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The aim of a mastopexy is to raise the breast projection, tighten the skin envelope, and place the nipples in an optimal position in projection to the inframammary fold. This procedure is often combined with prosthetic implants or an autoimplant. Given the current increasing demand for the use of autologous tissue, we evaluated mastopexies combined with either an autoimplant or prosthetic implant in terms of patient satisfaction and long-term results. We evaluated 34 patients who underwent a mastopexy with simultaneous breast prosthesis or an autoimplant. During follow-ups we obtained standardized breast measurements, BREAST-Q score, and pre- and postoperative photographs to perform photometric measurements. Regarding breast shape, photometric evaluations presented a significantly different breast shape with higher upper pole fullness in augmentation-mastopexy patients. No statistical significance between long-term results and complication rates could be observed in either patient groups. The BREAST-Q score implies a higher overall long-term satisfaction in patients that received autoimplant-mastopexy with similar long-term results compared with augmentation-mastopexy. Breast ptosis is a common issue in plastic surgery that may result from a combination of breast parenchyma involution and reduced elasticity of the skin envelope. This therefore leads to a low breast profile and nipple-areolar complex NAC that descends towards the inframammary crease.
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They create an unflattering comparison but also an unobtainable ideal. I wanted to rehumanise women through honest photography. Dodsworth interviewed each woman at length, starting by asking them how they felt about their breasts. The interviews soon became more emotional than she anticipated. I realised that this had become an exploration of what it means to be a woman. Her subjects range in age from 19 to , and include a priest, a lapdancer, cancer survivors and women who have had surgery. The absolute anonymity she granted her subjects elicited honest interviews, ranging from the beautiful through the mundane to the painful. Many women cried. I felt more in touch with them and they became more erogenous. Dodsworth also took part, but will not be anonymous, which she found difficult.
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By Joe Middleton For Mailonline. Record numbers of women are suffering pain from their breast implants, the latest figures reveal. Women can report a number of issues after having breast implant surgery such as severe aching. There can also be other side-effects related to the implant itself which can leak or rupture. She added: 'It should only be undertaken when the woman understands the long-term effects and risks. Almost 8, operations were carried out by private surgeons last year according to the British Association of Aesthetic Plastic Surgeons. Women underwent 92 per cent of all cosmetic procedures recorded, with the most popular procedures being breast augmentation, breast reduction and blepharoplasty. The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline. By posting your comment you agree to our house rules. Do you want to automatically post your MailOnline comments to your Facebook Timeline?
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The aim of a mastopexy is to raise the breast projection, tighten the skin envelope, and place the nipples in an optimal position in projection to the inframammary fold. This procedure is often combined with prosthetic implants or an autoimplant. Given the current increasing demand for the use of autologous tissue, we evaluated mastopexies combined with either an autoimplant or prosthetic implant in terms of patient satisfaction and long-term results.

We evaluated 34 patients who underwent a mastopexy with simultaneous breast prosthesis or an autoimplant. During follow-ups we obtained standardized breast measurements, BREAST-Q score, and pre- and postoperative photographs to perform photometric measurements. Regarding breast shape, photometric evaluations presented a significantly different breast shape with higher upper pole fullness in augmentation-mastopexy patients. No statistical significance between long-term results and complication rates could be observed in either patient groups.

The BREAST-Q score implies a higher overall long-term satisfaction in patients that received autoimplant-mastopexy with similar long-term results compared with augmentation-mastopexy.

Breast ptosis is a common issue in plastic surgery that may result from a combination of breast parenchyma involution and reduced elasticity of the skin envelope. This therefore leads to a low breast profile and nipple-areolar complex NAC that descends towards the inframammary crease. Besides aging, several factors can contribute to breast ptosis such as massive weight loss, pregnancies, breast-feeding, and postpartum involution 1.

A variety of mastopexy techniques have been described to address the degrees of breast ptosis 2 - 5. These approaches aim to raise the breast projection, tighten the skin envelope, and place the NAC in an optimal position perpendicular to the inframammary crease. However, in patients with extensive breast tissue loss, a mastopexy often needs to be combined with prosthetic implants in order to restore the projection of the breast and gain a sufficient upper pole fullness.

While breast implants cause a foreign body reaction that can lead to capsular contracture and results in poor aesthetic results, and pain in the long run, several authors have proposed the use of glandular rearrangement to optimize central mound projection in effort to avoid the use of implants 6 - 8.

