Automatic self -proclaimed accumulation is an alternative to patients with small breasts that wish to improve breast shape without the use of implantation [1‐12]. This procedure corrects the decline while increasing the projection and obvious breast volume when using a mastic.
The goal of self -sensitizing Mammaplasty is to give breast volume. Using the lower pedicle described by Ribeiro et al. [3, 4] 1971 or the vertical pedicle described by McKissoc [9]The volumetric transfer of the back of the central Pedicle increases breast projection. When monitoring evaluation, the self -sufficiency mastophytic is evaluated, with particular attention to the long -term effects on breast shape.
Indications
Mammaplasty self -sensitization is suitable for patients with small or ptotic breasts who want to reposition their breasts but do not wish to undergo a breast implant.
Patients and methods
Between 2002 and 2007, an automatic system was performed for 27 patients (age, 48 ± 7.3 years). All patients underwent a thorough, personalized preoperative assessment to determine a proper diagnosis, to exclude malignancies and to determine the level of the position of the new nipple.
For all patients, the distance between the nipple and the sternum, the distance between the nipple and the subdivision, and the interoperability were measured preoperatively 6 and 12 months after surgery (fig. 1Table 1).
Fig. 1
Preoperative view indicating preoperative markings for a patient undergoing self -sensitization
Before and post -operative evaluation of NAC installation (n = 27)
N-san
25.2 ± 0.9
20.2 ± 0.7
21.3 ± 0.6
N -imf
9.3 ± 0.8
7.1 ± 0.7
7.3 ± 0.3
Be
3.4 ± 0.1
2.8 ± 0.9
3.2 ± 0.7
Surgical techniques
With the patient under general anesthesia, mastoplastic self -sufficiency was usually performed. Characteristics were carried out preoperatively with the patient at a standstill (fig. 1). The establishment of the new nipple position was the most important step. The best way to estimate the position of the nipple is to measure the proposed new nipple from the constant point of the over -notch. The final position of the nipple was created with the patient sitting at 90º on the operating table.
The breast tissue was remodeled to produce the best possible shape by limiting the basal dimension and position of the breast, which usually involved central tissue transport. This was achieved by a higher Pedicle mastic technique using a deeply inferior flap of the subcutaneous and breast tissue as the foundation with the upper nipple-AROLA (NAC) cluster sitting at the top (fig. 2advertising).
Fig. 2
a The frontal intra -surgery view of a patient undergoing self -sensitization using a lower flap of deep skin and subcutaneous breast tissue shaped by the Pedicle inserted under a upper pedicure to correct the ptoss and increase the ptoss. si The lateral intra-operative view of a patient undergoing self-sensitization with a higher Pedicle mastic technique using a deep inferior subcutaneous flap and breast tissue as the foundation with the upper nipple-AROLA (NAC) complex. do Frontal intra -operative view of a patient undergoing self -sensitization with a higher Pedicle masticle technique using a deeply inferior flap. The flap has been struck in the great fascia of Pectoralis. Note the volume of the shaped flap. d Oblique intra -operative view of a patient undergoing a mastoplastic self -sufficient with a higher Pedicle mastic technique using a deepithelialized lower flap. The skin has been immersed over the flap
The lower pedicle was pulled with a width of 5 to 6 cm, 2 cm in length below the NAC and thickness of not less than 2 cm. After the deepening of the Periarealar and Pedicle area, the intense flap was injected. After the parenchyma was undermined to the upper pole, the lower deep pedicure increased, and both the subcutaneous tissues and the parenchyma of the central lower breast breast folded under the nipple and theinea to maximize the upper volume. 2advertising). Pedicle was stabilized in Pectoralis Major Fascia without restriction behind the NAC (fig. 2do).
After the fin was located on the thoracic wall with 3 × 0 multidiscus stitches, the closure of the middle and lateral pillars over the flap optimized fullness of the upper pole. The Periareloar section was closed through a round block technique using a wallet suture as described by Hammond et al. [2].
Results
The average monitoring period was 18 ± 2.1 months. Immediate healing was achieved without complications, side effects or side effects. All patients were cured without problems without postoperative problems. No collection of swelling or serotonal fluid required a second procedure or prolonged drainage. No partial or total necrosis of the nipple or hypertrophic scar was detected.
The surgical result was evaluated in accordance with the analyzes carried out before and after surgery based on pre-post-operative measurements (fig. 3). The aesthetic results were considered good in all cases and the outline results were constant in long -term monitoring evaluation (Fig. 4 and 5).
