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Complications in Breast Reduction, An Issue of Clinics in Plastic Surgery, E-Book

Complications in Breast Reduction, An Issue of Clinics in Plastic Surgery, E-Book

Dennis C. Hammond

(2016)

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Book Details

Abstract

This issue of Clinics in Plastic Surgery, devoted to Complications in Breast Reduction, is guest edited by Dr. Dennis C. Hammond. Articles in this issue include: Assessing Risk and Avoiding Complications in Breast Reduction; Management of Shape Distortion After Vertical Breast Reduction; Management of Shape Distortion After Wise Pattern Breast Reduction; Management of Shape Distortion After SPAIR Mammaplasty; Management of the Ischemic NAC After Breast Reduction; Nipple Reconstruction After NAC Necrosis Following Breast Reduction; Management of Recurrent Macromastia; Management of Occult Cancer After Breast Reduction; Mammographic Management of the Post-reduction Breast; Management of Asymmetry After Breast Reduction; Management of the High Riding Nipple After Breast Reduction; Breast Reduction in the Burned Breast; Avoiding Complications in Gigantomastia; and Avoiding Medicolegal Risk in Breast Reduction.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Complications in Breast Reduction\r i
Copyright\r ii
Contributors iii
EDITOR iii
AUTHORS iii
Contents v
Preface: Complications in Plastic Surgery\r v
Assessing Risk and Avoiding Complications in Breast Reduction\r v
Reduction Mammaplasty and Breast Cancer Screening\r v
The Management of Breast Cancer Detected by Reduction Mammaplasty\r v
Avoiding the Unfavorable Outcome with Wise Pattern Breast Reduction\r v
Managing Complications in Vertical Mammaplasty\r vi
The Short Scar Periareolar Inferior Pedicle Reduction Mammaplasty: Management of Complications\r vi
Management of Asymmetry After Breast Reduction\r vi
Management of Recurrent or Persistent Macromastia\r vi
Management of the High-Riding Nipple After Breast Reduction\r vii
Management of the Ischemic Nipple–Areola Complex After Breast Reduction\r vii
Managing Necrosis of the Nipple Areolar Complex Following Reduction Mammaplasty and Mastopexy\r vii
Breast Reduction in the Burned Breast\r vii
Avoiding Complications in Gigantomastia\r viii
Medicolegal Issues in Breast Reduction\r viii
CLINICS IN PLASTIC SURGERY\r ix
FORTHCOMING ISSUES ix
July 2016 ix
October 2016 ix
January 2017 ix
RECENT ISSUES ix
January 2016 ix
October 2015 ix
July 2015 ix
Preface:Complications in \rPlastic Surgery xi
Assessing Risk and Avoiding Complications in Breast Reduction 323
Key points 323
INTRODUCTION 323
ASSESSMENT OF RISK HISTORY 325
ASSESSMENT OF RISK: PHYSICAL EXAMINATION 326
AVOIDANCE OF COMPLICATIONS: GENERAL CONSIDERATIONS 327
AVOIDANCE OF COMPLICATIONS: TECHNIQUE SELECTION 327
AVOIDANCE OF HEMATOMA 327
AVOIDANCE OF SKIN ISCHEMIA, SKIN LOSS, AND WOUND SEPARATION 328
AVOIDANCE OF NIPPLE–AREOLA COMPLEX ISCHEMIA 328
AVOIDANCE OF UNATTRACTIVE SCARS 328
AVOIDANCE OF VOLUME AND NIPPLE–AREOLA COMPLEX ASYMMETRY 329
AVOIDANCE OF NIPPLE–AREOLA COMPLEX MALPOSITION 329
