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Breast Surgery

Introduction

Authors: Mia Steffenssen, MD, Mia Demant, MD

This chapter first describes the normal breast and then reviews the surgical possibilities for non-malignant and abnormal breast conditions.

Definitions

Inframammary fold (IMF): is a zone of adherence of the superficial fascial system to the underlying chest wall. It is anatomically defined as the area where the skin of the lower pole of glandular breast tissue meets the chest wall forming a groove known as the inframammary crease.

Nipple areola complex (NAC): is a major anatomic landmark of the breast, serves to drain and express breast milk during lactation.

Breast reduction: (also known as reduction mammaplasty) is a procedure used to remove excess fat, tissue, and skin from the breasts.

Breast lift: (also known as mastopexy) is a procedure used to remove mainly skin from the breast, which makes it different from breast reduction.

Breast augmentation: (also known as augmentation mammoplasty) is surgery to increase breast size. This can be achieved by implants and/ or autologous tissue.

Background

The story about benign breast surgery really kicked off in the 1950s. For nearly 30 years, breast reductions had been conducted by removing the lateral quadrant of the breast and undermining larger skin flaps. However, this often was complicated by necrosis. In 1956 Wise started a modern era of breast reduction by making a keyhole pattern and underlined the importance of preoperative drawing.

In the early history of breast implants, doctors were experimenting with injections and operations ranging from wool, glass, paraffin, sponges to ox cartilage. The postoperative complications were major. The first human receiving silicone breast implants was a female fabric worker and mother of six children. She was visiting the hospital for tattoo removal on the chest but ended being a good candidate for the procedure and got a successful breast enlargement. Nearly three decades passed before the U.S Food and Drug Administration (FDA) investigated breast implant failures and subsequent complications in 1988. It now exists two types of FDA approved breast implants: saline-filled (saltwater solution) and silicone gel-filled. Both have a silicone outer shell and vary in size, shell thickness, shell surface texture, and shape (contour).

References

  1. Lockwood TE. Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plastic and reconstructive surgery. 1991 Jun 1;87(6):1009-18.
  2. Giess CS, Keating DM, Osborne MP, Ng YY, Rosenblatt R. Retroareolar breast carcinoma: clinical, imaging, and histopathologic features. Radiology. 1998; 207:669–673.
  3. Stephen P. Daane, MD, W. Bradford Rockwell, MD, Breast Reduction Techniques and Outcomes: A Meta-analysis, Aesthetic Surgery Journal, Volume 19, Issue 4, July 1999, Pages 293–303.
  4. https://en.wikipedia.org/wiki/Breast_implant#History
  5. https://www.fda.gov/medical-devices/implants-and-prosthetics/breast-implants
  6. https://www.fda.gov/consumers/consumer-updates/what-know-about-breast-implants

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