Objective
To explore the surgical procedures of reduction and lifting mammaplasty with the short vertical scar and breast lateral fibrous septum vascular pedicle to improve the clinical effect and reduce the complications.
Methods
Sixty-four patients underwent reduction and lifting mammaplasty: a incision around the areola and under the breast, using the breast lateral fibrous septum vascular pedicle and medial superior dermal pedicle to ensure the blood supply of the nipple. The skin and glands of the lower part of the breast were resected with suspension; upper part was lifting, with skin shaping and sutured.
Results
There were no postoperative complications such as hematoma, infection, skin and nipple areolar necrosis. The breasts were tall, plump and symmetry with little scar.
Conclusions
The breast reduction and lifting mammaplasty with breast lateral fibrous septum vascular pedicle and verical incision is effective in the treatment of macromastia and ptosis breast; breast form is satisfied and the complication is less; the operation is simple, safe, effective and worth promoting.
Key words:
Macromastia; Ptosis breast; Narrowing up; Short vertical scar; Breast lateral fibrous septum vascular pedicle
Objective
To evaluate the design formulas of the optimal location for splitting pectoralis major in terms of making type Ⅰ or Ⅱ dual-plane implant pocket.
Methods
Sixty-five patients with micromastia were collected. Breasts were divided into two types according to the soft-tissue pinch thickness of the lower pole: type Ⅰ (thickness>2 cm; 34 cases) and type Ⅱ (thickness ≤2 cm; 31 cases). The optimal levels at which the pectoralis major (PM) was severed were 3/4 or 2/4 of the distance of new inframammary fold for type Ⅰ or Ⅱ dual-plane pockets, respectively. All patients completed the pre- and post-operative BREAST-Q augmentation modules before and 6 months after surgery. The scores were changed into hundred-mark system by QScore software.
Results
The recovery processes were well-off. The breasts contour was good. Patients reported higher scores of satisfaction with breasts, psychosocial well-being and sexual well-being after surgery than before surgery (62.0±8.9 vs 27.9±4.3, 65.0±17.2 vs 17.4±8.3, 60.5±14.2 vs 30.3±5.5, P<0.05). The mean satisfaction score for the overall outcome was 90.6±5.4. However, there was no significant difference in physical well-being between before operation and aftre operation (85.3±9.5 vs 84.7±10.6). No complications such as severe capsular contracture, or displacement occurred.
Conclusions
The design formulas make the determining procedure of the optimal location for pectoralis major splitting for two types dual-plane implant pockets easier and more exactly. Our modified design method can provide the implant with the optimal soft tissue coverage, and bring desired and stable breast aesthetic outcomes. The higher satisfaction and quality of life reported by patients indicate that the formulas are feasible and worth to recommend.
Key words:
Endoscopy; Breast augmentation; Dual-plane; BREAST-Q questionnaire; Transaxillary incision
Capsular contracture is a serious complication that occurs after augmentation mammaplasty. The authors previously identified that carboxymethyl chitin had an inhibitory effect on capsule formation. This study was performed to elucidate the possible molecular mechanisms through which carboxymethyl chitin inhibits the formation of a capsule around silicone implants.In this study, the authors cultured human dermal fibroblasts and treated them with carboxymethyl chitin in vitro. The difference in proliferation between treated and untreated cells was analyzed through the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Protein levels of transforming growth factor beta-1 and alpha smooth muscle actin (α-SMA) were examined by Western blot analysis. Expression levels of type I and type III collagen were checked by enzyme-linked immunosorbent assay. In vivo, silicone implants were placed under the pectoralis muscle in 12 female rabbits. The thickness of the capsule was measured by histologic analysis, and the effect of carboxymethyl chitin on α-SMA, collagen type I and III expression levels was evaluated by real-time polymerase chain reaction analysis, enzyme-linked immunosorbent assay, Western blot, and immunofluorescence analysis.In the in vitro study, we confirmed that carboxymethyl chitin inhibited the proliferation of fibroblasts. The protein expression levels of collagen type I, transforming growth factor beta-1, and α-SMA were inhibited by carboxymethyl chitin treatment. In vivo, carboxymethyl chitin treatment reduced capsular thickness and the expression of α-SMA and collagen types I and III in capsules around silicone implants.The authors' results showed that carboxymethyl chitin could influence capsule formation around silicone implants by inhibiting the fibroblast activity, interrupting fibroblast-to-myofibroblast differentiation, and decreasing collagen synthesis.Carboxymethyl chitin influence capsule formation around silicone implants. Although more clinical studies are needed to verify the effect of carboxymethyl chitin on capsular contracture, the authors believe that it will play an effective role in the clinical application of reducing the occurrence of capsular contracture.
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