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Electron Physician 2018 Aug 25;10(8):7230-7234. Epub 2018 Aug 25.

M.D., MRCS, Lecturer of Plastic Surgery, Kasr Alainy Medical School, Cairo University, Cairo, Egypt.

Reduction mammaplasty in huge breasts poses a great challenge for plastic surgeons. The classic technique is free nipple and areola grafting after breast amputation. This paper is a short technical report of reduction mammoplasty on 40 patients with severe breast ptosis (suprasternal notch to nipple >35 cm) and giganticomastia (anticipated resection of more than 1 kg per breast) were operated upon using superomedial pedicle technique for reduction mammaplasty. Read More

S Afr J Surg 2016 Nov;54(4):46-50

Background: Reduction mammoplasty procedures in patients with macromastia and gigantomastia can prove a major challenge to the plastic surgeon. Although several techniques have been described to reduce very large breasts, they can often result in vascular compromise to the nipple-areola complex (NAC) and skin flaps, decrease in NAC sensation and inability to breast-feed. The superomedial pedicle (SMP) procedure is often used in patients with moderate to large breast reductions. Read More

Euro Surveill 2015 Feb 26;20(8). Epub 2015 Feb 26.

Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands.

Post-discharge surveillance (PDS) for surgical site infections (SSIs) normally lasts 30 days, or one year after implant surgery, causing delayed feedback to healthcare professionals. We investigated the effect of shortened PDS durations on SSI incidence to determine whether shorter PDS durations are justified. We also studied the impact of two national PDS methods (those mandatory since 2009 (‘mandatory’) and other methods acceptable before 2009 (‘other’)) on SSI incidence. Read More

Aesthetic Plast Surg 2014 Aug 6;38(4):718-26. Epub 2014 Jun 6.

Department of Plastic and Reconstructive Surgery, Bagcilar Research and Training Hospital, Oztopuz cad. Camli konak, Ulus-Besiktas-Istanbul, Istanbul, Turkey,

Background: Although the free-nipple breast-reduction technique is essentially an amputation, achieving aesthetic results still is important. The authors present their technique for free nipple-areola complex (NAC) transfer over the superomedial or superior pedicle full-thickness flaps in patients for whom a free-nipple technique is inevitable due to certain risk factors.

Methods: The study included 25 patients who underwent surgery with the aforementioned method for addressing severe gigantomastia. Read More

Aesthet Surg J 2013 Jan 27;33(1):77-83. Epub 2012 Nov 27.

Plastic Surgery, University of Texas Medical Branch, Webster, TX 77598, USA.

Background: Nipple hypertrophy is associated with physical and psychological sequelae, leading patients to seek corrective treatment.

Objectives: The authors present a simple surgical technique to reduce nipple height with minimal tissue manipulation.

Methods: Between November 2000 and October 2010, the senior author (CM) employed a nipple amputation technique to correct nipple hypertrophy in 30 consecutive patients. Read More

Ann Plast Surg 2013 Nov;71(5):471-5

From the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Lodz, Poland.

Background: The aim of the study was to evaluate the surgical management of gynecomastia focusing on techniques, complications, and aesthetic results. The authors also proposed an evaluation scale of the cosmetic results after the treatment.

Methods: We conducted a retrospective analysis of 113 patients undergoing the surgery for gynecomastia in our department. Read More

Aesthetic Plast Surg 2012 Dec 9;36(6):1340-6. Epub 2012 Oct 9.

Department of Plastic Surgery, Inonu University School of Medicine, Malatya, Turkey.

Background: Reduction mammaplasty for macromastia provides relief from uncomfortable symptoms and improves self-confidence and the ability to participate in sports activities. Reduction mammaplasty using the free nipple graft technique may result in bottoming-out deformity and a lack of upper-pole projection. We describe a modified breast reduction technique that combines the Graf and Thorek methods. Read More

Aesthetic Plast Surg 2012 Oct 31;36(5):1140-3. Epub 2012 Aug 31.

Department of Plastic Reconstructive and Aesthetic Surgery, ESOGU Medical School, Meselik Eskisehir, Turkey.

