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Breast Reduction with Dermoglandular Flaps Tessier’S “Total Dermo-Mastopexy” and the “Yin-Yang Technique”
BREAST SURGERY Breast Reduction With Dermoglandular Flaps Tessier’s “Total Dermo-Mastopexy” and the “Yin-Yang Technique” Francesco Gargano, MD, PhD,* Paul Tessier, MD,† and S. Anthony Wolfe, MD‡ skin and the gland and less “isolation” of the areola from the skin Abstract: The use of dermoglandular flaps in reduction mastopexy was and its vascular and nerve network. Because of this, there was advocated by Paul Tessier, who never published his method, but had actually greater security for the nipple and the skin flaps; but, the most rapid almost finished the following article before his death in June 2008. Dr. method seemed also to be a reason for its choice. Tessier is acknowledged as the “father” of craniofacial surgery, but he had The Ragnell procedure, and particularly the Biesenberger interest in aesthetic surgery, and was quite proud of the technique he procedure, has been criticized because of a lack of vascular security had developed using dermoglandular flaps in reduction mammoplasty. He associated with an extended dissection between the skin and the had literally hundreds of techniques and methods that he had developed but gland. During 1947 or 1948, I observed Mcindoe brilliantly per- which never found their way into print, both because of his enormous forming a Biesenberger procedure, and noted a good shape of the surgical schedule, and perhaps his self-imposed standards for anything that breast at the end of the operation. Thus, I began using the Biesen- he published, which were almost impossibly high. The technique proposed berger procedure in this pure form, but was never satisfied with my by Dr. -
Breast Reconstruction Surgery for Mastectomy in Hospital Inpatient and Ambulatory Settings, 2009–2014
HEALTHCARE COST AND Agency for Healthcare UTILIZATION PROJECT Research and Quality STATISTICAL BRIEF #228 October 2017 Highlights Breast Reconstruction Surgery for ■ From 2009 to 2014, in 22 Mastectomy in Hospital Inpatient and States, the population rate of Ambulatory Settings, 2009–2014 breast reconstruction for mastectomy increased by 62 Adela M. Miller, B.S., Claudia A. Steiner, M.D., M.P.H., percent, from 21.7 to 35.1 per Marguerite L. Barrett, M.S., Kathryn R. Fingar, Ph.D., M.P.H., 100,000 women aged 18 years and Anne Elixhauser, Ph.D. or older. ■ Increases occurred for all age Introduction groups, but disproportionately so for women aged 65 years After a mastectomy (surgical removal of the breast), a woman and older, those covered by faces a complex and emotional decision about whether to have Medicare, and those who were breast reconstruction or live without a breast or breasts. There uninsured. are usually three main considerations in the decision: medical, sexual, and physical. Medical considerations include concerns ■ In 2014, women who lived in that breast reconstruction surgery lengthens recovery time and rural areas had fewer increases the chance for infection and other postoperative reconstructions (29 per 100 complications. Sexual considerations involve the impact of the mastectomies) compared with mastectomy on future sexual encounters. Physical features urban-dwelling women (41 include how breasts may define femininity and sense of self.1 reconstructions per 100 mastectomies). Several previous studies have shown an increase in breast ■ Growth in breast reconstructive 2,3,4 reconstruction for mastectomy. One study used a 2007 surgery was primarily national surgical database, another study used 2008 claims-based attributable to the following data of women insured through large private employers, and a factors: third study used the Nationwide Inpatient Sample (NIS) for 2005– 2011,5,6,7 part of the Healthcare Cost and Utilization Project o Ambulatory surgeries (HCUP) increased more than 150 percent. -
Breast Reconstruction with Expanders and Implants
Evidence-Based Clinical Practice Guideline: Breast Reconstruction with Expanders and Implants INTRODUCTION Disclaimer Evidence-based guidelines are strategies for patient management, The American Cancer Society estimates that nearly 230,000 American developed to assist physicians in clinical decision making. This women were diagnosed with invasive breast cancer in 2011.1 Many of guideline was developed through a comprehensive review of the these individuals will require mastectomy and total reconstruction of scientific literature and consideration of relevant clinical experience, the breast. The diagnosis and subsequent process can create signifi- and describes a range of generally acceptable approaches to diagnosis, cant confusion and distress for the affected persons and their families management, or prevention of specific diseases or conditions. This and, consequently, surgical treatment and reconstructive procedures guideline attempts to define principles of practice that should are of utmost importance in the breast cancer care continuum. In generally meet the needs of most patients in most circumstances. 2011, the American Society of Plastic Surgeons® (ASPS) reported an increase in the rate of breast reconstructions, citing nearly 100,000 However, this guideline should not be construed as a rule, nor procedures, of which the majority employed expanders/implants.2 should it be deemed inclusive of all proper methods of care The 3% increase in reconstructions over the course of just one year or exclusive of other methods of care reasonably directed at highlights the significance of maintaining patient safety and obtaining the appropriate results. It is anticipated that it will be optimizing surgical outcomes. necessary to approach some patients’ needs in different ways. -
