No Abstract Available.
Breast* ; Mastectomy, Subcutaneous* ; Nipples*

Objectives: To describe the demographic distribution of patients who had foreign body injections to the breast who were seen by the Division of Plastic Surgery in the past 5 years. To determine the number of cases of patients with foreign body injection to the breast seen by the Division of Plastic Surgery from January 2004- August 2009. To determine the demographic distribution of patients who have had foreign body injections to the breast with regard to age, occupation, and socioeconomic status. To describe the clinical profile of cases. To review the present management procedures for the treatment of foreign body injections to the breast. Methods: This is a retrospective study on patients seen by the Division of Plastic Surgery of the Philippine General Hospital from January 2004 to August 2009 who were seen for complications from foreign body injections to the breast. Cases were identified by querying the electronic patient registry of the Department of Surgery (ISIS). A review of the records was done. The following information was clinical presentation and treatment done in these patients. Results: Thirty six female patients both private and charity were seen by the Division of Plastic Surgery of the Philippine General Hospital from January 2004 to August 2009. The incidence of foreign body injections to the breast was most common in young females 25-35, who were entertainers (72.2%). Forty four breasts presented with changes that were classified under Type II of the Ueno classification (firm induration with or without pain) seen between 6-15 years from the time of injection (58.3%). Majority of the patients (27 patients, 74%) did not know the volume injected. Only 25% of the women had knowledge of the volume injected, 6 patients (16.7%) received injections ranging from 160-300cc, 2 patients (5.6%) received more than 300cc. Twenty four patients were seen and treated as private cases and 12 patients were seen and treated as charity cases. Seventy two breasts were treated mostly with subcutaneous mastectomy with implant or flap reconstruction. Conclusion: Based on the data gathered, most susceptible were young women with occupations wherein an attractive physical appearance would give them an edge or an advantage in their particular career. This is regardless of financial capability. With this, it is important to have a concerned, cooperative effort to stop the practice through public education that can be directed at this population. This will also be a jumpstart point to make large volume foreign body injections to the breast illegal and less accessible in the Philippines. Knowledge of the clinical profile may guide other surgeons to early detection and appropriate treatment. Key words: siliconoma, subcutaneous mastectomy
Human ; Female ; MASTECTOMY, SUBCUTANEOUS ; SURGERY, PLASTIC

PURPOSE: Subcutaneous mastectomy has been accepted as a standard for the treatment of gynecomastia. Surgical managements including ultrasound-assisted liposuction(UAL) have had limited success and several combined approaches were tried to find the most effective method. We designed a modified subcutaneous mastectomy, which we call "pan-cake method". The purpose of this study is to evaluate the results of our method for the treatment of gynecomastia. METHODS: 16 patients from 16 to 31 years of age having gynecomastia were operated using the pan-cake method. 11 patients were in grade I, and 5 patients were in grade II, no patient were in grade III or IV, according to Rod's classification. The pan-cake method started with modified periareolar incision. We executed subcutaneous dissection first and suprafascial dissection next. After dividing the breast into four equal quadrants, we removed breast tissue from each quadrant as necessary. The operation time for the resection was recorded and the weight of removed parenchyme tissues was measured. RESULTS: All the operations were successful. There were no asymmetries, contour deformities, or irregularities. Only 6 cases needed the combined therapy with ultrasound-assisted liposuction(UAL) because of the step deformities. The average operation time was 24.1 minutes and the average weight of removed breast tissue was 98.1g. All the patients were satisfied with the aesthetic results. CONCLUSION: We concluded that the pan-cake method is an alternative option for the surgical treatment of gynecomastia, giving good aesthetic results and relatively short operation time.
Breast ; Classification ; Congenital Abnormalities ; Gynecomastia* ; Humans ; Male ; Mastectomy, Subcutaneous

