The Omega Mastopexy Technique for the Correction of Breast Ptosis after Breast Implant Explantation

Background

The past few years have seen a 50% increase in breast implant explantations. Patients with ptotic breasts may desire mastopexy, although conventional techniques are often invasive. We describe our experience with the omega mastopexy technique after breast implant explantation and capsulectomy.

Methods

In the past 2 years, 10 patients with breast Regnault classification ptosis grade I-III underwent the omega mastopexy technique following breast implant explantation and capsulectomy. A detailed description of our operating technique is provided.

Results

This series includes a total of 10 patients. The median age was 48.5 (IQR 42.8-52.5), median body mass index 26 (23.8-28.3) and median implant volume 355 (IQR 325-375). Excellent and stable aesthetic results were achieved without recurring ptosis. One patient, an active smoker, underwent reexcision after 1 year due to hypertrophic scars. No complications have been reported until this date at 2 years follow-up.

Conclusions

The omega mastopexy technique offers an excellent alternative to classic lifting techniques for ptotic breasts after breast implant explantation. Patients with increased risk of wound healing impairment are especially likely to benefit.

"The Batwing Mastopexy in Immediate Implant-based Breast Reconstruction: An Aesthetic Enhancement For Cancer Patients"

BACKGROUND

Historically, many patients with breast ptosis have been excluded from nipple-sparing mastectomies (NSM). By performing mastopexy at the time of immediate reconstruction, more ptotic patients can be considered for NSM. We review our experience of simultaneous batwing mastopexy performed at the time of immediate implant-based reconstruction.

METHODS

A retrospective chart review identified patients who underwent immediate implant-based breast reconstruction from 2015 to 2020 at a single institution. The patients were divided into two cohorts, batwing mastopexy and standard reconstruction (no mastopexy) and compared.

RESULTS

A total of 324 breast operations in 188 patients were included (80 concurrent batwing and 244 standard implant-based reconstructions). Patient demographics were similar for both groups, except patients in the batwing group had greater ptosis, while more patients in the standard group underwent adjuvant chemotherapy. Mean follow-up was 15.9 months (range 3.19 to 55.20 months). Complications rates were comparable in the batwing and standard groups with no statistically significant differences in rates of hematoma (1.3% vs 3.3%; p=0.34), seroma (5.0% vs 8.2%; p=0.34), major infection (8.8% vs 9.0%;p=0.94), skin/nipple necrosis (6.3% vs 11.5%; p=0.18) and explantation (11.3% vs 14.8%; p=0.43). Rate of minor infections was higher in the group with concurrent batwing mastopexy (10.0% vs 3.7%; p=0.03).

CONCLUSION

We demonstrate that simultaneous batwing mastopexy can be safely performed at the time of immediate breast reconstruction. In our experience, this technique provides comparable complication rates, improves aesthetic outcomes in patients with significant ptosis or macromastia and allows NSM to be an option for those who would otherwise be excluded.

Pectoralis major myo-parenchymal flap for local reconstruction of partial mastectomy defects. Description of a new technique

INTRODUCTION

Breast conservation is the standard of care treatment for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience of using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects.

PATIENTS AND TECHNIQUE

Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40-50% breast defect. The parenchymal defect was repaired with an advancement muscle flap of the ipsilateral pectoralis major muscle.

RESULTS

All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient.

CONCLUSION

The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A-B breasts.

A Novel Level I Oncoplastic Surgery Technique for Tumors Located in UIQ of the Breast Far from the Nipple: The "Cross" Technique

Breast surgery was revolutionized with the use of oncoplastic reshaping techniques minimizing breast deformities and esthetic complications. However, the application of the current oncoplastic techniques becomes challenging in some situations such as small-size breasts and when the tumors are located in special locations of the breast, for example, upper inner quadrant. In this article, an optimized oncoplastic technique named the "Cross" technique is introduced to overcome the abovementioned problems in the surgery of breast tumors located in the upper inner quadrant far from the center of the breast. Nineteen oncoplastic surgeries were performed by the same breast surgeon. The mean diameter and weight of the excised specimens were 20 mm and 74 g. The mean age of the patients was 51 years. Clear surgical margins were obtained in all patients. There was no marked deformity in the breast after surgery. The optimized technique produced promising results in our hands when applied to a selected group of patients. Moreover, the technique was found to reduce the need for revision surgery in ptotic breasts, as the alteration in the shape of the breast undergoing surgery is not significant enough to introduce asymmetry to the breasts.