AVOIDANCE OF NIPPLE RETRACTION 329
SUMMARY 329
REFERENCES 330
Reduction Mammaplasty and Breast Cancer Screening 333
Key points 333
INTRODUCTION 333
Preoperative Screening Recommendations 334
IMAGING FINDINGS POSTREDUCTION MAMMAPLASTY 334
MAMMOGRAPHY 334
ULTRASOUND AND MRI 336
FOLLOWING ONCOPLASTIC BREAST REDUCTION 337
SUMMARY 339
REFERENCES 339
The Management of Breast Cancer Detected by Reduction Mammaplasty 341
Key points 341
INTRODUCTION 341
FACTORS INFLUENCING THE INCIDENCE OF OCCULT BREAST CANCER FOUND AFTER REDUCTION MAMMAPLASTY 341
Age 341
Family History of Cancer 341
Previous Breast Biopsy Showing High-Risk Pathology 342
Personal History of Breast Cancer 342
Thoroughness of Preoperative Examination: Imaging 343
Thoroughness of Postoperative Examination: Pathology 343
MANAGEMENT OF INCIDENTALLY DETECTED BREAST CANCER 343
SUMMARY 344
REDUCTION MAMMAPLASTY AND THE RISK OF BREAST CANCER 345
SCREENING FOR BREAST CANCER AFTER REDUCTION MAMMAPLASTY 346
REFERENCES 346
Avoiding the Unfavorable Outcome with Wise Pattern Breast Reduction 349
Key points 349
INTRODUCTION 349
HISTORICAL CONSIDERATIONS 350
DESIGNING SKIN FLAPS TO MINIMIZE SHAPE DISTORTION 352
CREATING THE PEDICLE TO MINIMIZE SHAPE DISTORTION 353
CLOSURE 353
NIPPLE POSITION 356
MANAGING SCARS TO OPTIMIZE OUTCOMES 357
POSTOPERATIVE REVISION 357
SUMMARY POINTS FOR AVOIDING THE UNFAVORABLE OUTCOME WITH WISE PATTERN BREAST REDUCTION 357
REFERENCES 358
Managing Complications in Vertical Mammaplasty 359
Key points 359
INTRODUCTION 359
PATIENTS AND TECHNIQUE SELECTION 359
THE MODIFIED LEJOUR TECHNIQUE 359
TECHNIQUE, MATERIALS, AND METHODS 360
COMPLICATIONS 360
Minor Complications 360
Major Complications 362
SUMMARY 362
REFERENCES 362
The Short Scar Periareolar Inferior Pedicle Reduction Mammaplasty 365
Key points 365
INTRODUCTION 365
TECHNIQUE 365
COMPLICATIONS 366
Standard Operative Complications 366
Delayed wound healing 366
Fat necrosis 367
Late seroma scar contracture 367
Shape distortion 367
Asymmetry 368
Nipple-areolar complex distortion 368
Areolar herniation 369
Infected Teflon suture 371
Rehypertrophy 371
SUMMARY 371
REFERENCES 372
Management of Asymmetry After Breast Reduction 373
Key points 373
INTRODUCTION 373
ASYMMETRY OF THE NIPPLE-AREOLA COMPLEX 374
ASYMMETRIES OF BREAST MOUND VOLUME AND SHAPE 377
DISCUSSION 380
REFERENCES 381
Management of Recurrent or Persistent Macromastia 383
Key points 383
INTRODUCTION 383
BACKGROUND 383
ETIOLOGY 385
Inadequate Primary Volume Reduction 385
Inadequate Breast Shape 385
Breast Tissue Hypertrophy 386
PREOPERATIVE CONSIDERATIONS 386
History and Physical Examination 386
Previous Operative Records 387
Informed Consent 387
TIMING OF REPEATED BREAST REDUCTION 387
OPERATIVE TECHNIQUE 388
Understanding the Blood Supply of the Nipple-Areola Complex 388
Skin Marking and Pedicle Selection 388
Infiltration 389
De-epithelialization 390
Excision of Breast Tissue 390
Liposuction 391
Closure 391
SUMMARY 391
REFERENCES 392
Management of the High-Riding Nipple After Breast Reduction 395
Key points 395
INTRODUCTION 395
SUMMARY/DISCUSSION 396