In our department, an inferior based dermoglandular flap proposed by Graf and Biggs was used 2. Concerning mastopexies combined with an autoimplant, literature is relatively sparse and heterogeneous due to different surgical techniques and outcome definitions 1 - 4.

All patients gave written consent prior to study participation. After a minimum of 1 year, a follow-up consultation included standardized breast measurements, standardized postoperative photographs, and BREAST-Q scoring took place. Standardized breast measurements included sternal notch to nipple distance SNN , nipple to inframammary fold distance, midline to nipple distance, diameter of nipple areolar complex, and breast width.

The study protocol provides an examination of all patients by the first author. Additional photometric measurements with Mirror 7. In all cases, the technique described by Graf and Biggs was adapted to create an autoimplant 2. Patients were marked in a standing position prior to surgery as per standard protocol. The operation proceeded with the deepithelialization of the Wise pattern Figure 1A , followed by horizontal incision of the dermis about one centimeter below the areola, perpendicular to the plane of the thoracic wall until the incision meets it at the fourth intercostal space Figure 1B.

In the upper portion of the flap, an oblique incision was made, therefore leaving intact tissue for the breast pillars laterally and medially. The lower portion of the flap was dissected down to the original inframammary crease widening at its base, thus creating an inferior pedicle flap Figure 1C. Blood supply was based on the arteries of the fourth and fifth intercostal spaces.

After a bipedicled pectoralis major sling was prepared, the flap was placed under the muscle and fixed to the thoracic wall, followed by closure of the breast pillars, as well as suturing of the dermis and skin plane-by-plane, which resulted in a typical inverted-T scar.

Surgical technique. A Deepithelialization of the Wise pattern; B horizontal incision of the dermis about one centimeter below the areola; C flap design before preparation of pectoralis muscle sling. To perform the circumvertical mastopexy combined with silicone implants, the operation commenced with an inframammary approach to prepare the pocket for the implant. This was subpectoral for 15 patients, and prepectoral in one. Afterwards, a sizer was inserted and the incision in the inframammary crease was temporarily closed.

In a supine position, the anchor-shaped pattern was deepithelialized and the final silicone implant inserted. The margins of the remaining skin envelope were brought together and sutured plane-by-plane which resulted in either a vertical scar alone or an inverted-T scar. Photometric measurements of lateral views were performed as described by Eric Swanson Briefly, photographs were orientation-matched, and calibration was performed using an average upper arm length of Afterwards, a vertical line was dropped at the level of the suprasternal notch to mark the posterior breast margin.

Then, a horizontal line was drawn at the level of maximum postoperative breast projection Mpost. Area calculations above and below this plane allow for lower pole area LPA calculation as well as upper pole area UPA before and after surgery. To assess the level of upper pole projection UPP the distance between the level of breast projection and the sternal notch was bisected.

The level of the lower pole LP was defined by the distance between the lowest point of the breast and maximum postoperative breast projection.

Additional calculations allow for breast mound elevation BME determination, which was the difference between the level of maximum preoperative breast projection Mpre and Mpost. Additionally, an assessment of the upper pole contour was performed in all patients.

To do so, a diagonal line was drawn at the level of UPP, and the contour of the upper pole was compared with the line and divided into the following categories: linear, concave and convex. Questionnaires were completed anonymously by all patients. For our study, the post-augmentation module ideally fit the patients that wished to have a more youthful and voluminous breast. The questionnaire was separated in two parts and consisted of 88 questions in total: I patient satisfaction and II health-related quality of life.

The satisfaction domain included satisfaction with breasts, outcome, information, surgeon, medical team, and office team. Quality of life domain included psychosocial, sexual, and physical well-being. Twelve questions specifically referring to silicone implants were excluded to allow for a valid comparison between both groups. The remaining majority of 76 responses were ranged on a Likert-like scale.

Statistical analysis was performed using descriptive and summary statistics to identify a central tendency. Microsoft Corp. The BREAST-Q score was calculated using the Q Score Excel template and corresponding Q Score program that converts raw survey scores from 1 to 3 or 5 in continuous scores, thus generating a total score ranging from 0 to An unpaired t -test was performed to analyze the significance of changes in mean scores between both patient groups.

The group test analysis was achieved by a Chi-square test. The study was conducted with 34 patients Table 1. Of these, 16 patients received an augmentation-mastopexy Figure 2 and 18, a mastopexy Figure 3.

