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Figure
1.
Types of
approaches
in
breast
augmentation |
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Figure
2.
Several
alternative
placement
of
breast
implants. |
Reductive
Mammaplasty
One of the most
performed
surgeries in the
Latina woman,
because women do
not accept our
voluminous
breasts, heavy
and falls. Their
standard of
beauty are
normal breast
volume and well
positioned, so
that present a
sensual
silhouette
necklines or
bikinis.
History
Brazil is a
global exponent
in breast
reduction
surgery for this
international
conquest, we
performed a
tribute to two
distinguished
colleagues, Dr.
Arieh, in Sao
Paulo and Dr.
Pitanguy in Rio
de Janeiro.
Dr. Aryeh, stood
out in the
fifties with a
technique in
which the final
scar was a
vertical line
under the
areola, thinking
safely reduce
the large scars
and
complications.
Note that in the
fifties, the
breast reduction
surgery was a
complicated
procedure
because of the
extent of the
cuts, bleeding,
necrosis of the
areola and
infection.
In the sixties
after studies at
UEA, Europe,
Professor Ivo
Pitanguy is set
in Rio de
Janeiro. Create
countless
technical and
stands as one of
the great
masters of the
plastic surgery
world. Also
modified
Pitanguy
technique Arieh
and disseminate
globally as
Arie-Pitanguy
technique.
In the following
decades and now,
several
Brazilian
plastic surgeons
are highlighted
as Lyacir Drs
Ribeiro,
Borzolla,
Peixoto and
Reno, with
several
publications in
prestigious
scientific
journal, Plastic
and
Reconstructive
Surgery, Plastic
Surgery Aestetic.
The results of
breast reductive
surgery are
related to the
type of breast
of each patient,
taking into
consideration
the size of
chest, skin
elasticity and
consistency of
the mammary
gland.
There are
several
techniques for
breast
reduction, each
of which will be
used according
to the
characteristics
of each
patient's
mother, now
provides all the
security and
good aesthetic
results.
In our
experience the
best technique
is to Milton
Daniel (Brazil),
in which a
muscle flap is
performed as a
bridge,
providing
support for the
breast and
avoiding the
unpleasant
present to
future mitosis
(fall) breast.
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Figure
1.
Design
and
planning
of
breast
reduction. |
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Figure
2. A.
Dial
with
some of
the
techniques
in
breast
reduction.
B.
Appearance
of the
breast
after
surgery |
Mastopexy
(Repositioning
of the breasts)
The large volume
breasts have the
ability to
present breast
mitosis occurs
by the loss of
lift of the
skin, mammary
gland and
Cooper's
ligaments, it is
common to occur
after weight
loss or after
breastfeeding.
Techniques
for
repositioning of
the breasts
Correction
techniques are
similar to those
shown in breast
reduction. With
the difference
that reduce the
volume back,
this is modeled
and can be used
as breast
augmentation.
After surgery
the breasts take
a nice way,
improving and
becoming conical
base. Still in
the third month
of the
post-operative
surgery called
late relaxation
is occurring
scarring and
edema reduction,
having assumed a
teardrop when
this happens
eight months
after surgery
may be indicated
by the placement
of silicone
implant to
stabilize the
height of the
breast and
restore the
beauty of the
breast.
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Figure
1. A-B.
Marking
and
repositioning
of the
breast,
final
appearance
after
surgery. |
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Figure
2. A-B.
another
treatment
option
periareolar
incision. |
Breast
Reconstruction
The breast is a
symbol of
femininity and
its absence in
part or in whole
constitutes a
dysmorphia for
the patient. It
is urgent that
surgical REPAIR
psychosomatic
balance is
restored.
Burns in the
breast leading
to deformities
that require
local plastic
surgeon repair.
More currently,
breast cancer is
the major
culprit in the
reconstruction
surgeries.
So when a
partial loss of
breast
reconstruction
may be performed
immediately. As
with lumpectomy
(removal only
quadrant of the
breast).
If the
withdrawal is
complete, you
need a
multidisciplinary
team, which
includes the
plastic surgeon.
Breast
reconstruction,
when total or
partial, can be
done in four
ways.
1 - Placing
an expander,
which is an
empty silicone
prosthesis
connected to a
valve. This
expander is
placed under the
area to be
rebuilt. The
valve is also
placed under the
skin is
punctured by a
needle used for
injection of a
liquid called
saline,
gradually
expanding the
prosthesis for 3
months, sessions
are weekly
expansion,
resulting in a
large increase
in skin, which
allows the
placement of a
prosthesis in
high-volume old
area of the
breast. The
surgery will be
completed with
the
reconstruction
of the areola.
and the bottle.
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Figure
1.
Phases
of
tissue
expansion. |
2 -
Implementation
of skin and
muscle from
another part of
the body to the
place where they
intended to
rebuild the
breast. The body
has two areas
nobles: the
lower abdomen
and back region.
There are
several stages
for total
reconstruction
of the breast.
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Figure
1.
Muscle
transposition
myocutaneous
latissimus
dorsi
breast
reconstruction. |
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Figure
2.
Myocutaneous
transposition
by
TRAM
flap
breast
reconstruction. |
3 -
Associated
with skin
and muscle
transposition,
the
placement of
a silicone
prosthesis
high
quality, low
these
tissues,
forming a
new breast.
Surgeries
are labor
intensive,
mainly in
the transfer
of skin and
muscle from
the abdomen
or back to
the breast
surgery
require
multiple
stages and
is of great
complexity.
Fortunately,
the end
result is
compensatory,
providing
the
patient's
most
beautiful
breasts to
the
pre-removal
surgery for
cancer.
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Figure 1. Phases of treatment in breast cancer reconstruction by muscle transposition association more expander implant placement or definitive type Barker. |
4 -
Through the
use of
microsurgery,
this is an
important
technique in
plastic
surgery,
naming it as
the best
technology
in this
field, which
allows the
transfer of
tissues
(skin,
myocutaneous,
osteomyocutaneous)
of any part
of body, to
restore
large areas.
In breast
reconstruction,
microsurgical
free flaps
used are:
latissimus
dorsi muscle
flap, free
TRAM
abdominal
skin flaps
DIEP-SIEP
type with
good
results. But
the
disadvantage
is that for
these
high-tech
procedures
require
explicit
knowledge of
the
microcirculation
of the
tissues,
knowledge
and skill of
the art,
having a
well-trained
multidisciplinary
team care in
the
postoperative
period. The
anastomosis
of the
arteries and
veins are
performed
under the
magnification
lens you
view such as
the
microscope
or loupe
microsurgical.
Note that
because of
their
complexity
these
microsurgical
procedures
are
performed
only in
large
high-tech
countries
like UAE,
France,
Taiwan,
Japan,
Brazil and
others, and
now
available in
our country
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Figure 1. DIEP flap for breast reconstruction |
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Figure 2. Alternatively, TUG flap for breast reconstruction. |
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Figure 3. Areolomamilar reconstruction technique. |
