of the breast falls below the IMF. Pseudoptosis usually occurs when the woman stops breastfeeding, because the mammary gland has stopped growing, thus reducing the volume of the breast, thus sagging on the skin of the breast envelope.

Parsialymal maldistribution - The lower breast has no fullness, very high infrared bending under the breast, and the nipple-areola complex is close to the IMF. Indications of maldistribution of parenchymal tissue suggest a developmental deformity.

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Anatomy of breast surgery

Composition

Operationally, the breast is a milk-producing apocrine gland that lines the chest; and mounted on the nipple, and suspended with ligaments from the chest; and which is an integral part of the female, integral body of the body. The dimensions and weight of the breast vary with the age of the woman and her habitus (body formation and physical constitution). Therefore, small to medium sized breasts weigh about 500 grams or less, and large breasts weigh about 750-1000 grams. Anatomically, breast topography and nipple-areola complex location (NAC) in specific breast hemispheres for each woman; thus, the statistically desired mean (mean averaged) measure is the sternum-21-23 cm distance (the nipple to the sternum-bone notch), and a distance of 5-7 cm lower, from the nipple to the inframammary fold , in which the breast joins the chest.

Blood and nerve supply

The arterial blood supply of the breast has medial and lateral blood vessel components; is given by blood by the internal mamaria artery (from the medial aspect), the lateral thoracic artery (from the lateral aspect), and the third intercostal intercostal artery, 4, 5, 6, and 7. The venous blood drainage of the breast is by the superficial vein system below dermis, and by the venous system in parallel to the arterial system. The primary lymph drainage system is a retromammary lymph ulcer in the pectoral fascia. The sensation in the breast is formed by the peripheral system of neural innervation and lateral skin branches of the 4, 5, and 6 intercostal nerves, and the spinal thoracic nerves 4 ( T4 nerve ) innervates and supplies the sensation to the nipple-areola complex.

Mechanical structure of breast

In realizing breast lift, mastopexic correction takes an anatomical and histological account of the biomechanical properties, load-bearing of three (3) types of tissues (glands, adipose, skin) that make up and support the breast; between the soft-tissue properties of near-incompressing breast ( Poisson ratio ~ 0.5 ).

1. Rib cage. Ribs 2, 3, 4, 5, and 6 of the thoracic cage are structural support for the mammary gland.
2. Chest muscles. The breast lies in the major pectoralis muscle, the pectoralis small muscle, and the intercostal muscle (between the ribs), and may extend to and cover part of the anterior (anterior serratus muscle (attached to the ribs, rib muscles, and shoulder blades), and to the muscles of the rectus abdominis (long and flat muscles extending upward from the pubic bone to the ribs). The female posture provides physical stress on the pectoralis major muscles and pectoralis minor muscles, causing the weight of the breast to induce static and dynamic shear forces (when standing and when walking), compression forces (when lying supine), and tension strength (when kneeling in four members body).
3. Pectoral Fascia. The pectoral main muscle is covered with a thin shallow membrane, a pectoral fascia, which has many extensions intercalated between its fasciculi (fascicles); in the midline, it is attached to the front of the breastbone, above it attached to the clavicle (the collarbone), while below and laterally, it continues with the fascia.
4. Suspension ligament. The subcutaneous layer of adipose tissue in the breast is passed by a thin suspensory ligament (Cooper ligament) that extends to the skin surface, and from the skin to the deep pectoral fascia. The structural stability provided by Cooper ligaments comes from a very dense parallel oriented collagen fiber bundle; The main, ligament-component cell is fibroblast, interspersed throughout the bundle of parallel fibers of the shoulder, axilla, and thoracic ligaments.
5. Glandular tissue. As a milk gland, the breast consists of lobules (lymph nodes in each lobe-tip) and the lactiferous ducts (milk ducts), which extend to form the ampules (sacs) of the nipple.
6. Adipose tissue. The breast fat tissue consists of lipid fluid (60-85% by weight) ie 90-99 percent of triglycerides, free fatty acids, diglycerides, cholesterol phospholipids, and minutes of cholesterol ester, and monoglycerides; Other components are water (weight 5-30%) and protein (2-3% by weight).
7. Skin envelopes. Breast skin in three (3) layers: (i) epidermis, (ii) dermis, and (iii) hypodermis. The epidermis has a thickness of 50-100Ã,Âμm, and is composed of flat keratin stratum corneum cells, which are 10-20 Ã,Âμm thick; protects the living epidermis, which consists of epithelial keratinization cells. The dermis is mostly collagen and elastin fibers attached to viscous water and glycoprotein medium. Upper dermis fibers ("papillary dermis") are thinner than inner dermis fibers, so the skin envelope is 1-3 mm thick. Hypodermic thickness (adipocyte cell) varies from woman to woman, and body part.

