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Breast

Introduction
breast surgery is performed to increase the size and shape of women's breasts. Surgery usually improves individual image. Historically, breast enlargement, which was accomplished by the third method, with varying records of success.



inert material, for example. silicone and paraffin was injected directly into the pulp tissue to increase breast size. This method was abandoned because of the extremely high incidence of acute and late complications. Granulomas Are Often this procedure, as are complications related the loss of skin and scar contracture producing excessive distortion. Gas
tissue injections also have been Used to enhance and try to increase the shape of women's breasts. Gas tissues, including omentum, fat, muscle, lipomas, and skin dermis in the form of fat and skin grafts were used to strengthen and enlarge the breasts. The results of the injection gas tissues were not positive and predictable. In addition to the scars and texture of inequality, which can be seen in patients who underwent injection of breast tissue, microcalcifications develop. This makes the exercise more mammograms to those women on the early detection of breast cancer possible.
Last suction pump was used to try to improve breast shape. However, although some extensions has been the general shape of the aesthetic of these missed greatly.
implants have been used since 1960 to strengthen and expand the shape of a woman's breast tissue. There are currently a solution for such extensions mammaplasty. For the first time in 1964, when reported by Cronin and Gerow, silicon is still used to supplement women breasts.1 silicone-filled implants advantages include a minimum solubility and excellent viscosity silicone material, providing an excellent feeling of the breast. Problems associated with silicone implants are pouches contracture, granulomas that develop after the leaching of silicone from the implant and the silicone MIGRATION Pacha. Autoimmune response observed in the silicone implants FIELD breast augmentation. Were discredited because of the amount of comprehensive long-term studies, which showed no increased incidence of long-term problems in many women who have silicone implants with extensions.

When the Food and Drug Administration (FDA) temporarily removed silicone implants because of the alleged increased incidence of autoimmune phenomena, a significant amount of interest generated in the use of saline implants to increase breast tissue. Saline-filled implants have been used since 1960. Is absorbed into the bloodstream Saline or loss of integrity of safe implant capsule develops. Saline is commonly used in intravenous (iv solutions) and poses no risk to patients.

Saline implants have a handbag allegedly contracture rate decreased as compared with silicone implants. However, little salt decreased compared to the viscosity of the silicone. The first use of saline implants resulted in the frequent occurrence of deflation (about 10%). Over the past 10 years, a lot of work, implant manufacturers to improve the consistency of implants, and in particular to improve the reliability of the valve mechanism for introduction of saline implant deflation rates led, which are envisaged for less than 1%.

After removal from the general use by the FDA, silicone implants have been thoroughly tested and proven low complication rates comparable and in some cases lower than saline implants. Subcommittee The FDA recommended that the silicone implants silicone implants to be reintroduced in the United States. Silicone implants were not ever removed from the European market.


History
procedure implants can be round or teardrop-shaped. Round implants are disc shaped and exhibit equal fullness in all four quadrants of the breast.




(Above) View Preoperative 28-year-old woman with micromastia. She had two children. Note: small breasts decreased upper pole fullness. (Below) View after submuscular surgical expansion of the round implant. Notice increased Pełni górnych piersi biegunów. Lokowania Submuscular sprawia, Że trudno zrozumieć krawędzi implantu.
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(Powyżej) Zobacz Przedoperacyjna 28-letnia kobieta z micromastia. Miała Ona 2 dzieci. Uwaga: małe piersi zmniejszyła się górny Pełni biegun. (Poniżej) Zobacz pooperacyjne po submuscular rozszerzeń z rundy implantu. Zawiadomienie wzrosła Pełni górnych piersi biegunów. Lokowania Submuscular sprawia, Że trudno zrozumieć krawędzi implantu.
Lub Teardrop implanty anatomiczne wykazują zmniejszenie Pełni Górnym w rozszerzeń biegunie piersi ze zwiększoną pełnię piersi w dolnej Field. These prostheses are also narrower in the upper and lower poles of the implants than rounded.