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign mesenchymal lesion with incidental histologic findings. Surgical excision is recommended as the treatment of choice for PASH, although the recurrence rates after excision range from 15% to 22%. A 46-year-old-female presented with a six-month history of bilateral breast enlargement and painful sensation mimicking inflammatory carcinoma. Imaging studies demonstrated innumerable enhancing nodules in both breasts. Due to the growth of the lesions and progressive clinical symptoms, bilateral subcutaneous mastectomy was performed. Grossly, the specimens were round and well-circumscribed, and the histologic examination revealed PASH. After mastectomy, we created a pocket with the pectoralis major muscle and a lower skin flap, which was deepithelized. Anatomical mammary implants were inserted, and the nipple areolar complex was transferred to a new position as a free graft. The aesthetic result was satisfactory after twelve months of follow-up.
Breast* ; Female ; Follow-Up Studies ; Hyperplasia* ; Mammaplasty ; Mastectomy ; Mastectomy, Subcutaneous ; Nipples ; Recurrence ; Sensation ; Skin ; Transplants

BACKGROUND: Gynecomastia is benign enlargement of breast tissue in males and is fairly common. Mastectomy not only helps in improving the shape of anterior chest, but can also improve the location of nipple. Therefore, a principle element of mastectomy design is defining the normal location of nipple based on major anatomical reference points. Here, the nipple location was compared for before and after gynecomastia surgery. In addition, the same was also compared between male patients undergoing gynecomastia surgery and control group of subjects without gynecomastia. METHODS: We retrospectively analyzed gynecomastia patients who underwent conventional subcutaneous mastectomy. Preoperative and postoperative anatomical landmark distances and chest circumferences were measured and compared to the same anthropometric data from 20 healthy adult male controls. RESULTS: Nipple locations were compared among 13 patients and 20 controls. The mean weight of resected breast tissue was 246 g, and overall patient satisfaction grade was 4.3 out of 5. In the patient group, the slopes for the height-distance from the sternal notch to the nipple and chest circumference-distance between the mid-line of the sternum and the nipple were 0.175 and 0.125 postoperatively, respectively. The slopes of the control group were 0.122 and 0.177, respectively; these differences were statistically significant (P<0.05). CONCLUSIONS: Nipple positions were considerably lower in patients with gynecomastia than in control subjects. Subcutaneous mastectomy was associated with mild elevations, but postoperative locations were still lower compared to controls. Further efforts are needed to improve the location of postoperative nipple-areola complex in patients with gynecomastia.
Adult ; Breast ; Gynecomastia* ; Humans ; Male ; Mastectomy ; Mastectomy, Subcutaneous ; Nipples* ; Patient Satisfaction ; Retrospective Studies ; Sternum ; Thorax

Preservation of the breast skin envelope during immediate implant-based breast reconstruction is important for producing symmetrical and natural-looking breasts. We propose the lazy S design for the closure of round-shaped wounds with the hope of improving the aesthetic outcomes and reducing the tension on the wound by preserving the skin. Additionally, the direction of tension is dispersed due to the shape of this design. Patients undergoing implant reconstruction after skin-sparing mastectomy may benefit from the lazy S design.
Breast Implants ; Breast* ; Female ; Hope ; Humans ; Mammaplasty* ; Mastectomy* ; Mastectomy, Subcutaneous ; Reconstructive Surgical Procedures ; Skin* ; Wounds and Injuries

BACKGROUND: In the literature on nipple-sparing mastectomy (NSM) with one-stage immediate implant reconstruction, contralateral symmetrisation has drawn little attention, with many surgeons still performing standard cosmetic mammaplasty procedures. However, standard implant-based mammaplasty usually does not result in proper symmetry with the mastectomy side, especially regarding breast projection, overall shape, and volume distribution. METHODS: We retrospectively reviewed 19 consecutive patients undergoing unilateral NSM with immediate prosthetic reconstruction and contralateral simultaneous symmetrisation by using the tailored reduction/augmentation mammaplasty technique between June 2012 and August 2013. RESULTS: The average follow-up time was 13 months (range, 10-24 months). No major complications, such as infection, haematoma, and nipple-areola complex necrosis, were experienced. CONCLUSIONS: Our experience suggests that simultaneous contralateral symmetrisation with tailored reduction/augmentation mammaplasty after unilateral immediate implant reconstruction after NSM facilitates durable and pleasant symmetric outcomes.
Breast Implants ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy* ; Mastectomy, Subcutaneous ; Necrosis ; Retrospective Studies