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Surgical procedure

Indication

The surgeon-physician evaluates the woman who requested breast removal surgery to ensure that she understands the risks and health benefits of the mastopection procedure. The surgeon insists that his ideal body image (an aesthetic goal) matches what is realistically achievable with the plastic surgery options available. The following conditions are indicative for mastopection.

• Squirming breasts, which prolapse (falls forward) as a result of diminished postpartum gland, menopause, gross weight loss, and so on.
• Ptosis post explanation, sagging skin of an inelastic skin, after being emptied of breast implants.
• congenital ptosis and pseudoptosis, as observed in conditions such as tuberous breast deformity (limited breasts).
• Acquired or relative ptosis, as seen in breast reconstruction post-mastectomy of a natural and proportionate breast size, look, and feel.

Dropping sagging breasts

The following descriptions of the full breast lift and breast lift modification technique are limited to the surgical incision used to treat the breast skin envelope, not the part in the parenchyma, the breast substance.

Raise the full breasts

The sagging breasts are lifted using the circumvertical and horizontal incision plan of the Anchor mastopexy (also the Lexer pattern, the inverted-T incision, the Wise pattern, the inferior pedicle), which features three incisions:

• Anchor Ring: a circular incision at the top edge of the edges of the nipple-areola complex.
• The Anchor shank: a vertical incision from the underside of the nipple-areola complex to an inframammary-fold incision.
• Anchor stock: horizontal incision along the infrared fold, where the breast joins the chest.

In cutting the excessive skin folds of the curved and inelastic skin of the breast (and occasionally reducing the diameter of the nipple-areola complex), the three incision technique of anchor mastopection allows maximum correction of the breast, resulting in increased bust with natural-sized breasts, see, and feel. In addition, each of the three scars to the breast hemisphere produced by the Mastopection-anchoring pattern has a typical healing pattern:

• in the periareolar area - the edge of the nipple-areola complex - the surgical scar is concealed by a light-to-dark skin color in a pigment transition, in which the breast skin is light-colored into dark-areola skin (anchor ring pattern)
• the medial vertical scar (calf of the Anchor pattern) extends from the lower edge of the nipple-areola complex to the inframammary fold; the shadow of the breast hemisphere hides it
• horizontal scar (Stock anchor pattern), which follows, and is hidden inside, inframammary folds.

Post-surgery, of the three former breast removal surgeries, scars on the inframammary folds show the greatest tendency for hypertrophy, thickness and large size. Although the color of mastopedic scars fades with full maturation of the tissue, they remain visible.

Modified breast lift

The cutting technique plan for modified breast lift has fewer cuts and fewer scars, but limits plastic surgeons by allowing fewer changes to the skin of the breast envelope. In surgical praxis, modified breast lift is often a sub-ordinate surgery in a mastopexy-breast enlargement procedure, lifting and enlarging the breasts simultaneously. In addition, the incision is applied to improve the ptosis discussed above; some technical variants of modified breast lift are:

1. periareolar lift , featuring a crescent-shaped incision, above and on the variable portion of the nipple-isola perimeter complex, enabling cutting and removal sickle meat, thus facilitating the elevation (transposition) of the nipple-areola complex to a higher (new) site in the breast hemisphere.
2. circumareolar lift ( Benelli breast lift , donut appointment ), showing the cutting of the concentric ring of meat from around the nipple of the complex, limiting the size and the diameter of a circular scar.
3. diagonal lift ( lollipop lift , vertical scar ), showing a circular incision, around the nipple-areola complex, and a vertical incision from the lower edge of the nipple-areola complex edge to the inframammary fold.

