Evaluation
What is the most important thing to document regarding the NAC preoperatively?
Where or not there is sensation
What can happen to the areola after a circumareolar-only approach?
Areolar widening
What is the strongest contraindication to a circumareolar-only approach to mastopexy?
Significant (Grade III) ptosis
What is the most common reason for revision after mastopexy?
Poor scarring (this can contribute to areolar widening)
What is the difference between accessory and ectopic breast tissue?
Accessory breast tissue occurs on the milk line. Ectopic breast tissue is much rarer and is when breast tissue occurs outside of the milk line.
Define Grade 1/2/3 Breast Ptosis and Pseudoptosis
Grade 1: NAC at or above IMF
Grade 2: NAC below IMF but above lowest contour of breast
Grade 3: NAC below IMF and at lowest contour of breast
Pseudoptosis: NAC above IMF but breast tissue below IMF
What techniques are good options for patients with significant breast ptosis?
Vertical
Inverted T/ Wise Pattern
What does vertical mastopexy do to the IMF?
Moves it superiorly
A 48-year-old woman, gravida 3, para 3, who wears a size 36B bra comes to the physician for evaluation of breast ptosis. BMI is 24 kg/m2. Physical examination shows the distance from sternal notch to nipple is 28 cm, and there is grade 2 breast ptosis with skin laxity. A combined augmentation/mastopexy is planned. Which of the following is the biggest risk of combining the procedures rather than staging them?
A) Hematoma
B) Need for revision procedure
C) Nipple-areola complex necrosis
D) Seroma
E) Transection of lateral intercostal nerves
B) Need for revision procedure
What is the ultrasound sign and MRI sign of implant rupture?
Ultrasound: snowstorm
MRI: Linguine
Attenuation of what structure in the breast causes ptosis?
Cooper ligaments
+ atrophy of breast tissue and loss of skin elasticity
When a patient has recurrent ptosis after mastopexy, what breast measurement has likely increased in size?
Nipple to IMF
What mastopexy technique is associated with a boxy breast shape?
Wise pattern
Nonhealing breast wounds seen in a patient after mastopexy-augmentation performed in Latin America. What's the likely diagnosis and appropriate next step?
Dx: Likely diagnosis is atypical mycobacterial infection
Tx: remove implants and wash out in OR
What is the most common cause of gynecomastia in men over the age of 40?
Drug-induced
What are 4 risk factors for breast ptosis?
- Age
- Hx weight loss (>50lbs)
- High BMI
- Larger cup size
- Number of pregnancies
- Smoking hx
NOT related: history of breast feeding, weight gained during pregnancy, level of upper body exercise
Performing a mastopexy on which pedicle is associated with the lowest recurrence rate of ptosis after a mastopexy?
Superior pedicle
What is the best way to correct a superiorly malpositioned NAC?
Resection of lower pole skin at the level of the IMF
A patient comes into your office six months after mastopexy and is unhappy with the position of her nipple. What issue with nipple positioning is the most difficult to correct?
Superiorly displaced nipple
What key technique is used when operating on tuberous breasts to restore volume to the breasts and prevent a double bubble deformity?
Radial scoring
What are some relevant pieces of history to obtain when evaluating a mastopexy patient? (Name 4)
- Previous breast hx
- Weight loss/gain
- Pregnancy hx
- Breast feeding hx
- Smoking hx
- Breast cancer hx
As a general guideline, the ratio between the outer diameter and inner diameter in regards to circumareolar markings should be what?
Less than or equal to 2:1 outer diameter to inner diameter
Blood supply to the superior pedicle: ________ branches of ________ artery from _______ interspace
Blood supply to the superior pedicle: superficial branches of internal mammary artery from second interspace
Several days after surgery, patients may sometimes develop transient galactorrhea. What is the most likely explanation for this?
Most likely due to surgical interruption of intercostal nerves during dissection
A breast cancer with invasion into overlying skin is automaticall T___ and Stage ___
T4 Stage IIIB