Complicated Lower Extre.Mity Wound Closure
CHAPTER 44 COMPLICATED LOWER EXTRE.MITY WOUND CLOSURE, Robefi M, Goecker, D.P.M Dauid M. Whiteman, M.D. The closure of soft tissue defects presents a one. This, however, may be unobtainable for challenging dilemma in reconstr"uctive surgery of clifferent reasons, making the other viscoelastic the lower extremity. Traditionally, local or distal properties of skin extremely important. flaps, or skin grafts have closed large wounds, Biologic creep is evident in situations with however, over the last few decades, substantial slowly expanding subcutaneous forces such as research and development in soft tissue expansion tllmor, obesity, and the gravid uterus or during the has lead to additional options in the reconstructive use of subcutaneous tissue expanders. This is not surgeon's armamentarium. Primary or delayed skin stretching, but rather a slow adaptation of primary closure of wounds involves the use of tissue. The epiclermis responds to expansion with several plastic surgical principles such as under- increased mitotic activity in the basal ceII layer, but mining and stretching. Presented is a review of the the thickness remains constant. Also noted on biomechanical propeties of skin, as well as curent histologic examination ate thickening of the trends in the closure of large wounds utilizing stratum spinosum and flattening of the rete pegs. tissue expanders, skin stretching devices, and a The dermis is substantially affected by expansion. recently developed technique of vaclrum- The dermis decreases in thickness, however, there assisted wound closure. Finally, the indications, are aL increased number of fibroblasts, myofibrob- contraindications, and applications of tissue lasts and bundles of collagen that are formed. -
Research Article TISSUE EXPANDER in PERIODONTICS
Available Online at http://www.recentscientific.com International Journal of CODEN: IJRSFP (USA) Recent Scientific International Journal of Recent Scientific Research Research Vol. 11, Issue, 08 (B), pp. 39498-39503, August, 2020 ISSN: 0976-3031 DOI: 10.24327/IJRSR Research Article TISSUE EXPANDER IN PERIODONTICS *Lakshana S., Esther Nalini H., Arun Kumar Prasad P., and Renuka Devi R Department of Periodontology, K.S.R. Institute of Dental Science and Research, Tiruchengode, Tamilnadu, India DOI: http://dx.doi.org/10.24327/ijrsr.2020.1108.5515 ARTICLE INFO ABSTRACT Article History: Periodontitis is a multifactorial inflammatory disease which leads to the destruction of soft and hard tissues surrounding the teeth. Tissue expansion in periodontics was introduced to correct the tissue Received 12th May, 2020 rd (soft and hard) defects, preserve and augment the dimensions of alveolar ridge. It overcomes the Received in revised form 23 complications like soft tissue dehiscence, poor tension free primary closure associated with the June, 2020 conventional augmentation procedures. Materials which are widely used as tissue expanders in Accepted 7th July, 2020 th dentistry are silicon expander, Hydrogel expander, Hydroxyapatite and Chitosan. Hydroxyapatite Published online 28 August, 2020 and chitosan are hard tissue expander, while Silicon and Hydrogel are soft tissue expanders. Hydrogel expander provides a greater advantage compared to silicon expander because of its hydrophilic Key Words: property which cause gradual expansion of the expander. In medicine it is mainly used for breast periodontitis, ridge, augmentation, augmentation after mastectomy, for renewing scar formation after burns, alopecia and to correct any expander, expansion facial deformities. In periodontics soft tissue expander is used in procedures like expansion of alveolar ridge, before bone augmentation procedure and implants dentistry so that it can provide a tension free flap closure and avoid dehiscence. -
ASPS Clinical Practice Guideline Summary on Breast Reconstruction with Expanders and Implants
CME ASPS Clinical Practice Guideline Summary on Breast Reconstruction with Expanders and Implants Amy Alderman, M.D., M.P.H. Learning Objectives: After reading this article, participants should be able to: Karol Gutowski, M.D. 1. Understand the evidence regarding the timing of expander/implant breast re- Amy Ahuja, M.P.H. construction in the setting of radiation therapy. 2. Discuss the implications of a Diedra Gray, M.P.H. patient’s risk factors for possible outcomes and complications of expander/implant Postmastectomy breast reconstruction. 3. Implement proper prophylactic antibiotic protocols. 