Mastopection of enlarged breasts

Women who have undergone breast enlargement are also susceptible to breast ptosis; any incidents that may be caused by the physical and mechanical pressure imposed by the breast implant on the internal tissue and the envelope skin; Such excessive stretching thins the skin and reduces its elastic qualities. Statistically, breast enlargement and mastoplasty are plastic surgery operations with a low incidence of medical complications; however, when performed as a combined mastopexy-augmentation procedure, physiological pressure on a woman's health increases the risk of wound infection, implanted breast implants, breast damage and nipple nerves leading to sensation of change, malformation of the nipple-areola complex, and malposition of breast implants in the implant pocket. Therefore, the augmentation-mastopection procedure has an increase in the rate of surgical complications, when compared with lower rates of complications of breast enlargement and mastopection as discrete surgical surgery; likewise, the individual incidence rates of surgical revisions and complications, when compared to the rates of revision and complications for combined mastopexy-augmentation procedures. Recent research on newer techniques for simultaneous augmentation mastopexy (SAM) indicates that it is a safe surgical procedure with minimal medical complications. The SAM technique involves invagination and connection of the first tissue, to previsualize the final outcome, before making surgical incisions to the breast.

Contraindications

Contraindications to a small mastopection: the use of aspirin, tobacco smoking, diabetes, and obesity are medical and health conditions associated with an increased incidence of nipple necrosis. In completing the perceived ptosis of a woman with encapsulated breast implants, the surgeon determines its suitability for the breast removal procedure after explanation, which facilitates an assessment of the actual level of ptosis present in detonated breasts; as well as an assessment of the effects of a combination of breast removal procedures and revision-augmentation, which displays removal and replacement of breast implants. For women at high risk for developing breast cancer (primary or recurrent), mastopasis may alter the histologic architecture of the breast, which tissue changes may interfere with accurate MRI detection and subsequent cancer treatment; risks and benefits will be discussed in that setting.

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Surgical technique

General

In promoting breast lifting, conservative surgery produces the least scar, at least visible after removing excessive skin folds from the envelope skin, when replacing or rearranging or adding to the internal breast tissue (parenchyma and adipose). Breast removal techniques are known based on the number of scars produced, which are associated with the level of breast lift that can be achieved. Preoperatively, patients and surgeons decide on appropriate surgical techniques (superior, medial, or inferior pedicles) that will achieve the best level of breast lifting. Generally, breast ptosis (sagging) is determined by the location of nipple-areola complex in the breast; the lower the nipple-areola complex, the greater the degree of breast prolapse (ptosis). Nonetheless, in breast removal surgery, the main consideration is tissue viability of the putole-areola complex, so the result is sensational breast functional natures of size, contour, and taste.

Evaluate the severity

Surgical management of breast ptosis is evaluated by severity.

• Level I: Light breast ptosis, which can be corrected with breast implant implantation, or with periareolar skin resection (crescent-up), with or without breast enlargement.
• Level II: Moderate ptosis, which can be corrected by the mastopexy circumareolar donut technique that features Benelli cerclage suturing; and with circumvertical-incision techniques (lollipop mastopexy) such as Reginault B Mastopexy (and Lejour-Lassus breast reduction).
• Level III: Severe ptosis, which can usually be corrected with circumvertical and horizontal incisions of Anchorage mastopexy (inverted-T incision), regardless of the type of pedicle used (inferior or superior).

Fixed fake ptosis

Pseudoptosis , or prolaps of false breasts, can be resolved in two ways:

• With breast enlargement, or with skin excision, or with both procedures; and without transmitting the nipple-areola complex, which requires cutting the skin from the underside of the breast.
• With the circular sutures that surround the nipple-areola complex. To achieve the desired level of breast lift according to the female anatomy, the circular mastopection technique (circular elevation) can be modified with additional vertical incision. The remaining skin-envelope tissue remaining after the vertical incision technique can be collected in a series of folds, along the incisal vertical limbs, or can be resected, cut and removed, on the infrared fold, resulting in horizontal incisions of varying length, such as circumvertical and horizontal breast lift.