(Above) View Preoperative 26-year-old woman with minimal Fully Upper Pole, asymmetrical breasts. (Below) the outcome in the postoperative period following submuscular placement of anatomically shaped implants. Notice increase in lower pole fullness and lack of upper pole fullness in relation to the round of the implant shown in the first Graphics
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(Above) View Preoperative 26-year-old woman with minimal Fully Upper Pole, asymmetrical breasts. (Below) the outcome in the postoperative period after submuscular placement of anatomically shaped implants. Notice increase in lower pole fullness and lack of upper pole fullness in relation to the round of the implant shown in the first Graphics
capsule implant can be textured or smooth. Textured implants were originally created as an alternative to polyurethane-covered silicone gel implants, which were first introduced in 1970. Initial reports indicated a polyurethane-covered silicone gel implants resulted in decreased capsule formation. Ingrowth scars on the surface of the polyurethane was requested to break down the forces of scar contracture of the vector. Because of changes in scar contracture vectors, scar capsule was not in a position to assume a degree this way, as always present around implants, however, never proved, this theory was finally in the scientific study.
However, it became clear that the polyurethane passed microfragmentation and phagocytosis. In addition, polyurethane will be possible to break down and dissolve the tissue locally after placement of implants these. Intense foreign body reaction with numerous macrophages and multinucleated giant cells of the capsule occurred in some patients who have this type of implant.

Because of these problems, implants coated with a layer of polyurethane were removed from the market. Implant manufacturers, trying to potentially play the Conservation Values \u200b\u200bfor contracture in polyurethane bags covered with silicone gel implants, sought to increase the wall standard saline implants reproduce the effect observed polyurethane. The same approach could also attempted to silicone implants. Unfortunately, not the result of increasing the thickness of the capsule surface texturing to reduce capsule contracture Ultimately patients undergoing breast augmentation. Reports due to increased wrinkles textured implants placed in patients undergoing breast augmentation has been reported.


Contraindications Severe prolapse
relative contraindication to surgery. Women with prolapse may require Significant reduction surgery, or both secondary proceedings. Women with breast ducts also are at significant risk of secondary procedures after the extension to resolve remaining deformity secondary to the primary tubular shape of the breast. Rate Serious illnesses related to the patient with each patient, as in the case of each surgery.

Product of Plastic Surgeons

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Introduction One of the great debates in the field of plastic surgery focused on the spot whether breast implants above or below the pectoralis major. This author's strong feeling, that in most cases, the implant should be placed in subglandular Positions, which is more than muscle.




Breast, subglandular. Cup large cup B.
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Breast, subglandular. Cup large cup B.
History
Breast Procedure was first taken in the early 1900s. Places subglandular placement ever. All of ivory and ebony paraffin was implanted, Of course, reject. In the 1950s, Ivalon sponges were used. Although they were biologically fibrous tissue grew into them, making them extremely difficult. Breast began in earnest in the mid-1960s, when silicone implants were introduced. Again, the place was always subglandular. A major problem

breast implants has been consistently hard. Implants do not become a difficult problem is that the human body recognizes that the implant is a foreign object. Because the body can not reject the implant (silicone not charged binding sites), for the body's defense mechanism is to I am from the membrane wall composed of myofibrils and collagen. This is commonly referred to as the capsule. If the capsule contracts around the implant, the result is similar to squeezing a balloon partially filled with water, it feels hard. It is to be known as the fibrous capsule contracture. Why capsule contracts in some patients remains a mystery. Even more mysterious is the fact that often occurs only in one breast and not others.

silicone implants early support he had from Dacron, which took hold at the implant site. What was not realized by a few years was that That caused a severe reaction to Dacron tissue as capsular contracture in the extreme. In the late 1960s, the idea of \u200b\u200ban implant under the muscle was introduced. This place was popularized in the mid-1970 because of the belief that breast felt softer with subpectoral implantation. Unfortunately, the characteristics of hardness is difficult to estimate. Although Baker classification system is widely accepted including the objective, where firmness of the breasts may be remains subjective, and there is a problem finding the procedure, minimizes Which ten problem.