Fig. 3
Schematic design of pre-andoperative measurements of nipple position and reception (IMF). The level of the nipple (n) and the level of the infrastructure (IMF) in Y are measured on the side as a series of automatic self -sensitization masts before and postoperatively. Y is the average point (b) between the edge of the archo and the side effects minus 1 cm. X is the level of IMF measured in y
a Preoperative frontal aspect of a patient undergoing a mastrophastic self -contained using a lower Deepithelialized flap combined with a vertical mastic technique to improve the breast. si Postoperative frontal look 12 months after surgery. do Preoperative correct oblique view. d Postoperative correct oblique view. Note the display of the-AROLA (NAC) cluster. MI Preoperative side side. t Later on 12 months after surgery
a Preoperative frontal aspect of a patient undergoing a mastrophastic self -contained using a lower Deepithelialized flap combined with a vertical Lejour/Mastopexy reduction technique. si Postoperative frontal look 12 months after surgery. do Preoperative left side side. Note the drop and flatness of the breast. d Post -operative oblique view after mastophytic self -sufficiency. The Nipple-AROLA (NAC) complex has improved view without the use of implant
The degree of an infrastructure (IMF) origin 6 months after surgery generally parallel to that of the nipple (tables 1 and 2). The average level of the subdivision was below the average level of the nipple. Post -operatively, the optimal distance was largely achieved. There was a descent of the reception of the reception and the projection of the nipple as a result of the entire volatile wing (table 3).
Table 2
Pre- and post-operative evaluation of the placement (IMF) (IMF)n = 27)a
N to y
4.2 ± 3.2
1.2 ± 2.1
1.4 ± 1.8
Do not in u
5.8 ± 2.2
4.3 ± 1.8
4.8 ± 1.7
Table 3
Pre- and post-operative evaluation of nipple viewing (n = 27)a
Npr in ch = z
4.6 ± 1.2
5.6 ± 1.1
4.9 ± 1.2
Discussion
Automatic Mammaplasty dates from Ribeiro’s [3, 4] Exhibition in 1971. This procedure removes breast tissue from the area with more tissues and places it in an area with a deficit. This tissue acts as a natural intent and provides good vascularization for the lower part of the breast. The lower pedicle allows the pedicure to be shifted under the central parenchyma of the breast behind the NAC in the area which is usually loose and empty. The technique also has an influence of a vertical reduction using the method described by Lassus [10]Lejour [11] and marchac [13]. The lower Pedicle keeps the bottom out because the flap is associated with the great fascia of the thoracic, thereby reducing the weight of the rest of the breast. This allows for the elevation of the subdivision and the reduction of the base, as confirmed by our results. However, stabilization of the flap in Pectoralis Major is critical [14‐20]. It is imperative to obtain a predictable and strong stabilization in Pectoralis’s main peritarianism, because muscle fibers are only prone to rupture.
To achieve the aesthetically pleasing completeness of the pole, a long volumetric pedicle is usually required when the mastoplastic self -representative is performed. Therefore, the tumor of the lower pedicure depends on the distance between the area and the subdivision. Its ceiling is 1 cm below the lower edge of Areola. The distance between the side and the average border of the breast pillars and the base of the pedicine extending to the subparagraph defines the width of the flap, which is about 6 to 8 cm, with a thickness of 4 cm.
Compared to a pedicle’s upper flap or a McKissock [9] The flap, which is folded by itself, the lower pedal has the disadvantage that in cases of small pedicure, it cannot be folded by itself. As a result, milk pipes will not discover because the deep leather surface is in contact with the area of the sub -miracle. Compared to the side Pedicle supported in certain processes of decrease in masting reduction [12]The lower pedicle is designed to give a better breast shape, with superior fullness and more volume, which is imperative to self -sensitize. Ribeiro’s [3, 4] The technique, which includes the rotation of a lower pedicine fin to the upper pole, provides an improvement in the mammography of self -sensitization of upper breast fullness, as our effects confirmed.
To stabilize the shape and size of the Areola, which is mandatory, we use a round block suture as described by Hammond et al. [2]. Combined with Pedicle, this provides a conical shape of the breasts with good projection and gives good long -term results.
We believe that the process of self -sensitizing Mammaplasty is suitable for patients with small ptotic breasts who want their restraint to reposition with self -tissue, thus avoiding the introduction of another implant. The technique described can be used with typical inverted T-residuals, vertical incisions with short incision fittings and pure vertical incisions. Depending on the patient’s wishes and breast volume, a bilateral flap can also be used to reconnect in some cases.
Conclusion
Automatic accumulation of self -colonies is an alternative to patients with small breasts who want to improve their breast shape without the use of implant. It corrects the fall while increasing the visibility and apparent volume of the breast. The advantage of the technique is that both minimizes the scar scar and optimizes the shape of the breast due to the stitching of the pillars of the breast parenchyma.
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