Background: Although widely used in women who have gigantomastia, free nipple graft breast reduction has several disadvantages with respect to the nipple-areola graft. In this report, we present the use of a nipple reconstruction method instead of free nipple grafting.

Method: Free nipple reduction mammaplasty is performed according to the Wise pattern. Read More

Surg Today 2011 Mar 2;41(3):390-5. Epub 2011 Mar 2.

Department of Surgical Oncology, Breast and Endocrine Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.

We report a case of early breast cancer, which was treated successfully by oncoplastic surgery. A 65-year-old Japanese woman was referred to us for investigation of a grouped calcification on mammography of her left breast, detected during mass screening for breast cancer. No mass lesion was palpated, but we suspected that the grouped calcification seen on the mammography was a malignant lesion in the lower area of the left breast. Read More

Ned Tijdschr Tandheelkd 2010 Apr;117(4):206-10

Afdeling Chirurgie van het Flevoziekenhuis, Almere.

In The Netherlands mamma carcinoma is diagnosed in about 12.000 women each year. The prognosis has improved due to screening, local control and adjuvant therapy. Read More

Plast Reconstr Surg 2008 Mar;121(3):735-9

Department of Plastic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa.

Background: The optimal reduction technique for the treatment of macromastia greater than 1 kg remains controversial. Conventionally, breast amputation and free nipple grafting has been used, but this leaves a flat and insensate nipple. Anatomical studies have suggested the superomedial technique to be a safe choice in these patients. Read More

Ann Plast Surg 2005 Jul;55(1):21-4; discussion 24

Division of Plastic and Reconstructive Surgery, Hand Center, Temple University School of Medicine, Philadelphia, PA, USA.

Excessive breast hypertrophy or gigantomastia (>2000 g excision of tissue per breast) has traditionally been approached with breast amputation and free nipple grafting during reduction mammaplasty procedures. Disadvantages of free nipple grafts include loss of sensation, poor projection, uneven nipple-areolar complex pigmentation, and loss of lactation. We report our experiences utilizing the inferior pedicle technique of reduction mammaplasty with successful preservation of the nipple-areola complex for patients with gigantomastia. Read More

Aesthetic Plast Surg 2005 May-Jun;29(3):205-9

Background: : Gigantomastia, characterized by massive breast enlargement during adolescence or pregnancy, is thought to be caused by an abnormal and excessive end organ response to a normal hormonal milieu. The amputation technique with the free nipple-areola graft is the mainstay for severe macromastia, but it has been criticized because it results in a flattened, nonaesthetic breast with poor projection. This report presents two sisters with unusual, excessive breast enlargement. Read More

Aesthet Surg J 2004 Mar-Apr;24(2):102-11

Division of plastic Surgery, Julia Kubistchek Hospital FHEMIG, Belo Horizonte, Brazil.

Background: The cutaneous sequelae resulting from mastopexy and reduction mammaplasty are serious drawbacks for patients, particularly young women, and physicians who are dissatisfied with extensive postoperative scarring.

Objective: The author reports on an L-incision technique that involves a base resection with an upper transposition of the nipple-areolar complex (NAC) to yield good shape and projection, short scars, and preservation of lactation.

Methods: Preoperative markings were made to aid estimation of the amount of breast tissue to be excised, to establish anatomic landmarks ensuring breast symmetry, and to position the scars. Read More

Aesthetic Plast Surg 2002 Nov-Dec;26(6):457-60

Women with extremely large and ptotic breasts have many complaints and difficulties during daily life. Conventional reduction mammaplasty techniques are not convenient because the presence of excess tissue beneath and over a long pedicle may cause nipple-areola complex necrosis. These patients mostly have systemic health problems so they benefit from a shorter operative procedure. Read More

Ann Plast Surg 2002 Jul;49(1):24-31; discussion 31-2

Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Reduction mammaplasty with nipple-areolar transposition on a medial pedicle was designed as an alternative to amputation and free nipple graft for women with severe mammary hypertrophy. The purpose of this study was to review the viability and sensory outcome of the nipple-areolar complex (NAC) in 72 women (133 breasts) after medial pedicle and inferior pedicle reduction mammaplasty between 1996 and 2000. The medial pedicle was used for 41 women (79 breasts) with moderate to severe mammary hypertrophy. Read More