problem
subpectoral argument (the muscle) placement is as follows:



Muscle covers the implant capsule contracture That So (breast, which feels hard) is less common.
For the same reason, rippling (wrinkling), the implant is less clear.
Mammography is more accurate.
women in very small breasts, outline the implant is less visible.
operation takes less time.
subglandular argument (in the tissue of the breast) placement is as follows:


Breast is obviously in the muscles, so there should be an implant.
subglandular For this reason, most of it looks more natural. Because the muscle covers
only one third of one half does not, when the implant is placed below the implant, Minimum Benefits Introduction There are no implant. (This does not apply not infrequently exercised true submuscular implants, that uses the serratus anterior muscle for coverage.)
Since most implants are not covered by the muscle is the introduction below, the introduction of Minimum Benefits There are no implants. Only a slight reduction in the incidence of capsule contracture, and there is a rippling of the implant.
Subpectoral placement requires cutting the insertion of muscles. For this reason, and / or pressure of the underlying implant, the pectoralis muscle becomes very atrophic and virtually is not destroyed. Claiming that the implant "enter" in a more natural positions in a few weeks after the surgery is false. Actually atrophying muscle (death), which results in reduction of the initial fullness of the Upper Pole.
If any degree of prolapse is present, extracts the breast implant subglandular much better. Properly executed
mammogram shows 95% of breast tissue. Magnetic resonance imaging, but you can imagine 100% of the breast and, possibly, be a standard criterion for cancer detection. Reduced risk of bleeding
Involved is surgery.
much less postoperative pain occurs.1
procedure can be performed in the intravenous sedation anesthesia and local communities that are safer alternatives for the general (full) anesthesia. However
about 50-60% of plastic surgeons perform submuscular implantation. The author of about 2% of implants under the muscle, usually only on the patient's job.




Breast, subglandular. This patient had a previous muscle for implants. Same implants placed in front of the muscle.
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Breast, subglandular. This patient had a previous muscle for implants. Same implants placed in front of the muscle.


Micromastia frequency is a common occurrence.

Presentation
Determine the patient's motivation and expectations. Watch out for the patient, who wants to please her partner's surgery. Try to respond to the expectations of the patient on the effects of which can be achieved. When a patient asks for a chest so big, That the author asks himself whether he wants to look natural. The answer is almost always positive. In such a situation, the author states that will make the breast as large as possible and yet they natural.

On physical examination, paying attention is important asymmetry because patients can not be aware of the problem, it can only be noted that after the surgery and blame the doctor. Differences of up to chest and breast size and shape are common.

This stretch marks and to evaluate their depth. Also observe any thinning of the breast tissue, because these problems cause a higher degree of rippling (wrinkling) of the implants.

Note the degree of ptosis and advice about the patient, how much will remain after surgery. With the exception of extreme situations the author does not wish to carry out the lift, as most patients are satisfied with the extensions and whatever Provides lift and do not want ADDITIONAL scars. Failing that, breast lift is often insufficient. Of course, to locate any discharge or breast masses. During the physical examination, discuss the patient's desires and the size of the implant. Indications


Micromastia (ie, small breasts) is obviously due to patients seeking procedures for extensions. But, surprisingly, what may seem like a big bust for the surgeon may seem quite small, patient to request extensions.

patient from time to time due to Operation CONCLUSIONS asymmetry.

Many of the cases subglandular lift drooping breast implants without the need for additional visible scars.


Relevant Anatomy
Women Breast covers the anterior chest wall with about Zebra second superiorly fourth to fifth or ribs inferiorly. Its upper half overlies a pectoralis major, serratus anterior one of its lower parts, some of the axillary fascia side.

Breasts in fact is the body skin. Closely related to the skin for the suspension tendon (Co ligament). Therefore, it is, that is evolutionarily from the ectoderm in the anterolateral wall of the body and the proliferation of epithelial cells from the glands of this site creates. For this reason, the opening of the natural plane between muscle and it is easy to breast implants can be placed in this place.

breast blood supply from branches of the axillary artery, the intercostal arteries and the arteries inside the breast. Few, if all vessels penetrate into the prostate gland from the primary.