INDIRECT CORRECTION OF THE NIPPLE-AREOLA COMPLEX POSITION 398
INFERIOR BREAST PARENCHYMA RESECTION 398
SUPERIOR BREAST VOLUME ADDITION 398
DIRECT CORRECTION OF THE NIPPLE-AREOLA COMPLEX POSITION 399
V-Y INFERIOR NIPPLE REPOSITIONING 400
RECIPROCAL TRANSPOSITION FLAPS 400
REFERENCES 401
Management of the Ischemic Nipple–Areola Complex After Breast Reduction 403
Key points 403
INTRODUCTION 403
ANATOMIC CONSIDERATIONS 403
Vascular Nutrition of the Breast 404
RISK FACTORS CONTRIBUTING TO NIPPLE–AREOLA COMPLEX NECROSIS 404
Be Alert to 404
ASSOCIATED RISK FACTORS 405
PREOPERATIVE CONTROL 405
INTRAOPERATIVE EVALUATION 406
Vitality of the Nipple–Areola Complex During Closure Is an Important Factor to Be Checked in Every Mammaplasty Procedure 406
INTRAOPERATIVE NIPPLE–AREOLA COMPLEX PERFUSION EVALUATION 407
INTRAOPERATIVE NIPPLE–AREOLA COMPLEX REPERFUSION MANEUVERS 407
POOR NIPPLE VASCULARITY 407
FREE NIPPLE–AREOLA COMPLEX GRAFT INDICATIONS 408
WHEN TO THINK ABOUT A FREE NIPPLE–AREOLA COMPLEX GRAFT 408
COMPLICATIONS OF FREE NIPPLE GRAFTING 408
POSTOPERATIVE CONTROL: HYPOTHERMIA AND PAIN 408
NECROTIC WOUND MANAGEMENT 408
Initial Treatment 410
First 30 days 410
After Debridement of All Necrotic Tissue 410
After 30 days 410
CAN WE PREDICT NIPPLE–AREOLA COMPLEX VIABILITY? 410
INTRAOPERATIVE PROCEDURE TO CHECK TISSUE PERFUSION WITH INDOCYANINE GREEN 410
TREATMENT OF SEQUELAE 411
Different Available Options 411
SUMMARY 411
SUPPLEMENTARY DATA 413
REFERENCES 413
Managing Necrosis of the Nipple Areolar Complex Following Reduction Mammaplasty and Mastopexy 415
Key points 415
INTRODUCTION 415
PREVENTING ISCHEMIA OF THE NIPPLE AREOLAR COMPLEX 416
MANAGING ISCHEMIA OF THE NIPPLE AREOLAR COMPLEX 417
RECONSTRUCTION OF THE NECROTIC NIPPLE AND AREOLA 420
REFERENCES 423
Breast Reduction in the Burned Breast 425
Key points 425
INTRODUCTION 425
RISKS OF OPERATING ON BURNED BREASTS 425
EVALUATION OF THE HYPERTROPHIC BURNED BREAST 426
PRINCIPLES FOR REDUCING THE BURNED BREAST 426
Improve Breast Contour by Releasing Scar Contractures 426
Delay Until Grafts Are Sufficiently Healed and Breasts Are Fully Developed 426
Be Conservative When Designing the Resection Pattern 426
Consider Balancing Procedures at the Same Time 426
TECHNICAL CONSIDERATIONS 427
Inferior Pedicle Mammaplasty 427
Avoiding Complications in Gigantomastia 429
Key points 429
INTRODUCTION 429
DEFINITION 429
CAUSES 430
ANATOMY 430
EVALUATION 430
Treatment Options 431
Preoperative Counseling 431
Other Preoperative Considerations 432
Surgical Management 432
Complications 434
Nipple-Areola Complex Necrosis 435
Hematoma 435
Seroma 436
Wound Dehiscence 436
Wound Infection 436
Nipple-Areola Complex Sensation Disturbances 436
SUMMARY 436
REFERENCES 438
Medicolegal Issues in Breast Reduction 441
Key points 441
GENERAL RISKS 441
SPECIFIC RISKS 441
SIZE AND SHAPE ARE ALWAYS AN ISSUE FOR THE PATIENT SEEKING BREAST REDUCTION 442
SYMMETRY 442
PATHOLOGY OF THE BREAST SPECIMEN 443
REVISION POLICY–FINANCIAL POLICY 443
PHOTOGRAPHS AND PATIENT PRIVACY 443
INFORMED CONSENT 444
REFERENCES 444
FURTHER READINGS 444
Index 445