4. Use Expander/Implant Breast the guidelines to improve their own clinical outcomes and reduce complications. Reconstruction Guideline Summary: In March of 2013, the Executive Committee of the American Society Work Group of Plastic Surgeons approved an evidence-based guideline on breast reconstruc- Arlington Heights, Ill. tion with expanders and implants, as developed by a guideline-specific work group commissioned by the society’s Health Policy Committee. The guideline addresses ten clinical questions: patient education, immediate versus delayed reconstruction, risk factors, radiation therapy, chemotherapy, hormonal therapy, antibiotic prophylaxis, acellular dermal matrix, monitoring for cancer recur- rence, and oncologic outcomes associated with implant-based reconstruction. The evidence indicates that patients undergoing mastectomy should be offered a preoperative referral to a plastic surgeon. Evidence varies regarding the as- sociation between postoperative complications and timing of postmastectomy expander/implant breast reconstruction. Evidence is limited regarding the opti- mal timing of expand/implant reconstruction in the setting of radiation therapy but suggests that irradiation to the expander or implant is associated with an increased risk of postoperative complications. -
Breast Lift (Mastopexy)
BREAST LIFT (MASTOPEXY) The operation for breast lift is aimed at elevation of your normal breast tissue. This operation will not affect back, neck and shoulder pain due to the other problems such as arthritis. It also is not a weight loss procedure for obesity, nor will this operation correct stretch marks which may already be present. Often times this opera- tion is done to recreate symmetry if there is a large discrepancy in the shape of the two breasts. This operation has inherent risks asso- ciated with any surgery including infection, bleeding and the risk associated with the general anesthesia which is necessary. In addi- tion this operation results in scars around the areola and beneath the breast as has been described. It is impossible to lift the breasts with- out obvious scars. Although attempts and techniques will be made to minimize the scarring, this is an area of the body in which scars tend to widen due to location and the weight of the breasts. Revi- sion of these scars may be possible depending on their appearance following a 9-12 month healing period. In addition, these widened scars may be the result of delayed healing resulting from a small area of skin death in the portion where the two incisions come to- gether. This area is prone to a partial separation of the scar due to the tension and often times marginal blood supply in this area. This usually can be treated with local wound care including hydro- gen peroxide washes and application of a antibiotic ointment. -
Placement of Breast Implant Following Breast Reconstruction by Tissue Expansion Informed Consent
Placement of Breast Implant Following Breast Reconstruction by Tissue Expansion Informed Consent ©2012 American Society of Plastic Surgeons®. Purchasers of the Informed Consent Resource CD are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only. All other rights are reserved by American Society of Plastic Surgeonsâ. Purchasers may not sell or allow any other party to use any version of the Informed Consent Resource CD, any of the documents contained herein or any modified version of such documents. Informed Consent – Placement of Breast Implant Following Breast Reconstruction by Tissue Expansion INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about placement of a breast implant following tissue expansion breast reconstruction, its risks, as well as alternative treatment(s). It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon and agreed upon by you. GENERAL INFORMATION The use of tissue expanders for breast reconstruction involves a two-stage process. A tissue expander is inserted either at the time of the mastectomy (immediate breast reconstruction) or at a later time (delayed reconstruction). The tissue expander is filled over time to increase the size of the breast mound. Once this is accomplished, a second operation is performed to place a breast implant. Additional procedures such as a capsulotomy or capsulectomy may be performed at the time of the insertion of the implant in order to make changes in the space where the breast implant will be located. -
Silicone-Filled Breast Implants
Important Information for Women About Breast Reconstruction with INAMED® Silicone-Filled Breast Implants RECON Patient Labeling Rev 11/03/06/06 page 1 TABLE OF CONTENTS Page GLOSSARY ..................................................................................................................................... 4 1. CONSIDERING SILICONE GEL-FILLED BREAST IMPLANT SURGERY ............................ 10 1.1 WHAT GIVES THE BREAST ITS SHAPE? ...................................................................... 11 1.2 WHAT IS A SILICONE GEL-FILLED BREAST IMPLANT? .............................................. 11 1.3 ARE SILICONE GEL-FILLED BREAST IMPLANTS RIGHT FOR YOU? ......................... 12 1.4 IMPORTANT FACTORS YOU SHOULD CONSIDER IN CHOOSING SILICONE GEL-FILLED BREAST IMPLANTS ................................................................. 12 2. BREAST IMPLANT COMPLICATIONS................................................................................... 14 2.1 WHAT ARE THE POTENTIAL COMPLICATIONS? ......................................................... 14 2.2 WHAT ARE OTHER REPORTED CONDITIONS? ........................................................... 19 3. ALLERGAN* CORE STUDY RESULTS .................................................................................. 22 3.1 OVERVIEW OF ALLERGAN’S CORE STUDY................................................................. 22 3.2 WHAT WERE THE 4-YEAR FOLLOW-UP RATES? ........................................................ 22 3.3 WHAT WERE THE BENEFITS? ...................................................................................... -