Its nerve supply comes from the anterior and lateral cutaneous branch of fourth, fifth and sixth thoracic nerves. One of the major side branches of the skin can often be seen, preserved during Operation magnification. Contraindications


One of the absolute contraindications to breast enlargements subglandular is irradiated. Because of the blood SUPPLY interference caused by radiation, subpectoral placement is much safer.

Another reason to consider placing an implant in the muscle is very thin breast tissue, may occur after pregnancy.

Some surgeons also believe that subpectoral implantation should be used Small breasts in a very patient, although the author believes, is that to be necessary only in a few patients.

Because a small amount of breast can be obscured at mammography, a patient with breast cancer probably should be strong under the extended Become a muscle, as well as patients undergoing postmastectomy breast reconstruction after the opposite is also magnified.

Involuntarily That a lot of silicone gel implants, the author, in patients with a history of autoimmune diseases is recommended to saline implants.

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Breast Surgery - Breast Anatomy Breast

Introduction
dominant trend is visible in all branches of surgery Minimal Access idea incisional surgery to achieve the desired results with the effects of surgical reduction and Articles to facilitate faster patient recoveries. Plastic Surgeons not dealt with this issue over a longer time than other treatments have disciplines. The intention was to get the cosmetic benefit for patients by reducing and masking the scars.

in breast augmentation, one of the methods for the Achievement Through remote access incision placement, as exemplified by endoscopic transaxillary mammaplasty extensions and enhancements transumbilical endoscopy (tube) mammaplasty procedures. With these procedures, incisions are hidden first in the axillary crease and umbilicus, respectively, so scarring as a result of very hard to recognize. For this reason, methods are preferred by many physicians and patients alike.

acts with fiberoptics and endoscopic remote manipulation, combined with the progress of technology, which resulted in consistently good results the hands of doctors trained. Reticulating endoscopes and high definition camcorder offers new possibilities for visualization. These advances continue to strengthen over the enthusiasm for these endoscopic methods.

History
Transaxillary endoscopic procedure mammaplasty extensions

Transaxillary approach to breast augmentation was described by Troques in 1972 and Hoehler 1973.1,2 in addition to the obvious benefits of the hidden incision approach to facilitate direct access to subpectoral aircraft. With this technique, the inframammary crease and changed the origin of the pectoralis muscle dissected blindly, which is much higher rate of implant malposition. Limited exposure of the blind technique does not allow a complete breakdown of prepectoral fasciitis, which causes the high-riding implants Trends Or double-bubble appearance of the inframammary crease.

appearance Endoscopic surgery in 1990 allowed the use of an endoscope to breast surgery. Emory group reported their experience with endoscopic breast augmentation incision through the underarms in 1993, using a specialized retractor and air-filled optical cavity.3 Ho reported glycine irrigation technique used to create a fluid-filled cavity of the optical, although now also specialist applications and optical retractor air-filled cavity.4 increased control resulting from the direct visualization of dissection prevents many previous failures, the blind approach Pacha. Howard demonstrated benefits of an endoscope with lateral approach reduces the incidence of implant malposition from 8.6% to 2% in the case of endoscopes was used.5

Endoscopic transaxillary mammaplasty expansion is now widely used technique and has stood the test of time. However, experience is essential, more simple cases should be considered during the initial experience. Axillary approach has limited application in secondary matters.

