By John Pilbeam, Chris Rodgerson, Derek Tribble
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Griffiths 1. Very small reduction: Liposuction only. Easier in older atrophic, less glandular breasts 2. Ptosis only: Mastopexy technique (see mastopexy chapter) 3. Sternal notch to nipple distance: • Less than 30 cm Vertical scar technique (but only if young, good quality elastic skin and non-smoker) • Greater than 30 cm Wise pattern technique of your choice Warn of risk of free nipple graft • Greater than 40 cm Risks/Complications General • Risks of GA including DVT/PE/Chest infection • Haematoma Specific Nipples: • Nipple loss/necrosis (partial or complete) • Decreased or increased sensation • De-pigmentation of NAC Wound: • Delayed healing • T junction breakdown Scar: • Hypertrophic scars (particularly at medial and lateral extent of wounds • Keloid scars (very important to counsel at risk patients adequately pre-operatively) • Dog ears (particularly laterally – this is often due to deficiencies in pre-op markings) Chapter 4.
Is patient requesting surgery for genuine reasons) • Any drug allergies • Medications (as above) • BMI (weight must be stable) • Smoking (associated with increased risk of wound breakdown/delayed healing) AIM: by the end of history you should know 1. Extent of patient’s symptoms 2. Need for additional investigations/treatment of any intrinsic breast lump/problem 3. Patient’s awareness of risks and complications 4. What the patient hopes to achieve 5. Chances of surgery meeting these expectations Examination Look Evidence of general obesity.
1007/978-1-84882-116-3_4, © Springer-Verlag London Limited 2012 25 26 R. Caulfield and M. 1 Candidate for breast reduction Specific breast • • • • • Grooving Intertrigo/maceration Requirement to wear bra at night Psychological effects Pain (Must make sure patient is wearing correct bra size (see below) – commonest cause of breast pain ) • Family history of breast cancer • Personal history of previous/current lumps, discharge, skin retraction, inverted nipples • Any previous breast investigations and the results: FNAs, biopsies, ultrasound, mammogram Risk factors • Family history of breast cancer • General obesity: In younger women – associated with oestrogen induced increase in dense glandular tissue; in older women – associated with increase in fatty/adipose content of breast • Smoking • Medication • Bleeding tendencies Chapter 4.
Adromischus by John Pilbeam, Chris Rodgerson, Derek Tribble