breast reduction and mastopexy - regnault b baps presentation
DESCRIPTION
Breast reduction and Mastopexy - Regnault B BAPS PresentationDr.Lakshmi Saleemwww.salaja.comTRANSCRIPT
The simplified Regnault B technique The simplified Regnault B technique
for breast reduction and mastopexy :for breast reduction and mastopexy :
a single surgeon experience of 56 consecutive casesa single surgeon experience of 56 consecutive cases
S Tadiparthi, A Edwin, R DeBono
University Hospital North Durham, Durham, UK
IntroductionIntroduction
Described by Paule Regnault in 1974 for breast reduction and mastopexy +/- prosthesis
Original markings resulted in a ‘B’ shape
Uncommonly used technique – markings and procedure perceived to be difficult
We describe a simplification of these markings
Simplified Regnault B - Breast MarkingsSimplified Regnault B - Breast Markings
3 markings with
patient standingstanding :
1. Midline
2. Breast meridian
3. Inframammary fold - IMF
Breast markings Breast markings
Sitting position Supine position
Breast markingsBreast markings
Final breast markings…….Final breast markings…….
Pre-operative ImagesPre-operative Images
35 year old female, 36G bra size
Sternal notch to nipple distance 36cm
Appearance following breast markingsAppearance following breast markings
• 5 cm nipple marked5 cm nipple marked
• Breast tourniquet applied (optional)Breast tourniquet applied (optional)
• Superior shaded area (pedicle) de-epithelialisedSuperior shaded area (pedicle) de-epithelialised
Superior pedicle de-epithelialised
Superior pedicle raised with a
thickness of approximately 2cm
Dissection Dissection vertically down to vertically down to chest wall chest wall beneath the beneath the pediclepedicle (at level of (at level of base of the 16 cm base of the 16 cm arc)arc)
Triangular wedge of tissue Triangular wedge of tissue below and lateral to the nipple below and lateral to the nipple is excisedis excised
Inferolateral wedge of tissue excised
665 grams of tissue removed from the right breast
Pedicle trimmed to remove excess breast tissue
Dermis of the 16cm arc divided so the pedicle fits better on
closure
Resulting medial and lateral flaps after excision of breast tissue
• Drain sited
• Nipple sutured in new
position – level of IMF
• Lateral flap moved medially
& inferiorly
• Medial flap moved laterally
Immediate Immediate postoperative postoperative appearanceappearance
ResultsResults
32 year female : grade III ptosis & 38F breasts
375 g from right breast and 350 g from left breast removed
24 month follow up : scars healed well, good symmetry, normal nipple sensation
ResultsResults
48 yrs old wears 32G bra, sternal notch to nipple distance of 29 cm
300g removed each breast
28 month F/U : good symmetry of breast size, shape and nipple position
ResultsResults
39 years old, 34F bra, sternum to nipple distance of 27 cms
375 g removed from each breast
9 month F/U : good symmetry, slight hypertrophic scarring around nipple
MethodsMethods 56 consecutive patients
Performed by the senior surgeon between 2005 and 2007
Data collected retrospectively from notes
Subjective patient evaluation questionnaires
Patients invited to clinic for review by independent assessors
ResultsResults
Age : range 17 – 60 years (mean 39 years)
BMI : range 20-34 (mean 26)
Breast tissue excised : range 208 - 937 gram (mean 620g)
Sternal notch to nipple distance : range 23.5 – 37.5 cms
ProceduresProcedures
Breast Reductions : 87% (n=49)Bilateral 66 %
Unilateral 21%
Mastopexies : 11% (n=6)Bilateral 4%
Unilateral 7%
Reduction and mastopexy : 2 % (n=1)
Risk factors and length of stayRisk factors and length of stay
Smoking 18% Hypertension 15% Hypercholesterolaemia 6% Diabetes, IHD, CVA 0%
Length of stay : mean 3 days
ComplicationsComplications
Wound breakdown 12% (mostly minor)
Wound infection 5 % (antibiotics only)
Haematoma 3.5% (1 evacuated in theatre & 1 aspirated using ultrasound)
Seroma 1.7% (1 patient)
Nipple necrosis 1.7% (1 partial necrosis)
Fat necrosis 0 %
No patients required revisional surgery
ResultsResults
61% (n=34) returned to clinic for review by independent assessors
Follow-up time : 4 – 32 months (mean 17)
Assessed with scale 1 (poor) to 5 (excellent) on :- breast shape/size/symmetry- nipple position
All patients scored 5 or 4 (excellent or good) for symmetry of breast size and shape and nipple position
Patient questionnairesPatient questionnaires
Nipple sensation :
Normal 64%
Reduced 30%Absent 6%
Breast feeding : None of our patients had tried to breast feed postoperatively
Patient satisfactionPatient satisfaction
92% rated their scars 4 or 5 (scale 1 poor – 5 excellent)
91% satisfied or very satisfied with the operative results
97% would recommend the operation to others
ConclusionsConclusions
Versatile technique
Resection up to 1000g
Omits medial inframammary scar
Broad superior pedicle: complete nipple necrosis rare
No pseudoptosis or dog ears
High patient satisfaction
Thank youThank you