The average follow-up time was 4 years range, 1—7. Two representative patients with breast ptosis A,B: 35 yrs; E,F: 34 yrs and involution of the breast after pregnancy before and 3 years after receiving a mastopexy with silicone implants C,D,G,H are shown.

Two representative patients with breast ptosis before A,B: 29 yrs; E,F: 25 yrs and after receiving a mastopexy with an autoimplant C,D: 27 months postoperative; G,H: 9 months postoperative are shown. The most prevalent reason to have surgery was breast ptosis, which was preoperatively graded using the grading scale described by Regnault Table 2 In two patients, indication for surgery was due to implant-ruptures, which were diagnosed by preoperative magnetic resonance imaging.

Seven additional patients presented with capsular contracture after esthetic breast augmentation. They were all located at the T-junction and classified as minor wound dehiscence due to an affected area below 0.

They all healed by secondary intention without further complications. In both groups, one patient presented a postoperative hematoma that required reoperation only after the augmentation-mastopexy. The majority of patients reported an unaffected sensitivity of the nipple areola complex regardless of the type of procedure. The preoperatively assessed SNN was decreased in most of the patients. The mean difference of SNN was 4. Based on photometric measurements Figure 4 , BME was analyzed in both groups in terms of a linear, concave or convex shape of breasts upper pole Table 4 , Figure 5.

Augmentation-mastopexy resulted in higher dimensions of the upper pole as well as maximum breast projection. The LP level showed a greater elevation after mastopexy. Interestingly, the mean of preoperative upper pole and maximum breast projection was almost similar in both groups. Orientation-matched lateral views of patients before and after mastopexy either with autoimplants A: 38 yrs, 1 year postoperative or silicone implants B: 35 yrs, 3 years postoperative are shown.

Breast mound elevation BME goes along with an increased maximum breast projection [maximum preoperative breast projection Mpre ]; maximum postoperative breast projection Mpost in both patients after surgery.

Upper pole projection UPP is slightly increased in patient A. The upper pole fullness was assessed by the contour of the upper pole of the breast between the upper chest takeoff and the maximum point of breast projection.

It was either convex A: 33 yrs, 5 years postoperative , linear B: 52 yrs, 2 years postoperative or concave C: 25 yrs, 2 years postoperative. Given the different reasons to have surgery, an additional group-matched analysis was performed.

While a tendency towards a higher satisfaction after mastopexy was observed, the difference was not statistically different for patients with breast ptosis.

The mean scores of the remaining categories including sexual well-being, satisfaction with information, satisfaction with medical team, and satisfaction with the office staff were comparable. The applied BREAST-Q post-augmentation module allowed for a reliable comparison of patient satisfaction after augmentation-mastopexy and mastopexy, especially in regards to a more firm, youthful looking, and voluminous breast.

Furthermore, the mean follow-up of 4 years allowed us to assess long-term satisfaction, which is crucial in validating a surgical breast procedure. Although our study is based on a small sample size, the comparison between both techniques regarding patient satisfaction has not been analyzed or reported yet elsewhere.

Traditionally, mastopexy was performed using primarily skin excision techniques such as crescent, periareolar, circumvertical, and inverted T-designs. However, since many patients seek restoration of the upper pole fullness, surgical techniques with an additional repositioning of an inferiorly, superiorly or central based glandular pedicle were introduced.

Since the first reports of autologous parenchymal flaps in the s 14 , 15 , numerous techniques with only subtle variations were published. These include variations regarding incision patterns, orientation of the pedicle and fixation maneuver 2 - 4 , 15 - Further techniques propose the additional use of tissue from the back, referred to as thoracic wall flaps, that are especially popular in massive weight loss patients 5 , Given these numerous surgical techniques, the superior technique regarding long-term stability remains a matter of debate.

In , Swanson reviewed 82 publications on mastopexy based on his proposed measuring system to quantitate and compare results. He claimed that any methods to increase upper pole fullness or projection, such as fascial sutures and glandular repositioning, generally did not maintain shape in the long term More recent studies include cohorts with 27— patients and analyze the outcome after mastopexy with an inferiorly-based parenchymal flap within one year after surgery.

Similar to our results, a mean nipple elevation between 4 to 8 cm has been reported. A natural sagging of the breast of 1 cm within the first year of surgery was observed.

Nevertheless, neither upper pole fullness, patient satisfaction nor long-term results after more than 1 year was assessed by any of the studies 1 , 3 , 4 , 9.



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