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Immediate repair before radiotherapy
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The author’s approach is therefore to keep things simple wherever possible and especially in those women with very small cancers. Breast reduction is offered to all women with very large breasts. Volume replacement with a local perforator flap and therapeutic mastopexy both give the option of maintaining a good breast shape and symmetry in the range of breast size that is most commonly encountered. With minor modification as necessary, the four main categories of procedure described can be employed to manage a wide local excision defect in any part of the breast and as such it would be rare to encounter a situation where one of these categories of procedure was not the best option. Surgery is almost always performed at one surgical sitting with simultaneous symmetrizing reduction/mastopexy or volume replacement as appropriate to the category of technique being used. Overall, our approach aims to offer women with breast cancer the benefit of established principles of cosmetic and reconstructive surgery and although these have evolved over many years, the principles illustrated in our chart remain constant. However, as stated at the outset, there are many different ways of performing oncoplastic breast-conserving surgery, and in general, the simplest technique in each of the four categories described is likely to be the best one. Many women are prepared to accept small indentations and asymmetries that surgeons would not be “proud of” and the primary focus should always be a successful oncological outcome. However, oncoplastic surgery allows this aim to be combined with an acceptable aesthetic outcome.
Breast disorders in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Nirupama K. De Silva, Monica Henning
One can argue that adolescents overestimate their deformities and thus are requesting surgery inappropriately. A study in the United Kingdom of adolescents and their motivations for plastic surgery revealed that when adolescents request plastic surgery intervention, they do have realistic appearance perceptions, and they are truly suffering appearance-related burden.74 For instance, reduction mammoplasty can improve an adolescent's appearance and functional status for female adolescents with extremely large breasts. Plastic surgery surveys always show a very high degree of patient satisfaction with the breast reduction procedure, with over 94% with evidence that patients increase physical activity, fit into clothes better, and have improved self-esteem.70 Similarly, a patient with asymmetric breasts may require either unilateral breast reduction or augmentation or both, and these procedures can have similar patient success with appropriate candidate selection. The best time for surgery is after breast development has stabilized.
Breast-Feeding
Published in James M. Rippe, Lifestyle Medicine, 2019
Julia Head, Stephanie-Marie L. Jones, Marcie K. Richardson, Angela Grone
Because of its destructive nature, breast reduction surgery may pose a different picture for the woman who desires to breast-feed. In 2009, 78,427 women had breast reduction surgery.102 This surgery often interferes with ductal anatomy and the innervation of the remaining tissue. Breast-feeding may be successful in up to 65% of women after reduction,103,104 depending somewhat on the location of tissue removed. Importantly, breast-feeding should not be discouraged in these patients. They should instead be offered anticipatory guidance and support, and the baby’s weight should be carefully monitored. Women who have undergone breast surgery may find the website www.BFAR.org105 a helpful resource—this site compiles information and supports resources for women who have undergone breast or nipple surgery.
Mastectomy is a safe procedure in transgender men with a history of breast reduction
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Floyd W. Timmermans, Lian Elfering, Thomas D. Steensma, Mark-Bram Bouman, Wouter B. van der Sluis
Prior to undergoing gender-affirming mastectomy, transgender men may have opted for breast reduction surgery. Reasons to seek breast reduction surgery prior to a mastectomy can be having large breasts, resulting in physical complaints, or more specifically in this population, breast dysphoria as an expression of gender dysphoria. In some clinics, especially in the past, breast reduction was offered as ‘top surgery’, as there was little or no experience with gender-affirming mastectomy. Resultantly, having undergone breast reduction surgery prior to a gender-affirming mastectomy may limit the available mastectomy techniques that are commonly used in transgender individuals. Some concerns are present that performing mastectomy with prior breast reduction surgery, increases the risk of complications and revision surgery [11,12]. Furthermore, the previous use of a NAC-bearing pedicle during breast reduction may endanger NAC vascularization and vitality during pedicled NAC mastectomy [13].
Oral isotretinoin (Roaccutane) use during incisional surgery: safe or risky?
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Matthew J. Davies, Darrell Perkins
A 19-year-old female trainee nurse wished to have breast reduction surgery due to neck and shoulder pain. She suffered polycystic ovarian syndrome and cystic acne but was otherwise healthy. She had no personal or family history of keloid and hypertrophic scarring. Her breasts were disproportionate for her general body habitus (12 F, 167 cm, 72 kg). The patient began therapeutic Roaccutane 2 months prior to her bilateral reduction mammoplasty, and continued until four and a half months after her surgery. Her scars healed well with minimal hypertrophic scarring on the right areola. At 9 months follow up, her scars had softened and the patient was pleased with their outcome (see Figure 1).
Bucillamine-induced gigantomastia with galactorrhea and hyperprolactinaemia
Published in Modern Rheumatology Case Reports, 2020
Tatsuo Mori, Naoto Yokogawa, Ryohei Higuchi, Motoyoshi Tsujino, Kota Shimada, Shoji Sugii
The laboratory examinations revealed elevated serum prolactin at 109 ng/mL (normal range: 6.12–30.54). The luteinizing hormone and follicle stimulating hormone levels were within the normal range. Contrast-enhanced magnetic resonance imaging denied a pituitary gland tumour. Cabergoline was started, and the prolactin level dropped to 28 ng/mL 3 months later. However, the gigantomastia worsened progressively. Her medication was bucillamine, prednisolone and eldecalcitol at that time. Based on the suspicion of drug-induced gigantomastia and hyperprolactinaemia, bucillamine was discontinued. We also stopped eldecalcitol. Breast reduction surgery was performed (Figure 2).