Aesthetic Plast Surg 2000 Nov-Dec;24(6):450-4

Breast reduction or amputation in female-to-male surgery presents a specific surgical problem: obtaining a good breast shape of the masculine type. Over a 2-year period, 17 patients (12 female-to-male transsexuals and 5 extreme gynecomastias) were operated on using the circumareolar approach for subcutaneous mastectomy. The nipple-areola complex was left on a very wide deepithelialized dermal pedicle, and the final closure of the wound was performed using a round-block technique followed by numerous fine sutures to reduce wrinkling. Read More

Handchir Mikrochir Plast Chir 2000 Sep;32(5):316-20

Abteilung für Hand- und Plastische Chirurgie, Kantonsspital Luzern.

In comparison with other surgical procedures concerning the breast, the history of reduction mammaplasty is relatively short. Some authors have mistaken Paulos of Aegina for the pioneer in this field, although he occupied himself exclusively with gynaecomastia. Since some decades Hanns Schaller, the so-called "barber" of Augsburg, is considered to be the first surgeon to have performed a reduction mammaplasty by breast amputation in 1561. Read More

J Bone Joint Surg Am 2000 Apr;82(4):544-54

Mayo Clinic, Rochester, Minnesota 55905, USA.

Background: The purpose of this study was to evaluate the functional results, rates of union, and complications associated with vascularized free fibular transfer combined with autografting for the treatment of nonunions in previously irradiated bone.

Methods: Seventeen patients who had had eighteen vascularized free fibular transfers combined with autografting for the treatment of nonunion of a fracture in previously irradiated bone were included in this study. There were eleven female patients and six male patients. Read More

Plast Reconstr Surg 2000 Mar;105(3):896-904

Division of Plastic Surgery at Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Current options in reduction mammaplasty for severe mammary hypertrophy include amputation with free-nipple graft as well as the inferior pedicle and bipedicle techniques. Complications of these procedures include nipple-areola necrosis, insensitivity, and hypopigmentation. The purpose of this study was to determine whether medial pedicle reduction mammaplasty can minimize these complications. Read More

Ann Plast Surg 1997 Apr;38(4):421-4; discussion 424-5

Albert Einstein Medical Center, Philadelphia, PA, USA.

Multiple techniques for breast reduction in the giant breast have been used. The amputation technique with the free nipple/areolar graft has been the mainstay for severe macromastia since 1921. Traditional methods for amputation of the inferior pole of the breast have created fairly flat breast mounds. Read More

Ann Plast Surg 1996 Dec;37(6):585-91

Department of Surgery, University of Iowa College of Medicine, Iowa City, USA.

In extreme cases of breast hypertrophy, amputation of the nipple-areolar complex and transplantation during reduction mammaplasty has been advocated to avoid nipple necrosis. We report our experience with 172 patients having inferior breast pedicle reduction without amputation of the nipple-areolar complex. Mean total weight of resected tissue was 1,946 g (548 to 5,100 g), with a mean nipple-areolar transposition of 10 cm (0. Read More

Surgery 1996 Aug;120(2):265-72; discussion 272-3

Department of Surgery, Duke University Medical Center, Durham, N.C. 27710, USA.

Background: Metastatic disease remains the most frequent cause of treatment failure in the management of patients with breast cancer. A novel method that allows delivery of a gene into primary tumor cells was used to generate tumor cell vaccines to inhibit metastasis formation in tumor-bearing hosts.

Methods: Inoculation of 2. Read More

Ann Plast Surg 1994 Nov;33(5):561-4

Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, CA 94305.

Patients with gigantomastia have severely distorted anatomical breast structures. Reduction mammaplasty in such cases using the inferiorly based pedicle containing the nipple-areola complex can be technically difficult, yield poor results, and cause postoperative complications such as nipple necrosis and loss. Alternative traditional methods such as amputation mammaplasty with free nipple-areola transplantation usually results in a flattened, nonaesthetic breast with poor projection. Read More

Plast Reconstr Surg 1993 Jun;91(7):1265-9

Plastic Surgery Program, Johns Hopkins University, Baltimore, Md.