310-C, Breast Reconstruction After Mastectomy
AHCCCS MEDICAL POLICY MANUAL SECTION 310– COVERED SERVICES 310-C - BREAST RECONSTRUCTION AFTER MASTECTOMY EFFECTIVE DATES: 10/01/94, 11/27/18 REVISION DATES: 10/01/99, 10/01/01, 05/01/06, 10/01/06, 01/01/11, 09/27/18 I. PURPOSE This Policy applies to AHCCCS Complete Care (ACC), ALTCS E/PD, DCS/CMDP (CMDP), DES/DDD (DDD), and RBHA Contractors; Fee-For-Service (FFS) Programs as delineated within this Policy including: Tribal ALTCS, the American Indian Health Program (AIHP); and all FFS populations, excluding Federal Emergency Services (FES). (For FES, see AMPM Chapter 1100). This Policy establishes requirements for breast reconstruction surgery following a Mastectomy. II. DEFINITIONS MASTECTOMY Removal of the entire breast through surgery. III. POLICY Breast reconstruction surgery for the purposes of breast reconstruction post-mastectomy is a covered service if the member is AHCCCS eligible. The member may elect to have breast reconstruction surgery immediately following the Mastectomy or may choose to delay breast reconstruction; however, the member shall be AHCCCS eligible at the time of breast reconstruction surgery. The type of breast reconstruction performed is determined by the physician in consultation with the member. A. COVERAGE POLICIES FOR BREAST RECONSTRUCTIVE SURGERY 1. Reconstruction of the affected and the contralateral unaffected breast following a medically necessary Mastectomy is considered an effective non-cosmetic procedure. Breast reconstruction surgery following Mastectomy for any medical reason is a covered service. 2. Medically necessary breast implant removal is a covered service. Replacement of breast implants is a covered service when the original implant was the result of a medically necessary Mastectomy. -
Breast Uplift (Mastopexy) Procedure Aim and Information
Breast Uplift (Mastopexy) Procedure Aim and Information Mastopexy (Breast Uplift) The breast is made up of fat and glandular tissue covered with skin. Breasts may change with variable influences from hormones, weight change, pregnancy, and gravitational effects on the breast tissue. Firm breasts often have more glandular tissue and a tighter skin envelope. Breasts become softer with age because the glandular tissue gradually makes way for fatty tissue and the skin also becomes less firm. Age, gravity, weight loss and pregnancy may also influence the shape of the breasts causing ptosis (sagging). Sagging often involves loss of tissue in the upper part of the breasts, loss of the round shape of the breast to a more tubular shape and a downward migration of the nipple and areola (dark area around the nipple). A mastopexy (breast uplift) may be performed to correct sagging changes in the breast by any one or all of the following methods: 1. Elevating the nipple and areola 2. Increasing projection of the breast 3. Creating a more pleasing shape to the breast Mastopexy is an elective surgical operation and it typifies the trade-offs involved in plastic surgery. The breast is nearly always improved in shape, but at the cost of scars on the breast itself. A number of different types of breast uplift operations are available to correct various degrees of sagginess. Small degrees of sagginess can be corrected with a breast enlargement (augmentation) only if an increase in breast size is desirable, or with a scar just around the nipple with or without augmentation. -
MICHAEL J. BROWN, M.D., P.L.L.C. Aesthetic Cosmetic Plastic Surgery
Informed Consent – Breast Reconstruction with Tissue Expander MICHAEL J. BROWN, M.D., P.L.L.C. Aesthetic Cosmetic Plastic Surgery Informed Consent – Breast Reconstruction with Tissue Expander INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about breast reconstruction with a tissue expander, its risks, as well as alternative treatment(s). It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by Dr. Brown and agreed upon by you. GENERAL INFORMATION There are a variety of surgical techniques for breast reconstruction. Breast cancer patients who are medically appropriate for breast reconstruction may consider tissue expander breast reconstruction, either immediately following mastectomy or at a later time. The best candidates, however, are women whose breast cancer, as far as can be determined, seems to be eliminated by mastectomy and other treatments. Breast reconstruction has no known effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation. Breast reconstruction with tissue expansion is a two-stage process. It first involves the use of a silicone rubber balloon-like tissue expander that is inserted beneath the skin and often also beneath chest muscles. Saline or air is gradually injected into the tissue expander to fill it over a period of weeks or months. This process allows the skin on the chest to be stretched over the expander, creating a breast mound. In most cases, once the skin has been stretched enough, the expander is surgically removed and replaced with a permanent breast implant.