Helmet Design Excision for Management of Skin Excess in Patients with Grade 2b/3 Gynecomastia Treated with Liposuction

2009 ◽  
Vol 26 (3) ◽  
pp. 197-200
Author(s):  
Mohan Thomas ◽  
James D. Silva ◽  
Hari Menon ◽  
Chetan Satish
Keyword(s):  
Design Technique ◽  
Aesthetic Outcome ◽  
Proper Position ◽  
Excess Skin ◽  
Nipple Areola Complex ◽  
Areola Complex ◽  
Skin Excess ◽  
Grade 3 ◽  
The Aesthetic ◽  
Helmet Design

Introduction: With the advent of liposuction, key-hole surgery for gynecomastia is on the rise. However, the skin excess in Grade 2b/3 gynecomastia that exists in vertical and horizontal axes in most cases has to be excised after completion of the liposuction. For the management of patients with Grade 2b/3 gynecomastia, we propose the helmet design for removing skin excess effectively and for relocating the nipple-areola complex in proper position concomitantly with suction-assisted liposuction. Method: The helmet design technique is described here. This technique was performed on 5 consecutive patients with Grade 2b/3 gynecomastia treated at our institute over a period of 2 years from November 2006 to November 2008 with a minimum follow-up period of 3 months. The aesthetic outcome was evaluated by patients on a grading scale from Grade 1 to Grade 3 (Grade J = poor, Grade 2 = satisfactory, Grade 3 = good). All patients were treated on a day care basis. Results: The helmet design technique takes care of the excess skin that remains after liposuction and avoids the skin pleating and puckering that result from use of the circumareolar method of skin excision. We did not encounter any complications when using this technique. Two patients had decreased nipple sensation that recovered later. The aesthetic outcome was rated as Grade 2 by 1 patient and Grade 3 by 4 patients. Conclusion: The helmet design excision used in patients with Grade 2b/3 gynecomastia treated with suction-assisted liposuction helps in relocating the nipple-areola complex to proper position and in achieving complete removal of excess skin. This is an effective single-stage treatment for patients with Grade 2b/3 gynecomastia.

scholarly journals Systematization of the Incisions in Nipple-Sparing Mastectomy

2021 ◽  
Vol 7 (4) ◽  
Author(s):  
Cammarota MC ◽  
Barcelos LDP ◽  
Dias RCS ◽  
de Aquino Filho TM ◽  
Neto AB ◽  
...  
Keyword(s):  
Breast Size ◽  
Excess Skin ◽  
Aesthetic Result ◽  
Nipple Areola Complex ◽  
Areola Complex ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Introduction: Nipple-Sparing Mastectomy (NSM) is a consolidated technique that has been used for years with good aesthetic results. Its indication is usually limited by breast size, due to difficulty repositioning the Nipple-Areola Complex (NAC) and treating excess skin in large breasts. The challenge in these cases is to maximize the aesthetic result without increasing the risk of necrosis and other complications.

scholarly journals Optimising aesthetic outcome after nipple-areola complex-sparing mastectomy and immediate one-stage prosthetic reconstruction: A simple surgical trick to fix nipple-areola complex position

2017 ◽  
Vol 50 (01) ◽  
pp. 064-067
Author(s):  
Luca Maione ◽  
Andrea Lisa ◽  
Federico Barbera ◽  
Mattia Siliprandi ◽  
Valeriano Vinci ◽  
...  
Keyword(s):  
Multiple Time ◽  
Moderate Degree ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Prosthetic Reconstruction ◽  
Nipple Areola Complex ◽  
One Stage ◽  
Areola Complex ◽  
Skin Envelope ◽  
The Aesthetic