Transumbilical endoscopic mammaplasty Extensions (tuba)

Transumbilical approach came into force in 1991 by Johnson and Christ and described in detail in 1993.6 technique is unique because it does not employ Regional or local incision, but rather uses a remote incision in the navel. TUBA endured criticism, but significant beginning has gained popularity as has been shown to be safe and reliable. TUBA Although technically more difficult, an increasing number of plastic surgeons gain knowledge of the procedures. Criticism has been the lack of basic operational control part, especially with regard to bleeding and the plane of dissection. With improved instrumentation and overall improvement in endoscopic skills these allegations have been proven invalid. The original study reported a lower level of Johnson less bleeding complications than other methods.6

Presentation
Importance initial consultation can not be overestimated. Talk to the four possible access to the patient's incision. Periareolar Current, ripple inframammary, axillary, and umbilical cord in the notches nonbiased way and assess the patient's enthusiasm axillary incision umbilical Or. Discuss the potential complications of breast augmentation, endoscopic complications emphasizing the unique methods. Discuss implant malposition, hematoma, underarms and lymph nodes. Finally, discuss the need for additional incisions inframammary crease to treat some complications of both approaches. All potential complications of breast augmentation should be discussed, including loss of nipple sensation, bleeding, infection, capsule contracture, asymmetry, unsatisfactory results, the need for revisionary Operations, and so on.

Perform a physical examination. Describe the location of the proposed cut and return the items and size of the surgical cutting of the tag. Pay particular attention to the distance from the areola is not inframammary crease and the transverse diameter of the breast. Assess the diameter of the breast, and then select the size and the implant immediately correct fold. The need for inframammary fold reduction in common is 1-2 cm but more than 3 cm should alert the doctor to the presence of constricted lower pole parenchyma and the need for Change, which can be a more direct approach to others. The ideal patient distances 5-6 cm from the areola is not inframammary crease, therefore requires less dissection worse.


Indications Indications for endoscopy to the patient's desire for breast augmentation incision remote and lack a well-developed inframammary crease to hide the crease incision below the horizontal axis of Visual. Contraindications


Zwæýenie lower pole

narrowed lower pole of the small distances from the inframammary crease to the areola is much more difficult and may require a radial scoring breast parenchyma. There is potential for implant displacement below overdissection (decrease) from the inframammary crease and the superior displacement of the implant underdissection the inframammary crease. In experienced hands and umbilical transaxillary approach can be used for this type of anatomy. Tubular breast



need herniated areola correction and scoring narrowed lower pole parenchyma makes perfect periareolar incision access tubular breast deformities.

the loss of

endoscopic breast augmentation can be performed in pseudoptosis and the degree of a drooping eyelid, but the anatomy of the inframammary crease required to reduce the base of vertical descent breast. Ptosis is considered not ideal for the inexperienced surgeon is, and I overdissection concern underdissection the inframammary crease.

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Vascular Anatomy of Blood
breast skin depends on the subdermal plexus, which is in contact with the primary deeper vessels supplying the breast parenchyma. Blood supply comes from (1) cutting the internal thoracic artery, (2) lateral artery chest pain, (3) thoracodorsal artery (4), the intercostal artery perforator, (5) thoracoacromial artery. The rich blood supply allows for a variety of reduction techniques, to ensure the viability of skin flaps after surgery.

innervation Sensory innervation of the breast breast
dermatomal in nature. It is mainly derived from the anterior and anteromedial branches of thoracic intercostal nerves T3-T5. Nadobojczykowy nerves from the lower fiber innervation of the cervical plexus and the upper and lateral parts of the breast. Scientists think the feeling to the nipple from the lateral cutaneous branch of T4.

Breast parenchyma and support structures
Breasts are composed of both adipose tissue and milk for the production of glandular tissue. The ratio of body fat compared to glandular varies between people. In addition, the onset of menopause (ie, a decrease in estrogen levels), the ratio of body fat increases the glandular tissue decreases.

breast soft tissues are supported by the suspensory ligaments of Cooper. These ligaments run throughout the breast parenchyma tissue of the deep fascia of the chest and attached to the dermis of the skin. Because they are not strained, as they allow for natural motion of the breast. Ultimately, this leads to breast ptosis of these ligaments to relax with age and time.

similar to the breast muscles Breast
lies on the muscles, which encases the chest. The muscles involved include the pectoralis major, serratus anterior, external oblique and rectus abdominus fascia. Blood supply, which provides movement of those muscles until then pierces the flesh of the breast, and thus the blood supply to the breast. By maintaining continuity with the main muscle, breast tissue is richly perfused, thereby preventing the complications of plastic surgery and reconstructive surgery requiring the placement of breast implants.