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Mastopection procedure

Pre-operative issues

The plastic surgeon describes the incision plan of mastopection in the patient's breast and body; The main corrective consideration is the correct level of nipple-areola complex in the breast hemisphere. In most women, the nipple should be located at, or slightly above, the infrared crease, because the attachment is too high it may lead to a difficult revision operation. The right local topography for the nipple is determined by transmitting a semicircular line from the inframammary fold to the breast face (anterior aspect), thus configuring the circle, where the putre-areola complex is centered. After determining the location of the nipple, the surgeon will describe the remaining skin incision of the correction, while maintaining the inferior border of the vertical incision at a distance above the inframammary fold prior to surgery, which precautions avoid extending the surgical scar to the chest wall after lifting the breasts and inframammary folds.

Intra-operative things

The only application of breast enlargement mammoplasty to correct minimal breast ptosis (Grade I) is usually done with breast implant prosthesis. Multiple applications of mastopection and breast enlargement surgery - as a surgical procedure - require thorough planning, due to the necessary resection of parenchymal tissue. The periareolar incision is suitable for implantation of breast prosthesis and transposition of the areola-nipple complex, while maintaining tissue viability of the nipple-areola complex.

Internal surgical mastopection is applicable for women who have undergone breast prosthesis exploration. In operative praxis, the plastic surgeon lifts the capsule flap trimmed by the breast arrangement, and folds it to increase the internal mass volume of the breast - thus increasing the breast projection from the chest surface. The nipple-areola complex increases with seam plication, and does not require skin resection when there is no excess skin.

Pedicles - superior, inferior, and medial

Although the above-mentioned description is from an incision used to treat the breast skin lining, breast tissue surgical management (parenchyme) is a separate consideration, including maintenance of neurovascular integrity of the nipple-areola complex. The degree of hemispheric elevation of the nipple-areola complex determines the type of pedicle (superior, inferior, medial) that will provide the best venous and arterial venous supply to the nipple-areola complex. Therefore, the application of the superior pedicle approach gives the surgeon greater procedural flexibility in determining where the incision is to coat the breast implants, but limits the likelihood of the height of the nipple. The application of the inferior pedicle approach provides higher levels of nipple-isola complex, but makes it difficult to implant breast implants, and the subsequent contours of the breast. The application of the medial pedicle approach maintains breast sensation with a reliable supply of venous and arterial veins, and avoids the technical and procedural constraints of superior pedicles and inferior pedicle approaches.

Post-operative issues

After breast removal surgery, minimal wound care when the seam closure is subcuticular (below the epidermis), and reinforced with a strip of adhesive tape that can be absorbed (butterfly sutures) applied to keep the wound closed.

Postoperative surgery on the breast can change the way women do breast self-examination for cancerous changes in the tissues; so it is possible that the mass of necrotic fat may be mistaken for palpation as a neoplasmic lump; or may be detected as such in the examination of a woman's scheduled mammogram; However, benign histologic changes are usually distinguished from malignant neoplasms.

Complications

Common medical complications of mastopasis include bleeding, infection, and secondary effects of anesthesia. Specific complications include skin necrosis, and dysesthesia, abnormal changes in sensation (numbness and tingling). Serious medical complications include seroma events, serous pouches of local accumulation, and the occurrence of hematoma, local blood accumulation outside the vascular system. Nipple necrosis and skin flap necrosis (or both), when it occurs, may be partial, and heal without treatment with wound care, or may be complete, and require reconstruction. Complications of mastopeksi Anchors are damage caused by tension at the junction of three limbs from the incision, but the scar usually heals without experiencing hypertrophy. Breast asymmetry is usually present before surgery, and breast removal surgery usually does not definitively eliminate it, regardless of the applied mastopection technique or surgical expertise of plastic surgeons. In addition, a combined mastopexy-breast enlargement procedure may make breast surgical asymmetry revisions more difficult due to overcrowding of the nipple-areola complex. In addition, it is possible, the undesirable outcome of periareolar mastopection (circular incision) is the lower projection of the breast that is corrected from the chest wall.

