Hybrid Inferior Pedicle Reduction Mammaplasty with Free Nipple Grafts in a Patient with Gigantomastia.

Gigantomastia presents a unique set of challenges for preservation of the nipple-areola complex in patients undergoing reduction mammaplasty. Historically an indication for breast amputation and free nipple graft (FNG), gigantomastia is now commonly treated using pedicle-based reconstruction. We present a case combining these two surgical techniques, using an inferior-pedicle reduction with an FNG in the management of extreme breast hypertrophy with 11,300 g in total resected.

The GLAND-IQ Technique for Surgical Correction of Moderate to Severe Gynecomastia.

Surgical correction of gynecomastia currently ranks in the top five cosmetic procedures performed in men in the United States. Although removal of excess gland is relatively straightforward, the combination of glandular/fatty excess, significant skin redundancy, nipple ptosis, and nipple-areolar complex hypertrophy poses a significant challenge in the male patient desiring inconspicuous scars. The latter renders any form of skin and nipple reduction/elevation using traditional mastopexy patterns or breast amputation with free nipple grafting less favorable due to the surgical stigmata and scars produced with these techniques.

Targeted muscle reinnervation: a brief history of a promising procedure for effective management of amputation pain.

Each year, 27.5% of the 150 000 people in the United States who require lower extremity amputation experience significant postoperative complications, including pain, infection, and need for reoperation. Postamputation pain, including RLP and PLP, is debilitating.

The evolution of breast reconstructions with free flaps: a historical overview.

Background: Breast cancer is the most frequent cancer among women and is responsible for the highest number of cancer-related deaths. Approximately 40% of the patients with breast cancer will undergo a mastectomy. Breast amputation is a lifesaving but mutilating procedure.

Cell-Trappable BODIPY-NBD Dyad for Imaging of Basal and Stress-Induced HS in Live Biosystems.

HS is a gaseous signaling molecule that is involved in many physiological and pathological processes. In general, the level of intracellular HS (<1 μM) is much lower than that of GSH (∼1-10 mM), leading to the remaining challenge of selective detection and differentiation of endogenous HS in live biosystems. To this end, we quantitatively demonstrate that the thiolysis of NBD amine has much higher selectivity for HS over GSH than that of the reduction of aryl azide.

Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors.

Body image concerns often arise during and after treatment and are a major concern in up to 67% of breast cancer survivors. Negative changes in body image are a predictor of worse satisfaction with appearance and poor quality of life outcomes. Opportunities to mitigate the negative impact of cancer treatment on a patient's body image present during preoperative education or in the neoadjuvant setting, or during surgical management, adjuvant therapy delivery, and survivorship.

Ischaemic breast necrosis following coronary artery bypass grafting using left internal mammary artery: understanding the risks.

Background: Coronary artery bypass grafting (CABG) is a common procedure performed commonly using left internal mammary artery (LIMA). We report a case of sternal wound dehiscence and breast necrosis following LIMA harvest in a 55-year-old obese lady with macromastia, diabetes mellitus, hypertension and end stage renal disease requiring dialysis. We also review the existing literature.

Stewart-Treves syndrome: Case report and literature review.

Lymphangiosarcoma, or Stewart-Treves Syndrome (STS), is a very rare skin angiosarcoma with poor prognosis, which usually affects the upper limbs of patients who underwent breast cancer surgery, including axillary dissection followed by radiotherapy (RT). Cutaneous lymphangiosarcomas, which account for approximately 5% of all angiosarcomas, usually originate in the limb with chronic lymphedema. Lymphatic blockade is involved in the onset of STS.

Current surgical techniques for nipple reduction: A literature review.

Background: Macrothelia, enlarged nipples, is a relatively uncommon condition causing psychological distress in both sexes. However, to date, there is no comprehensive comparison of the spectrum of surgical techniques for nipple reduction. This review summarises the current practices to guide surgical approach to macrothelia.

SGLT2 Inhibitors: A Review of Their Antidiabetic and Cardioprotective Effects.

Type 2 diabetes mellitus is a chronic metabolic disease associated with high cardiovascular (CV) risk. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are the latest class of antidiabetic medication that inhibit the absorption of glucose from the proximal tubule of the kidney and hence cause glycosuria. Four SGLT2i are currently commercially available in many countries: canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin.

Is There an Association Between Insurance Status and Survival and Treatment of Primary Bone and Extremity Soft-tissue Sarcomas? A SEER Database Study.

Background: Several recently published population-based studies have highlighted the association between insurance status and survival in patients with various cancers such as breast, head and neck, testicular, and lymphoma [22, 24, 38, 41]. Generally, these studies demonstrate that uninsured patients or those with Medicaid insurance had poorer survival than did those who had non-Medicaid insurance. However, this discrepancy has not been studied in patients with primary bone and extremity soft-tissue sarcomas, a unique oncological population that typically presents late in the disease course and often requires referral and complex treatment at tertiary care centers-issues that health insurance coverage disparities could aggravate.

Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis.

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.

Macromastia and gigantomastia: efficacy of the superomedial pedicle pattern for breast reduction surgery.

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.

Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration.

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.

The free-nipple breast-reduction technique performed with transfer of the nipple-areola complex over the superior or superomedial pedicles.

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.

Treatment of nipple hypertrophy by a simplified reduction technique.

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.

Surgical management of gynecomastia: an outcome analysis.

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.

An autoprosthesis technique for better breast projection in free nipple graft reduction mammaplasty.

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.

e-Flap nipple reconstruction in amputation mammaplasty.

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.

Oncoplastic surgery combining partial mastectomy with breast reconstruction using a free nipple-areola graft for ductal carcinoma in situ in a ptotic breast: report of a case.

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.

[Mammary carcinoma].

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.

Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia.

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.

Avoiding free nipple grafts during reduction mammaplasty in patients with gigantomastia.

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.

Familial severe gigantomastia and reduction with the free nipple graft vertical mammoplasty technique: report of two cases.

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.

Mammaplasty with L-incision.

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.