October 14th, 2011 by John Di Saia, M.D. in Health Tips, Opinion
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Breast Lift surgery (Mastopexy) is obviously surgery to lift the breast. There are variations of this operation – quite a few variations. Breast lift operations are usually discussed relative to the “full breast lift” which has also been called the anchor lift. This operation leaves scars around the areola, under the breast and vertically between the two. The shape of the scar configuration resembles an anchor, hence the name. The potential for scars is one of the major concerns potential patients have with the surgery. This version of the operation also has the greatest potential to change the shape of the breast.
Reduced scar breast lifts came into creation to limit the potential for scarring. The important compromise, however, is that these modified breast lifts “lift” less. Reduced scar lifts can involve any portion of the full lift scar pattern. The modified lift with an incision above the areola only is called a “Crescent lift.” It provides only Read more »
*This blog post was originally published at Truth in Cosmetic Surgery*
August 27th, 2009 by RamonaBatesMD in Better Health Network
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Two nice articles in the June edition of the Journal of Plastic and Reconstructive Surgery. Full references are given for both below.
There are many techniques used for nipple reconstruction which should tell you that none is perfect. One of the main issues is loss of nipple projection over time. So if it is safe to spare the nipple when doing a mastectomy so no nipple reconstruction is needed – perfect!
The first article below looks at when it can be safely spared in prophylactic mastectomy (risk-reduction mastectomy) and therapeutic mastectomy clinical scenarios. Spear and colleagues did a literature review and came to the following conclusion:
It is clear from a review of the literature of the past 15 years that the subject of nipple-sparing mastectomy is complex and evolving. The subject is properly divided into two parts: risk prevention and therapeutic mastectomy.
There now seems little doubt that nipple-sparing mastectomy is an oncologically safe approach to prophylactic mastectomy. For that purpose, proper patient selection and technique remain open questions. ……….
Nipple-sparing mastectomy at the time of therapeutic mastectomy remains more controversial. There is developing consensus by those interested in nipple-sparing mastectomy as a possibility with therapeutic mastectomy that it is best suited for women who meet certain criteria. …….
The collective data suggest that, using the above below criteria, the risk of occult tumor in the nipple should be 5 to 15 percent; that frozen section of the base of the nipple will identify many if not most of those occult tumors; and that the risk of occult tumor still being present in patients screened as above with frozen section-negative findings is as low as 4 percent.
The tumor criteria listed include:
- The tumor should be 3 cm in diameter or less
- The tumor should be 2 cm away from center of the nipple
- Clinically negative axillae or sentinel node negative
- No skin involvement, and no inflammatory breast cancer.
- If possible, they should undergo preoperative magnetic resonance imaging of the breast to further exclude nipple involvement.
When the nipple can be spared then there is no need for nipple reconstruction. When it can’t be, then the nipple sharing technique can be useful. As with the above, the cancer risk is addressed:
Fears of cancer in the transplanted nipple and concerns for surveillance are thus far unfounded. This occurrence has never been described in the literature. Furthermore, as more liberal use of nipple-sparing mastectomy occurs, a large cohort of patients with retained nipples will be able to be followed over time to see whether we even need to be concerned. For now, simple self-examination as performed by these patients is appropriate.
The article gives a good description of two different ways to perform the nipple sharing depending on the shape of the donor nipple.
Both articles are worth your time to read.
REFERENCES
Nipple-Sparing Mastectomy; Plast & Recontr Surg 123(6):1665-1673, June 2009; Spear, Scott L.; Hannan, Catherine M.; Willey, Shawna C.; Cocilovo, Costanza
Unilateral Nipple Reconstruction with Nipple Sharing: Time for a Second Look; Plast & Reconstr Surg 123(6):1648-1653, June 2009; Zenn, Michael R.; Garofalo, Jo Ann
Related Posts
Breast Reconstruction – Part I
Breast Reconstruction – Part II
Integrating Radiation Therapy & Breast Reconstruction
*This blog post was originally published at Suture for a Living*