ABSTRACT Background: Nipple-areola complex (NAC) sparing mastectomy (NSM) is mostly indicated in patients with small-/medium-sized and non-ptotic breasts, while skin-reducing mastectomy is used in patients with medium or large breasts with severe ptosis. NAC location on the reconstructed breast is one of the major factors in determining the final aesthetic result and patients’ satisfaction. An optimum result obtained at the end of surgical procedure may be altered and compromised by skin redistribution and consequently NAC depositioning during the post-operative period in patients with medium-sized breasts and a moderate degree of ptosis. Aims: In the present study, we propose a simple surgical trick to fix the NAC in the desired position with a long-lasting result. Methods: We selected 35 patients undergoing NAC sparing mastectomy for breast cancer and immediate one-stage prosthetic reconstruction and we performed a single suture to fix NAC in the desired position before closing the skin envelope. We evaluated NAC complex position stability overtime comparing pre-operative standard photographs with early (3 weeks after surgery) and late (1 year after surgery). Results: In all patients, we were able to place the NAC complex on the desired position, and the result was stable at 1 year follow-up. The aesthetic outcome was satisfactory in all patients with no change in the complication rate. Conclusions: This simple surgical trick has been shown to be safe and effective in optimising the aesthetic outcome in a patient undergoing NAC sparing mastectomy and immediate one-stage prosthetic reconstruction. Level IV: evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

scholarly journals Skin Sparing Mastectomy with Preservation of Nipple Areola Complex and Immediate Breast Reconstruction in Patients with Breast Cancer: A Single Centre Prospective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Debarati Chattopadhyay ◽  
Souradip Gupta ◽  
Prabir Kumar Jash ◽  
Marang Buru Murmu ◽  
Sandipan Gupta
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Local Recurrence ◽  
Breast Reconstruction ◽  
Frozen Section ◽  
Immediate Breast Reconstruction ◽  
Breast Cancer Patients ◽  
Nipple Areola Complex ◽  
Areola Complex ◽  
The Aesthetic

Background. Skin and nipple areola sparing mastectomy (NASM) has recently gained popularity as the management of breast cancer. This study aims to evaluate the aesthetic outcome, patient satisfaction, and oncological safety of NASM. Methods. The study prospectively analyzes the results of NASM and immediate breast reconstruction in 34 women with breast cancer. The criteria for inclusion were core biopsy-proven, peripherally located breast cancer of any tumor size and with any “N” status, with documented negative intraoperative frozen section biopsy of retroareolar tissue, and distance from the nipple to tumor margin >2 cm on mammography. Results. The median age of the patients was 45 years. The majority had either stage II or stage III breast cancer. The median mammographic distance of tumor from nipple areola complex (NAC) was 3.8 cm. The overall operative morbidity was minimal. The NAC could be preserved in all the patients. There was no local recurrence of tumor at median follow-up of 28.5 months. The aesthetic outcomes were satisfactory. Conclusion. NASM and immediate breast reconstruction can be successfully achieved with minimal morbidity and very low risk of local recurrence in appropriately selected breast cancer patients, with acceptable aesthetic results and good patient satisfaction.

scholarly journals Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results

2016 ◽  
Vol 106 (1) ◽  
pp. 74-79 ◽  
Author(s):  
M. Kääriäinen ◽  
K. Salonen ◽  
M. Helminen ◽  
U. Karhunen-Enckell
Keyword(s):  
Chest Wall ◽  
Surgical Techniques ◽  
Patient Characteristics ◽  
Reoperation Rate ◽  
University Hospital ◽  
Transverse Incision ◽  
Excess Skin ◽  
Nipple Areola Complex ◽  
Areola Complex ◽  
Index Value