pectoralis major muscle

pectoralis major is a broad muscle that extends from its origin at the medial clavicle and sternum lateral to its insertion on the humerus. Thoracoacromial is its main artery blood flow in the intercostal perforating arteries arising from the inner segment to provide breast's blood supply. Medial and lateral anterior thoracic nerves provide innervation to the muscle, entering posteriorly and his side. Activities pectoralis major is the flex, adduct, and rotate the arm medially.

pectoralis major is extremely important for both aesthetic and reconstructive breast surgery because it provides cover muscle breast implants. In surgery, the pectoralis major muscle covers the implant, providing a reduction in the risk of implant extrusion in the skin and subcutaneous tissue core are often considerably reduced after mastectomy. Provides additional muscle tissue between the implant and the skin, thus reducing the palpability of the implant. Often placing the implant under the muscle makes it noticeable when it is contracted pectoralis. In such cases, it may help release the breast muscle with its inferior and medial attachments to reduce the frequency of contractions noticeable. In addition, in a worse version of the pectoralis muscle implant lower position can be achieved by a more aesthetic appearance.

serratus anterior muscle

serratus anterior muscle is the large muscle that runs along the anterolateral chest wall. Its origin is the outer surface of the upper limit of the first through eighth ribs and the insertion is on the deep surface of the blade. Its vascular supply is also derived from the lateral thoracic artery and branches from the thoracodorsal artery. Long thoracic nerve innervate serratus anterior is used, which acts to rotate the shoulder, arm and raise the point of drawing the shoulder forward toward the body. Transection of long thoracic nerve is carefully avoided during the dissection of axillary lymph nodes, because its loss results, "winging" as the blade is released from the chest and moves up and out. Since

serratus anterior lateral aspect of the breast based on the aesthetic surgery, blunt elevation pectoralis major inadvertently puts aside a small part of the serratus muscle. In order to completely cover the implant with the muscle in surgery, often serratus anterior must be substantially increased to obtain a sufficient layer of muscle in order to ensure coverage. Rectus abdominus

rectus abdominus

muscle provides a lower limit of the breast. It is elongated muscle that runs from the beginning of the comb interpubic cartilage and ligaments to the insertion Teenager mieczykowaty and cartilage of the fifth through seventh ribs. It acts to compress the abdomen and flex the spine. 7. to 12 intercostal nerves provide sensation to the skin covering and energize muscles. Myocardial blood flow passes through the network between the superior and inferior deep epigastric artery.

placing an implant for breast reconstruction in an effort to achieve full protection of the muscles, the rectus fascia often must be raised to the implant site so much worse. This dense thick fascia is often closely adjacent to the rib below. When I raised and released, proper positioning and expansion of the implant can be continued.

external oblique muscle

external oblique is a broad muscle that runs along the anterolateral aspect of the abdomen and chest. Its origin is from the lower eight ribs, and its introduction is along the front half of the iliac crest and linea alba aponeurosis from the xiphoid to the pubis. It acts to compress the abdomen, flex and rotate to one side of the spine and lower ribs. 7. to 12 intercostal nerves innervate the external oblique to serve. Segmental blood supply is maintained by the inferior intercostal arteries 8 rear.

Mięsień skośny zewnętrzny abuts piersi gorszy aspekt bocznej. Podwyższone wraz z rectus powięzi abdominus świadczenia niższe pokrycia implantów piersi w chirurgii rekonstrukcyjnej, jego powięzi, jak powięzi rectus muscle abdominus, muszą być wydane odpowiednio w celu zapewnienia właściwego miejsca i rozbudowy implantu. W chirurgii estetycznej, umieszczenie implantu inferiorly zazwyczaj nie jest poniżej tych powięziowy załączników. Jeżeli implant jest umieszczony z tyłu deski rozdzielczej, implant często "Jazda zbyt wysokie" i może doprowadzić do "double bubble" efekt, w którym miąższ piersi ślizga się i wyłącza implant