PURPOSE: After the first subcutaneous mastectomy with nipple preservation in 1974 at the Nottingham Breast Clinic in United Kingdom, many studies have shown that skin-sparing mastectomy (SSM) with the preservation of the nipple-areola complex (NAC) is an oncologically safe procedure with good cosmetic outcomes in selected mastectomy patients. However, the clinical indications for NAC preservation have not yet been precisely defined. This study was performed to investigate the predictive factors for NAC-based neoplastic involvement to determine the indications for NAC preservation. METHODS: A retrospective study of 198 patients with invasive breast cancer who underwent modified radical mastectomy (MRM) at the Department of Surgery at Chonnam University Hospital from April of 2004 to April of 2006 was performed. Patients with bilateral breast cancer were excluded from the study. The predictive factors analyzed for NAC involvement were the hormone receptor status, tumor size, tumor localization, multiplicity, axillary lymph node status, nuclear grade, tumor-nipple distance (TND), and lymphovascular invasion (LVI). RESULTS: The overall frequency of malignant NAC involvement was 19 out of the 198 patients (9.5%) as determined by definitive histology. Significant differences were found for tumor size (P=0.015), axillary lymph node status (P=0.008), TND (P=0.044), and LVI (P=0.014). There were no significant differences for the hormone receptor status, multiplicity, nuclear grade, and localization. CONCLUSION: Although the sample size in this study was small, the findings suggest that the clinical contraindications for NAC preservation should include tumors >2.4 cm, a positive axillary lymph node status, TND <4 cm, and positive LVI. NAC preservation can be offered in selected patients after preoperative or intraoperative evaluation of the tumor size, axillary node status, TND, and LVI.
Breast ; Breast Neoplasms ; Cosmetics ; Great Britain ; Humans ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Subcutaneous ; Nipples ; Retrospective Studies ; Sample Size

PURPOSE: Gynecomastia is an abnormal increase in the volume of the male breast. Subcutaneous mastectomy was the first surgical treatment for gynecomastia. But because of the complications such as nerve injury and scar formation, subcutaneous mastectomy has been substituted with liposuction. Recently various techniques including ultrasound-assisted liposuction has been used for treatment of gynecomastia. The purpose of this study is to evaluate the results of XPS(R) microresector (Shaver) for treatment of gynecomastia. METHODS: 17 patients, 33 breasts of gynecomastia, Simon grade I or II have been treated with XPS(R) microresector (Shaver). The mean age was 24.5. The subcutaneous tissue and glandular tissue were removed with XPS(R) microresector (Shaver). The operation time, the weight of removed tissue and patients' satisfaction score were accessed. RESULTS: The mean operation time was 78.2 minutes. The mean weight of removed tissue was 113.8 g. There were no significant complications such as necrosis, hematoma, infection or scar contracture. Patients' satisfactory score of scar, shape and confidence were 8.4, 8.2 and 8.4 respectively. As the average score was 8.3, most of the patients were satisfied with their breasts. CONCLUSION: The authors have treated 17 patients suffering from gynecomastia with XPS(R) microresector (Shaver). We obtained short operation time, early recovery, minimal operative scar and less complications with XPS(R) microresector (Shaver) for the treatment of gynecomastia, and patients were satisfied with the results of our method. We concluded that XPS(R) microresector (Shaver) is an alternative option for the treatment of gynecomastia.
Breast ; Cicatrix ; Contracture ; Gynecomastia ; Hematoma ; Humans ; Lipectomy ; Male ; Mastectomy, Subcutaneous ; Necrosis ; Stress, Psychological ; Subcutaneous Tissue

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.
Breast* ; Female ; Free Tissue Flaps ; Granuloma ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Subcutaneous ; Microsurgery ; Middle Aged ; Perforator Flap* ; Silicon ; Silicones ; Tissue Donors