Background and Aims: Chest-wall contouring surgery is an important part of the gender reassignment process that contributes to strengthening the self-image and facilitating living in the new gender role. Here, we analyze the surgical techniques used in our clinic and report the results. Material and Methods: Female-to-male transgender patients (n = 57) undergoing chest-wall contouring surgery at Tampere University Hospital between January 2003 and April 2015 were enrolled in the study. Breast appearance was evaluated and either a concentric circular approach or a transverse incision technique was used for mastectomy. Patient characteristics and data regarding the technique and postoperative results were collected and analyzed retrospectively. Results: In addition to the transgender diagnosis, 40.4% of the patients had another psychiatric diagnosis. For mastectomy, a concentric circular approach was used in 50.9% and a transverse incision approach in 49.1% of the patients. In the transverse incision group, 21.4% of the patients underwent pedicled mammaplasty and 78.6% mastectomy with a free nipple–areola complex graft. Compared with the transverse incision group, breasts were smaller (p < 0.001) and body mass index value was lower in the concentric circular group (p = 0.001). One-third of the patients had complications (hematoma, infection, seroma, fistula, or partial necrosis of nipple–areola complex) and the reoperation rate was 8.8%. Hematoma was the most frequent reason for reoperation. Corrections were required for the scar in 14.0% of the patients, the contour in 28.0%, the areola in 15.8%, and the nipple in 5.3%. Secondary corrections were needed more often in the concentric circular (55.2%) than in the transverse incision group (25.0%; p = 0.031). Conclusions: The larger the breast, poorer the skin quality, and greater the amount of excess skin, the longer the required incision and resulting scar is for mastectomy of female-to-male patients. Hematoma is the most common reason for acute reoperation and secondary corrections are often needed.

scholarly journals Combined Surgical Treatment of Gynecomastia

2015 ◽  
Vol 42 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Y. Yordanov ◽  
J. M. Lasso ◽  
A. Shef
Keyword(s):  
Surgical Treatment ◽  
Surgical Excision ◽  
Aesthetic Outcome ◽  
Reliable Technique ◽  
Good Balance ◽  
Breast Enlargement ◽  
Areola Complex ◽  
Skin Excess ◽  
The Mean

Summary Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.

scholarly journals Areola Reconstruction: Principles and Techniques

2018 ◽  
Vol 5 (1) ◽  
pp. 84-92
Author(s):  
Francesco Simonacci ◽  
Nicolò Bertozzi ◽  
Marianna Pesce ◽  
Pier Luigi Santi ◽  
Edoardo Raposio
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Skin Tone ◽  
Aesthetic Outcome ◽  
Color Selection ◽  
Labia Minora ◽  
Areola Complex ◽  
Tattoo Pigment ◽  
Reconstructive Technique ◽  
The Aesthetic

At the end of breast reconstruction, the creation of a natural-appearing areola is very important for patient satisfaction with the surgical result. The challenging aspects of achieving this include matching the color and texture as well as the size, shape, position, and projection of a normal areola, particularly in unilateral cases. The most common techniques that have been used to create a naturalistic nipple–areola complex have included skin grafting, tattooing, or a combination of both. Surgeons are finding that tattooing, the intradermal electric deposition of pigments, can be used to closely approximate natural areola pigmentation. Using the appropriate technique is essential as it is known that tattoo pigment fades over time and appears somewhat different after intradermal applied. Indeed, physicians’ experience and color selection greatly affect the aesthetic outcome. Skin grafting has long been used in nipple–areola reconstruction, and skin donor sites such as retro- auricular, inner thigh, labia minora and contralateral areola have been employed. The choice of donor site depends on different factors, including the presence of a healthy contralateral areola and the skin tone of the patient. In some cases, tattooing may be used in conjunction with grafting. Regardless of areolar reconstructive technique, medical pigmentation is becoming a preferred method of producing a more realistic-appearing breast, although periodic touch-ups may be required for optimal results.

CHANGES IN THE NIPPLE-AREOLA COMPLEX IN PATIENTS WITH BREAST CANCER

2017 ◽  
Vol 63 (4) ◽  
pp. 593-597
Author(s):  
Aziz Zikiryakhodzhaev ◽  
Nadezhda Volchenko ◽  
Erik Saribekyan ◽  
Yelena Rasskazova
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Molecular Subtypes ◽  
Breast Cancer Patients ◽  
Nipple Areola Complex ◽  
Histological Types ◽  
Areola Complex

The article presents data about the lesion of the nipple-areola complex in breast cancer. In 2015-2016 surgical treatment was performed in 101 breast cancer patients, different in size but with the mandatory removal of the nipple-areola complex. There are analyzed the dependence of the lesion of the nipple-areola complex from histological types of breast cancer, molecular subtypes, multicentricity, the location of tumor in the breast. The most significant criterion was the dependence of the lesion of the nipple-areola complex from the distance between tumor node and the nipple.

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