Skin-reducing oncoplasty: A new concept and classification in breast cancer surgery

BACKGROUND AND OBJECTIVES

Breast-conserving surgery and skin-sparing mastectomy are nowadays widely accepted as the standard of care in selected patients with early breast cancer. After an accurate review of the literature, it appeared that no ordered list of the numerous techniques described for conservative breast surgery has been established so far. The aim of this study was to develop a simple classification of the different skin incision patterns that may be used in breast surgery.

METHODS

A systematic review of the English literature was conducted using the PubMed database to identify all the articles reporting breast-conserving surgery and skin-sparring mastectomy techniques up to the 31st of December 2016.

RESULTS

Among the 1426 titles identified, 230 were selected for review. Based on the reviewed papers, the skin-reducing oncoplasty incision pattern (SROIP) classification was elaborated.

CONCLUSIONS

Breast cancer surgery should nowadays optimise aesthetic outcomes by improving the final breast shape, volume and scar location. This may be achieved using different procedures that we grouped together under the term skin-reducing oncoplasty (SRO). Depending on the breast cancer location, the SROIP classification helps in the choice of the best technique to be used.

Breast segmentectomy with rotation mammoplasty as an oncoplastic approach to extensive ductal carcinoma in situ

Background

The aim of this study was to assess the usefulness of the breast segmentectomy with rotation mammoplasty (BSRMP) in conserving therapy for an extensive ductal carcinoma in situ (DCIS) with or without an invasive component.

Methods

Thirty-six women with DCIS visible as large area of microcalcifications distributed out of the retroareolar area regardless of the quadrant were studied prospectively. All the patients underwent BSRMP and axillary procedure (31 sentinel node biopsy, 5 axillary dissection) followed by radiotherapy. In each case, follow-up was carried out carefully and special effort was made to identify postoperative complications. Cosmetic result was judged 6 months after radiotherapy by the patient herself and two surgeons being rated as poor, mediocre, medium, good or excellent.

Results

Operation was completed without any difficulties in all the cases. Appropriate BSRMP was easily done after the skin marking. Regardless of the type of axillary approach, it was conveniently performed. Wound was healed by primary adhesion; skin or breast tissue necrosis did not develop. Neither haematoma nor surgical site infection was observed. In none of the patient, centralisation of the nipple-areola complex (NAC) was needed. Three patients (8.3 %) with close margins (1 mm or less) successfully underwent subsequent re-excision. The scar did not result in any impairment of arm movement. Cosmetic outcome was evaluated by the women as excellent and good in 55 (87 %) and 8 (13 %) cases, respectively, while by the surgeons as excellent, good and medium in 52 (82 %), 8 (13 %), and 3 cases (5 %), respectively.

Conclusions

BSRMP is a simple and safe technique achieving good cosmetic results without NAC centralisation and giving the wide and easy access to axilla for both sentinel node biopsy and lymphadenectomy. It can be helpful in cases of extensive, radially spreading tumours (in particular DCIS or invasive cancers with intraductal component), eccentric lesions, or superficially located cancers when the neighbouring skin is excised. However, due to its limitations (long incision, difficult subsequent mastectomy, possibility of scar placement in the visible area of decollete), a careful patients’ selection should be done. Further studies are needed to assess long-term cosmetic outcomes including delayed post-radiotherapy effects.

Quality of information reporting in studies of standard and oncoplastic breast-conserving surgery

The aim of this systematic review was to establish the completeness of reporting of key patient, tumour, treatment, and outcomes information in the randomized-controlled trials (RCTs) of standard breast-conserving surgery (sBCS) considered to be the 'gold-standard', and to compare this with the reporting of the same key criteria for all published studies of oncoplastic breast-conserving surgery (oBCS). Pubmed (1966 to 1st April 2013), Ovid MEDLINE (1966 to 1st April 2013), EMBASE (1980 to 1st April 2013), and the Cochrane Database of Systematic Reviews (Issue 4, 2013) were searched separately for the following terms: (i) 'oncoplastic AND breast AND surgery'; and (ii) 'therapeutic AND mammaplasty'. Only English language and full text articles were reviewed. Following a pilot evaluation of all studies, key reporting criteria were identified. 16 RCTs of sBCS (n = 11,767 patients) were included, and 53 studies met the inclusion criteria for oncoplastic BCS (n = 3236 patients), none of which were RCTs. No study reported all of the criteria identified, with a mean of 64% of key criteria (range, 55-75%) reported in studies of sBCS, and 54% of criteria (range, 10-85%) reported in studies of oBCS. It is therefore evident that there is much room for improvement in the quality of reporting is BCS studies. Standards are proposed to give future studies of BCS a framework for reporting key information and outcomes.