Mastopeks with medial pedicle spots

Pre-operative issues

To realize breast lift using the medial pedicle technique, the surgeon describes the sliced ​​plan on the breast, chest, and breast of the woman:

1. Meridian breast for bone length of the sternum (from the sternalum in the lower throat) to the xifoid process (at the lower end).
2. An ellipse, centered above and dividing, the breast meridian line on the breastbone.
3. The shape and dimensions of the medial pedicle skin-flap, the base is above the elliptical centerline. A 6 cm (2.4 inch) long pedicle will provide adequate supply of venous and arterial blood vessels to ensure tissue viability of the putole-areola complex.
4. Semicircle circle on the superior face of ellipsis - either hemisphere (1/2 circle) or sickle (circle 3/4) - to indicate the diverted location of the nipple-areola complex. The top half of the circle is marked at 21 cm (8.3 inches) from the superior margin of the sternal notch. In surgical praxis, the incision plan is modified into female anatomy (height, weight, ptosis degree), and treatment of parenchymal tissue.

Operative technique

Editing plan

After describing a surgical incision plan that establishes a technically reliable central axle from the front of the torso, and before cutting into the breast, the plastic surgeon confirms the topographic accuracy of the incision plan described, by triangulating the measurements in the upper sternum. and in the umbilicus, and modify the incisional lines, if necessary. After that, the surgical incision line is infiltrated into the breast skin with a mixture of local anesthesia (1.0% lidocaine and 1: 100,000 epinephrine) that constrict the corresponding vascular system to limit bleeding.

Pedicle skin-flap

After establishing the new nipple-areola complex dimension, the surgeon de-epithelializes the medial pedicle skin-flap that provides the vascular system of the veins for the nipple-areola complex. The first incision is through the network of parenchyma, and separates the medial pedicle. The incision is done to avoid weakening the skin pedicles and so preserve the blood vessels of the complex nipple-areola supply. Therefore, the volume of pedicle flap tissue is very important to establish an adequate projection of the upper pole of the breast, where the breast is from the chest. Surgeons resects (cut and remove) an almost-triangular network segment beneath the medial pedicle. Finally, to attach the nipple-areola complex, the incision is completed by cutting the ellipse and tissue adjacent to the medial pedicle.

If the incision to the breast is satisfactory, the patient's homeostasis is feasible at the time of mastopection surgery. The surgeon then evaluates the tissue-thickness of the medial pedicle sponge, and its physical ability to rotate in a superomedial direction (up and down the center) without the resulting torque voltage to the inferior pedicle tissue; after that, the surgeon reduces the thickness of the skin pedicle tissue. Once positioned superior, the thickness of the pedicle tissue is reviewed to ensure that it fits in with the new position, without undue pressure or constriction; thereby securing tissue viability of the medial pedicle and from the nipple-areola complex.

Symmetry

An important procedural step in shaping the new breasts is to collect and join the three folds of breast tissue (the medial pillar and the two lateral pillars) of the lower pole of the breast, where it meets the chest. Tailoring is essential for supporting and forming a flabby breast tissue into a hemispheric breast mound that also comes from the chest wall - the raised breast. The supine patient is then elevated to a sitting position so that the breasts are naturally dependent, and the surgeon then paints them an incision plan for resection (cut and remove) from the inferolateral and inferomedial outer bending of the new breasts. Afterwards, the patient lies on his back, and excess breast skin is cut; to avoid scars on inframammary folds, the closing of a rope-bag collects excessive skin folds at the bottom pole of the breast; in time, the three pillars that join the skin will integrate into the infrared fold. Again, the supine patient is elevated to a sitting position so that the surgeon can ascertain the size, shape, and symmetry, or asymmetry, of the corrected breast. If the breast lift level is satisfactory, the patient is put back to the operating table, and the plastic surgeon sews the incision wound.

Post-operative issues

During the initial postoperative period, the plastic surgeon examines the patient for the occurrence of the hematoma, and to evaluate the histological feasibility of the breast-pedicle skin flap and of the nipple-areola complex.

During the first three (3) weeks of postoperative recovery, the surgeon monitors the healing of mastopacial lesions during weekly consultation with the patient. Depending on the progress of women's wound healing, more or less follow-up examinations should follow.