A vibrometer and Semmes-Weinstein monofilaments were used to delineate the sensory threshold for quickly and slowly adapting fibers in 13 women with gigantomastia (bra size D or greater) as compared with small-breasted women (bra size A or B). It was found that the mean thresholds for gigantomastia patients were significantly higher (i.e. Read More

Ann Plast Surg 1991 Feb;26(2):117-21

University of Michigan Medical Center, Catherine McCauley Health Center, Ann Arbor.

Multiple techniques for breast reduction have been proposed. For carefully selected women with macromastia, the technique of choice may be amputation mammoplasty with free nipple-areolar grafting. These select groups include the following: the poor-risk elderly, women with systemic disease that could affect the vascularity of the skin flaps or impair wound healing, women with previous operative procedures in the breast affecting skin flap or pedicle vascularity, and women with indications for removal of tissue in the region of the inferior pedicle. Read More

J Pediatr Surg 1988 Nov;23(11):1014-5

Department of Plastic Surgery, Central Emek Hospital, Afula, Israel.

Juvenile breast hypertrophy in a 12-year-old girl was treated by bilateral reduction mammoplasty (amputation type) with free transplantation of the areolae and nipples and removal of 8,200 g of breast tissue. Eleven months later, subcutaneous mastectomy with subpectoral tissue expander insertion was performed due to recurrent enlargement of the breasts, with removal of an additional 5,000 g. Three months later, silicone prostheses replaced the tissue expander, with reconstruction of areolae and nipples. Read More

Strahlenther Onkol 1986 Feb;162(2):93-9

A significant amelioration of treatment results is achieved by sequential chemotherapy and radiotherapy in patients with lymphogranulomatosis of stage IIb to IVb and in patients with non-Hodgkin's lymphomas in corresponding stages. Similar results will probably be obtained in patients with small cell bronchial carcinomas in a limited stage. Patients suffering from an initially inoperable ovarian cancer often reach an operable condition by sequential chemotherapy and radiotherapy. Read More

Plast Reconstr Surg 1985 Nov;76(5):708-12

Black women have not embraced cosmetic and reconstructive surgery of the breast with the same enthusiasm as their Caucasian counterparts because of fear of hypertrophic scars. The authors offer suggestions on how to minimize the scarring associated with breast surgery in black women. They feel that intraareolar incisions should be used whenever circumareolar incisions are indicated in augmentation mammaplasty, because the areola, being a favored area, is less likely to produce hypertrophic scars. Read More

Ann Plast Surg 1980 Sep;5(3):167-77

Transposition of the nipple-areola on a narrow, single, inferiorly based breast subcutaneous pedicle in reduction mammaplasty is safe, even in patients with massive macromastia. We report breast reduction performed with the single pedicle in 15 breasts in 10 patients, with bipedicles as long as 51 cm (prior to amputation), with single inferior pedicles as long as 30 cm, and with resections of up to 3,000 gm per breast. We are not proposing resection of the superior pedicle in all vertical pedicle mammaplasties; we are saying, rather, that the superior pedicle may be discarded with the resected breast tissue, and the nipple-areola may be transferred safely on a pedicle that is narrower than previously described by others. Read More

South Med J 1976 Oct;69(10):1367-71

There are many technics available today for reducing the oversize female breast. The most commonly used operations may be divided into two catergories, depending on treatment of the nipple-areolar complex: (1) free graft or (2) transposition on underlying tissue. According to this division, various methods are outlined and discussed. Read More

Chirurg 1976 Jun;47(6):336-44

Eight pathologic fractures of benign and 52 of malignant origin are reported. Open reduction and rigid internal fixation should be performed to give the patient the use of his affected limb as soon as this can be accomplished. Treatment consists of internal fixation in lesions of the shaft and prosthetic replacement in the case of lesions near joints. Read More

Plast Reconstr Surg 1969 Nov;44(5):441-6

Proc R Soc Med 1950 Jun;43(6):487-8