Mammoplasty


 * Mammoplasty**

Definition:
Mammoplasty is the reshaping of the breasts through plastic surgery. There are three general categories of mammoplasty (cosmetic surgery) performed on the breasts: augmentation, reduction, and reconstruction/lifts. (Grayson, 2003, p. 3)

History:

 * 1895 – Czerny attempted the first augmentation mammoplasty in which he transferred a lipoma to the breast (Ramachandran, 2008, p. S41)
 * 1921-1923 – Lexer and Kraske described a procedure for subcutaneous undermining and nipple transpoition ( Purohit, 2008, p. S64)
 * 1950 – Longacre performed autogenous flap augmentation. (Ramachandran, 2008, p. S41)
 * 1961 – Uchida reported the use of injectable silicone (Ramachandran, 2008, p. S41)
 * 1962 – Silicone Gel Prosthesis Introduced by Cornin and Gerow (Ramachandran, 2008, p. S41)
 * First Generation implants had thick shells, thick gel, and a Dacron patch in the posterior aspect. It had a tear drop shape. (1962-1970) (Ramachandran, 2008, p. S41)
 * Second Generation implants had thin shells, thin gel and a round shape. (1970-1982) (Ramachandran, 2008, p. S41)
 * Third Generation implants had thicker shells, thicker gel and a round shape. (1982 onwards) (Ramachandran, 2008, p. S41)
 * Fourth Generation implants from 1986 onward have features similar to the third generation, expect that they had textured surface. (Ramachandran, 2008, p. S41)
 * Fifth Generation implants from 1993 onward have enhanced cohesive silicone gel and texture silicon surface. Available in anatomic and round shapes. (Ramachandran, 2008, p. S41)
 * 1965 – Inflatable saline filled implant was first reported by Arion in France. (Ramachandran, 2008, p. S41)
 * 1968 – Dempsey and Latham, First augmentation mammoplasty procedure using sub pectoral prosthesis implantation (Ramachandran, 2008, p. S41)
 * 1969 – Saline breast implant (Worley, 2001, p. 304)
 * 1992 – FDA announced a voluntary moratorium on the sale and use of silicone gel-filled breast implants. (Ramachandran, 2008, p. S41)

Breast Augmentation:
**Done to enhance the appearance, size, and contour of a woman’s breasts**. Woman typically determines the size by fitting trial implants (Grayson, 2003, p. 3) There are several diffeent types of incisions that can be made, all typically 3 centimeters in length, to insert the silicone, saline, or silicone and saline implants. **The four common incisions** include transaxillary (armpit), periareolar (around the nipple), inframammary (along the normal breast fold), and transumblicial (around the belly button). In some cases an endoscope, a small thin tube with a camera and light, may be used during the procedure (Grayson, 2003, p. 1).

The physiological **reasons most commonly cited for surgery** include cosmetic correction, tubular breast, changes in breasts due to pregnancy, correction of asymmetrical breast size or shape, or correction of the breasts from mastectomy as a result of breast cancer. Other psychological reasons for breast augmentation include women believing that their breasts are too small or underdeveloped (hypomastia) and beliefs that increasing their breast size will result in greater financial gains or increased self confidence. (Ramachandran, 2008, p. S42)

The **risks and complications from breast augmentation** vary. The most common complications include hematomas, seroma, infection, reduced nipple sensation, skin irritation, pain, implant displacement, implant rupture, implant rippling, capsular contracture (breast becomes firm and unnatural feeling due to scarring), calcification, immune system problems, breast deformity, wrinkles, and bleeding (Ramachandran, 2008, p. S46). The following are other less common complications. Difficulty diagnosing and treating breast cancer (Worley, 2001, p. 305). Breastfeeding problems due to insufficient lactation or severed milk ducts and altered nipple sensation as a result of surgical procedure (Worley, 2001, p. 306). Contamination of dust, lint, skin oil, powder, or soap during procedure (Finn, 1979, p. 62).

The **results women experienced from breast augmentation** included firmer breasts, better positioning of the areolas and nipples, more aesthtetically pleasing size of the areolas, an increased quality of life resulting from increased self confidence or acceptance of their body image. (Surgery.org, retrieved 2011, p. 1)

Breast Reduction:

 * Often used in women with large, heavy breasts who experience significant discomfort including neck pain, back pain, numbness or weakness due to the weight of the breasts** (Grayson, 2003, p.3). Theincisions made for surgery are similar to those of breast augmentation (see breast augmentation).


 * The reasons for a breast reduction** are typically the result of physiological problems resulting from the weight or size of the breasts but may include psychological reasons. The most common physical reasons for breast reduction are chronic shoulder pain, back pain or breast pain. In some cases giant virginal hypertrophy (a condition in which young girls around puberty develop massive breasts[[image:reduction.jpg width="436" height="347" align="right" caption="In a breast reduction surgery, the breast tissue is cut along predetermined lines and (A) excess tissue is removed (B). The nipple is placed higher on the breast (C), and the two sides of the incision are brought together (D), removing any excess skin (E). (Illustration by GGS Inc.)"]]which are out of proportion to the rest of their body) is also a reason for a breast reduction. (Purohit, 2008, S65) Social or psychological aspects with having large breasts, lower self-assessed quality of life (Eggert, 2009, p. 201). According to Kai Saariniemi, "Up to a third of women who want reduction mammaplasty have anxiety or depression, or both" (2009, p. 320).