Complications

The complex necrosis complex of the nipple-areola is a major medical complication of mastopexy. To prevent nipple-areola complex necrosis, the surgeon monitors and evaluates the viability of the transplanted tissue; by the presence of oxygenated and bright red blood arteries exhibiting proper function of the vascular system of the nipple-areola complex. The more common complication of post-operative nipple-areola complexes is dysesthesia, manifests as an abnormal sensation of numbness, and as a tingling sensation, propagating for the wound healing period, but diminishing as the full function of the birth fracture of the breast. full sensitivity to nipple-areola complex; However, permanent numbness of the nipple-areola complex is rare.

The tissue necrosis of the medial pedicle spots is a potential, but rare, complication of mastoption procedures. In addition, the occurrence of hematoma is also possible; in postoperative praxis, large hematomas are immediately dried, whereas small hematomas can be observed for self-resolution, before being dried.

Dehiscence wounds, surgical wound scars on the seam closing line, are medical complications resulting from poor wound healing. Unless the aesthetic dehiscence wound compromises the result of breast lifting, it is managed conservatively.

Breast contour irregularities occur when the inferior tissue of the incision is collected to avoid scar formation in the inframammary folds. If the complications do not heal on their own, if the network is not leveling, or becomes smooth, they are revised with additional surgery.

Mastopexy with B-Pedicle

B mastopexy or the Regnault mastopection technique

The mastopexy (breast lift) is a variation of the circumvertical approach that features an upper-revised letter incision B, which, when performed with simultaneous breast enlargement by submuscular or subglandular implantation of the breast prosthesis , restore natural contour and breast appearance. In addition, the mastopection B technique may be procedurally included simultaneous microliposuction to reduce lateral and adipose parenchymal tissue to achieve the correct size, volume, and contour of the corrected breast. Mastopection B can correct some types of breast deformities, any form of breast ptosis, and breast hypertrophy; usually have a low incidence rate of hypertrophic scarring, and loss of sensation in the nipple-areola complex; Furthermore, mastopection technique B also applies to mammoplasty reduction, breast correction is too large.

The technical and procedural efficacy of B-mastopedic techniques was founded in Clinical Techniques: B Mastopexy: Versatility and 5-Year Experience (2007), a retrospective study of 40-group mammoplasty women who performed 13 breast removal procedures without breast enlargement, and 27 procedures with simultaneous breast enlargement, using medium-sized breast implants. Cohorts reported no medical complications, only one (1) woman underwent scarring revision surgery; and each of the 40 women were satisfied with the results of her mastopedies.

Surgical Consultation - The plastic surgeon explains the technical and aesthetic considerations of breast tightening surgery to women. That technique mastopection B produces better aesthetic results with chest skin pedicles made with a curvilinear incision (upper-case B). Such curved incision technique eliminates the medial incision of mastopeksi Anchors, thus creating breasts raised with breast size, appearance, and contour, and some surgical scars. The consultations include detailed photographs, preoperative, post-operative, and healing that illustrate the nature and extent of the incisions of mastoplasty and the resulting scar. That full recovery (scar maturation) may take about a year to form the final contours of the raised breast, after the suspensory ligaments and parenchymal tissue have settled on and over the breast as aesthetically pleasing breasts of natural size, appearance, and contour.

Pre-operative issues

For standing patients, the plastic surgeon describes the incision plan of mastopeksi to the breast, breast, and chest of a woman. The distance from the suprasternal notch (above the sternum) to the nipple is measured and recorded to the medical record; an infrared-fold rate is identified and portrayed to the front of the breast (anterior aspect), which indicates elevated locale where the nipple-areola complex will be diverted. The medial aspect of the new localized nipple-areola complex is marked about 10 to 11 cm (3.9-4.3 inches) from the midline, along the middle of the breast; and a semi-circle with a diameter of 38 mm depicted around the nipple; the semicircle spacing of the pentotypic nipple complexes shows the new location of the nipple-areola complex in the breast hemisphere.

Operative technique

Editing plan

With the patient lying on his back on the operating table, the surgeon performs a free curve of the curve, from an upwardly reversed letter B to the breast. Then, per a landmark of an incision-start plan, a semicircle pattern is illustrated around the nipple-areola complex. The vertical and horizontal component incisions of mastopection B are made with an oval, curved incision starting from the underside of the areola to the lateral folds of the breast. The B-pattern incision produces vertical closures of 5 to 7 cm (2.0 to 2.8 inches) from the lower margin of the isola-areola complex to the inframammary fold.

