Abstract

The New Iraqi Journal of Medicine 2009 ; 5 (1):                                   Surgical experience                               

 20 cases of the females with mild   to moderate drooping of breasts, undergone mastopexy and augmentation of breast at the same time, through    letter A (upper half of areola) periareolar incision, after pointing the position of new areola towards the narrow part of letter A. We excised the excess skin, insert the breast implant (silicon, saline filled) according to the size that the patients selected, closed the skin in layers. High satisfaction rate about 80% was achieved with very small post operative scars and few complications. The aim of this paper is to report our surgical experience in performing one-stage  mastopexy with  breast augmentation, with  small   periarolar  scar, in   20  patients with  mild to moderate drooping  of the breasts.

Keywords: Mastopexy, Breast implant, letter A incision

Introduction

The breast is the most important organ in the female’s bodies, so any deformity to the breasts will affect their femininity. So there are many procedures to improve the shape of the breasts and correct any deformity.

Vertical mammoplasty is an effective alternative to inverted-T methods.

Among other benefits, it results in a significantly reduced scar pattern. There exists a subset of patients with ptosis who are candidates for a scar pattern that is further reduced [1].

A technique of mastopexy has been outlined that is extremely versatile for restoring an aesthetic and youthful breast shape in the patient who has lost a massive amount of weight [2]. Mastopexy is virtually always required in the female massive weight loss patient, and breast augmentation is often an important adjunct to breast-lifting procedures [3].

One-stage mastopexy with breast augmentation is an increasingly popular procedure, although some recommend a staged mastopexy and breast augmentation [4).

The inverted-T incision for mastopexy of saggy breast continues to be associated with the three most common complications for this technique; suture spitting, excess scarring, and bottoming out [5].With time, the augmented breast frequently becomes ptotic and patients may return requesting mastopexy. Experience has shown that secondary mastopexy in the augmented breast is fraught with potential complications, including fat necrosis, skin flap loss, and nipple ischemia.

The long-term presence of implants typically results in changes in breast anatomy and physiology, including parenchymal atrophy, tissue thinning, and diminished skin blood supply. These factors greatly increase the surgical risks of secondary mastopexy [6].

Primary augmentation/mastopexy is a commonly performed procedure and has a significantly less complication rate than secondary augmentation/mastopexy which is also common and has higher revision and complication rates [7].

 In one   study   the most common complications after breast surgery were hematomas, present in 46 patients (1.5%), infections in 33 patients (1.1%), and breast asymmetries in 23 patients (0.8%), rippling in 21 patients (0.7%), and capsular contractures in 14 patients (0.5%)  [8].

Problems with circumareolar mastopexy procedures include areola spreading, hypertrophic scar, and recurrence of the ptosis largely because of tension on the closure. To minimize this tension associated with a conventional crescent mastopexy procedure, by excising parenchyma with the crescent of skin as well as two small triangles of parenchyma on either side of the areola. Implant augmentation was performed at the same time. The described operation is indicated for patients who have a small to moderate amount of ptosis. The best candidate is the patient whose areola-inframammary distance is not excessive. Nine such patients received this extended crescent mastopexy with augmentation and were followed for up to 3 years. Areola spreading and hypertrophic scar were kept to a minimum. Although not the final answer for ptosis patients, the extended crescent mastopexy with augmentation has been a step in the right direction [9].

The image of the breast is a symbol of femininity and plays an essential role in the way a woman looks at herself and contributes to her personal and social development. Fashion nowadays uncovers rather than covers a woman’s body, and long scars resulting from mammoplasty are less accepted now than they were in the past, more so because the scar quality is unforeseeable. The main concern of mastopexy is to limit the scars, creating a nice breast shape. Ideally scarring is confined to the periareolar circle [10].

Mastopexy and augmentation together can be a very difficult combination of procedures to perform. In many cases, the position of the implant can be inappropriate, necessitating reoperation[11].Periareolar mastopexy with mammary implants in treatment  of ptosis (NAC).This technique does not allow great elevation of the areola (no more than 4-5 cm), but it is good and safe for correcting minor to moderate ptosis combined with volume augmentation[12].

The aim of this paper is to report our surgical experience in performing one-stage  mastopexy with  breast augmentation, with  small   periarolar  scar, in   20  patients with  mild to moderate drooping  of the breasts.

Patients and Methods

 20 female patients with small to medium size breasts with moderate drooping of areolar-nipple complex (ANC) one stage mastopexy augmentation of their breasts. Their age ranged from 29-45 years.14 patients (70%) have moderate drooping of the breasts and 6 patients (30%) have mild drooping of the breasts.     

We prepared the patients  and take photography, then we draw letter  A in upper  half of  ANC ,the position of new  (ANC)  will be in the direction of the narrow part  of letter  A, then we incise

the skin deepithelialized, the triangle of letter   A. The breast implant inserted through the periareolar line of letter A, to sub glandular area, the parenchymal breast tissue and the skin sutured in layer followed by the application of local antibiotic, and frequent dressing. The patients were followed up for 2 years without recurrence.

Results

The numbers  of the patients have drooping of the breast increased with the increase of the age as shown in table [1]. 13 patients (65%) have very good the post-operative scar results  after 8 months   from surgery. 

. Table (1): The numbers of the patients and their age groups      

5 patients (25%) have good the post-operative scar results after 8 months   from surgery ,and 2 patients (10%) have poor the post-operative scar results after 8 months  from surgery. Only 3 patients developed complications; small hematoma, wound dehescence, and infections.                       

16 (80%) patients were highly satisfied with surgical results, 2 (10%) patients were  satisfied with surgical results, 2 (10%) patients were not  satisfied with surgical results.

Discussion

The female when  grow older, become more concerned with  the shape of their breasts. The aging process  have great role  in the sagging of the breast, also hormonal changes that affect  the breast paranchymal, glandular tissue, so breast  become laxly and redundant [13].

The different techniques were evaluated with regard to patient selection, operative techniques, scar length, and complications .Plastic surgeons should weigh the advantages and limitations of each technique to correctly address breast ptosis [14].The determining variables in the selection are ptosis of the nipple-areola complex (NAC) and distance from the NAC to the inframammary fold , in using  the  periareolar pexy for correction of ptosis,  the  degree of general satisfaction with  this technique was 82% [15].

In this study the surgical results and  satisfaction rate     of 80%  are comparable to other studied[16,17,18].The main limitation of this report is the small sample of patients.

Conclusion: According to our modest experience on this small sample of patients, we think it is possible to perform the combined procedure of mastopexy and implantation, to minimize the complications, and to obtain satisfactory results over the mid and long terms

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