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Case 2.12
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
What complications would you counsel the parents and child for?Acute complications consist of:infection,haematoma,skin loss, anddonor site complications such as:atelectasis,pneumothorax,chest wall deformity, andhypertrophic scar – which may become significant in girls with respect to the inframammary fold.Long term complications include:cartilage resorption, andfinal size discrepancy in 50% of patients.
Breast cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Breast radiotherapy leads to breast erythema, swelling, skin irritation and tenderness, which settle within 4–8 weeks of completing treatment. The skin may temporarily break down in areas subject to friction such as the inframammary fold. Late complications of radiotherapy are uncommon and include chronic breast or chest wall discomfort, breast shrinkage, breast swelling, breast firmness, telangiectasia of the skin, rib fractures, radiation costochondritis and pulmonary fibrosis. Data from randomized trials initiated prior to 1975 have suggested an increased risk of death from cardiovascular disease, confined to those women with left-sided breast cancers, possibly relating to irradiation of the coronary arteries rather than the myocardium itself − this should be avoided with modern radiotherapy techniques. Axillary irradiation (and surgery) is associated with late morbidity such as lymphoedema of the arm, stiffness of the shoulder and exceptional radiation injury to the brachial plexus and radionecrosis of the irradiated skeleton. With current techniques the incidence is very low.
Breast
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Inframammary fold (IMF) incisions are the simplest to use and almost as versatile as the periareolar. It is easier to change planes with this incision and allows accurate subpectoral placement particularly for those with less experience. It is less useful for secondary cases requiring capsulectomy as it is at the periphery of the pocket. They are ideal in those with significant breast volume beforehand and have significant ptosis. Conversely, they should be avoided in patients with a poorly defined IMF.
Short-term treatment outcomes and safety of two representative brands of the fifth-generation silicone gel-filled breast implants in Korea
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Dong Seung Moon, Woo Sik Choi, Ho Chan Kim, Jeong Pil Jeong, Jung Youp Sung, Jae Hong Kim
Peri-areolar, inframammary fold (IMF) and axillary incisions were made under general anesthesia and intravenous sedation for the purposes of preventing visible scarring. Selection of surgical incision is based on our desired outcomes, types of breast implants, the degree of augmentation, the anatomical characteristics of patients and patient-surgeon preference. Based on the Ranquist formula, we determined the distance extending from the nipple to the IMF, the size of breast implant and the scope of dissection. After the dissection, each breast was irrigated using a 100 cc of normal saline mixed with H2O2 solution at a ratio of 1:1, followed by the use of betadine 100 cc. Then, a breast implant was immersed in a normal saline mixed with ceftezole 1 vial and gentamycin 1 ample and then inserted in a pocket either under the pectoralis muscle (a submuscular placement) or in the retromammary space above the pectoralis major muscle (a subglandular/submammary placement). Methods for inserting and positioning a breast implant in the pocket were dependent on its types, the degree of augmentation, characteristics of a patient’s body and our recommendations. Thus, we performed a dual-plane I/II augmentation on a case-by-case basis. Intraoperatively, the patients were intravenously given ceftezole 1.0 g. Incisions were closed using layered sutures in the breast tissue. In addition, skin adhesive or surgical tape were used to close the skin.
Thorax anthropometric position index: a simple evaluation of the inframammary fold position in the thorax
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Kou Fujisawa, Tomoyuki Ito, Shohei Aoyama, Tomoki Kiuchi, Jun Araki, Junichi Nakao, Masahiro Nakagawa
The shape and position of the inframammary fold (IMF) significantly influence the contour of the breast [1–3]. In breast reconstructive surgery, positioning the IMF in an appropriate position is a crucial step for obtaining an aesthetically pleasing result. It is important to create a breast that is similar to the contralateral breast and to achieve symmetry between the right and left sides; therefore, the aesthetic results of breast reconstruction are often evaluated based on the symmetry of the vertical position of the IMF [4,5]. Recently, a growing number of women diagnosed with hereditary breast and ovarian cancer syndrome (HBOC) choose to undergo bilateral risk-reducing mastectomy and reconstruction [6,7]. However, judging the results of bilateral breast reconstruction is difficult because the original IMF structures are lost or destroyed on both sides. Therefore, the search for an ideal IMF height and a standard protocol for measuring the breast is becoming an increasingly important task.
Breast reconstruction with a dermal sling: a systematic review of surgical modifications
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Emma Hansson, Christian Jepsen, Håkan Hallberg
The dermal sling has been described both as a one-stage procedure with an implant/permanent tissue expander or a two-stage procedure with a tissue expander (Table 1). Some authors argue that the inframammary fold can be better preserved and a more natural ptosis and breast shape achieved if a permanent implant is used [28]. Others argue that a tissue expander should be used to make it possible to place a bigger final implant in stage two and to create minimal tension to the mastectomy flaps in the immediate post-operative period [30]. A potential disadvantage of a tissue expander is that the skin could contract in an unfavorable way [64]. Moreover, the usage of expanders requires extra visits for inflation and if a temporary TE is used a second operation is necessary, whereas a permanent TE may lead to an unsatisfactory aesthetic result in some cases [63]. In summary, more studies are needed to explore indications for and choice of implant/tissue expanders when a dermal sling is used, but depending on the configuration of the patient’s breast and her post-operative wishes both could have a place in immediate reconstruction with DS.