Closure of the wound

The surgeon tests the tension of the closure of the wound suture by folding the breast over the index finger, and towards the nipple complex of the areola being diverted, to observe whether the skin turns white or too enlarged, afterwards, nipple-areola dermis complex-area undergoes deepiorialisation. In a combined mastopexy-augmentation procedure, in which the breast prosthesis is attached to a submuscular implant pocket, a tumescent anesthetic solution is injected along the marked incision line. When the breast implant will be attached to a subglandular implant bag, the hypodermic needle penetrates without resistance into the anatomical plane above the major pectoral muscle; anesthesia tumescent solution allows blunt dissection. After establishing the anesthesia, the surgeon de-epithelializes each edge of the skin by tearing down 3 to 4 mm (0.12-0.16 inches), with a razor blade razor, thus facilitating the closure of surgical wounds without a tight stitch. In mastopexy-augmentation, the pocket breast implant (local) determines when the surgeon performs the de-epithelialization of pedicle B; for submuscular implantation, the pedicle skin deisialization is performed after the emplacement; for subglandular implantation, the pedicle skin deisialization is performed before emplacement.

If mastopacies include simultaneous breast enlargement with submuscular emplacement, the surgeon observes that the primary pectoralis muscle is divided from the sternum and ribs. After cutting the implant bag, the surgeon then mendes the epithelialize B-pedicle. To facilitate dermal closure (joining the wound edges) with minimal tension at the seams, the breast implants will be transferred to the implanted bag, or partially deflated. For subglomerular placement of breast implants, the technique is different; de-epithelialization of the dermis pedicle is performed initially, after which the incision is made through the de-epithelialized dermis, at the base of the mastopedic vertical branch, and then, by means of blunt dissection, the implanted pocket is cut above the pectoralis main muscle.

Symmetry

During dermal closure, the nipple-areola complex is transferred to a new site, as determined by the skin pedicle. To make the curvilinear scar, deep dermal closure is done by turning the lateral flap down and then medial. The deep dermis is estimated (joined) with stitches, in a simple and disconnected way. The stitching of the lock is attached to the junction where the vertical incision peaks together with the nipple-areola complex - since the skin of the breast is subject to the greatest stress (s). Subcutaneous dermal closure is affected by disconnected sutures. As required, final adjustment before seam tailoring, may include micro liposuction or additional de-epithelization. After dermal closure, the sutures are superimposed to achieve a continuous approach of nipple-areola complex to adjacent skin edge, and to lower skin incisions.

Post-operative issues

Recovery - Minimum postoperative care after mastopection procedure; the raised breasts are supported with soft and porous elastic bands, which are removed 7-10 days after surgery, and then reapplied to the incision of mastopection for an additional 1-2 weeks during the recovery period. For a comfortable wound healing, the woman wears a surgical brassiÃÆ'¨re, and avoids wearing a bra that is not tied until a breast implant has entered her position. Mastopection results are photographed in 2-3 months postoperatively.

Observation of mastopexty techniques

Result of mastopexic correction of surgical scar on raised breast; the result of periareolar mastopexy is often the breast with the lowest appearance, with a wrinkled surgical scar; and the Anchor mastopexy result is aesthetic breast size, look, and natural nuance, but with many scars. Meanwhile, the supporters of the mechanical principle of mastopection B technique proposed that the creation of rotational pedicles (with high epidermal flaps rotating around the nipple-areola complex), raised the breast with an incision plan with vertical and horizontal incisions that removed the medial incision and vertical scar), while providing a good projection of the breast that is corrected from the chest, and a healthy nipple-areola complex. Furthermore, proponents of the technical mastopection report B that usually do not require secondary correction, as it allows for better transposition of the excessive lateral tissue of the breast by means of curvilinear incisions (inverted, uppercase, B-letter) to the skin envelope.

src: www.health2blog.com

See also

• Breast
• Breast enlargement (augmentation mammoplasty)
• Breast implants
• Breast reduction (reduction of mammoplasty)
• Mammoplasty
• Plastic surgery

src: cdn.houstonbestbreasts.com

References

Source of the article : Wikipedia