T**he requirements of an ideal breast reduction** include:
 * The breast should be lifted to a youthful and natural form in proportion to other parts of the body
 * Both breasts should be symmetrical
 * The nipple and areola should be translocated to an appropriate location.
 * Blood supply to nipple and areola should not be jeopardized
 * Function of the breast should be preserved.
 * Scars should not be visible through normal clothing or be above the areola
 * The operation must be applicable to all forms of deformity
 * The procedure should be a one stage operation (Purohit, 2008, p. S65).

The **risks and complications from breast reduction surgery** are less than those of breast augmentation surgery. Women experience reduced sensitivity – the areola and nipple complex is the most densely innervated part of the breast and receives nerves from two directions, laterally from the lateral branches of the intercostal nerves, and medically from the medial branches of the intercostal nerves (Eggert, 2009, p. 205). There is also an inability to breastfeed properly and in extremely large reductions there is greater chance of an inability to breastfeed (Grayson, 2003, p. 3). Overweight or obese women have been found to have more complications (Eggert, 2009, p. 204).

The **results from breast reduction surgery** include:
 * Improved Quality of life (Eggert, 2009, p. 204)
 * Specifically improved the ability to move, breath, sleep (Saariniemi, 2008, p. 195)
 * Similar increases to quality of life experienced by individuals having a hip joint replacement or major joint replacement (Saariniemi, 2008, p. 197)
 * Reduction in anxiety, depression, discomfort, distress (Saariniemi, 2008, p. 195)
 * Better sexual activity, vitality, and ease of elimination or performing usual activities (Saariniemi, 2008, p. 195)

Breast Reconstruction:
**The procedure recreates a breast with the desired appearance, contour and volume.** (Grayson, 2003, p. 2)

The **reasons women cited for breast reconstruction** are: breasts lacked substance or firmness, nipples pointed downward, loss of skin elasticity, significant weight loss, aging, heredity, pregnancy, breast feeding, or one breast was lower than the other. (Plasticsurgery.org, Retrieved 2011, p. 1) Women who undergo mastectomies as a treatment for breast cancer often have breast reconstruction later. (Grayson, 2003, p. 2) The incisions made for the surgery are similar to those of breast augmentation (see breast augmentation).

**Similar to breast augmentation, implants may be used during the reconstruction**. Typically the implant is used to match the size of the opposite breast and the implant is place beneath the chest muscle. A breast also can be recreated using a woman’s own tissue. At times, a segment of the lower abdominal wall can be used. Other tissue options for autologous (using your own tissue) reconstruction use back muscle and skin or fat and muscle from the buttock. (Grayson, 2003, p. 2) Breast lifts can be done at any age but plastic surgeons usually recommend waiting until breast development has stopped (Surgery.org, Retrieved 2011, p. 1).

**One common type of breast reconstruction is a breast lift** which is performed usually because too much skin compared to breast tissue, the areola is lifted to a higher position with excess skin removed. There are three common techniques for performing a breast lift. (Grayson, 2003, p. 2)
 * Wise pattern. The incision, in the shape of an anchor, goes around the chest and below the breast.
 * LeJeour. The incision goes around the areola and down.
 * Donut or peri-areolor. The incision goes around the areola only.

**The risks and complications from breast reconstruction** include scarring, bleeding, infection, and loss of sensation in the nipple or areas of breast skin. During breast lift procedures the nipple is often moved resulting in a detachment from the nerves around the nipple resulting in a loss of sensation. Since the milk ducts and nipples are left intact, breast lift surgery usually will not affect breast feeding and many women have breast lift surgery before having children. (Surgery.org, Retrieved 2011, p. 1)

The **results for breast reconstruction vary** depending on the type and purpose for reconstruction. Most of the results are those similar to individuals with breast augmentation surgery (see breast augmentation).

References:
**// Breast lift //****. (n.d.). Retrieved from [] ** **// Breast lift surgery //****. (n.d.). Retrieved from [] ** ** Breast reduction **. [Web]. Retrieved from []   **// Breast revision surgery //****. (2007). [Web]. Retrieved from [] ** ** Eggert, E. (2009). Clinical outcome, quality of life, patients' satisfaction, and aesthetic results, after reduction mammaplasty. ****// Scand J Plast Reconstr Surg Hand Surg //****, ****// 43 //**** , 201-206. ** ** Finn, K. (1979). Augmentation mammoplasty. ****// Nursing Update //****, 60-63. ** ** Grayson, C.E. (2003, September). ****// Options in mammoplasty (breast cosmetic surgery) //****. Retrieved from [] ** // How breast implants work: subpectoral implant //. [Web]. Retrieved from []  ** Purohit, S. (2008). Reduction mammoplasty. ****// Indian J Plast Surg Supplement //****, ****// 41 //**** , S64-S67. ** ** Ramachandran, K. (2008). Breast augmentation. ****// Indian J Plast Surg Supplement //****, ****// 41 //**** , S41-S47. ** ** Saariniemi, K. (2008). The improvement in quality of life after breast reduction is comparable to that after major joint replacement. ****// Scand J Plast Reconstr Surg Hand Surg //****, ****// 42 //**** , 194-198. ** ** Saariniemi, K. (2009). Breast reduction alleviates depression and anxiety and restores self-esteem: a prospective randomised clinical trial. ****// Scand J Plast Reconstr Surg Hand Surg //****, ****// 43 //**** , 320-324. ** ** Worley, J. (2001). Augmentation mammoplasty: implications for the primary care provider. ****// Journal of The American Academy of Nurse Practitioners //****, ****// 13 //**** (7), 304-309. **