Describing the deformities

Published on 23/05/2015 by admin

Filed under Plastic Reconstructive Surgery

Last modified 23/05/2015

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Chapter 53 Describing the deformities

Anatomic Considerations

We have grouped the body into six unique anatomic areas that require surgical attention.

Surgery of the Breast

We have described a variety of deformities of the female breast as well as a classification of these deformities (Table 53.1).2

TABLE 53.1 Classification of the Deformities of the Female Breast

The anatomic innervation to the breast has been described in multiple articles, dating back to Sir Astley Cooper’s description in 1840.3 Craig and Sykes identified the role of the third, fourth, and fifth anterior cutaneous nerves, and the fourth and fifth lateral cutaneous nerves, in supplying sensation to the nipple–areola complex.4 The importance of the lateral cutaneous branch of the fourth intercostal nerve as innervation to the nipple–areola complex was documented by Courtiss and Goldwyn.5 In light of these anatomic considerations, we generally employ a superolateral dermoglandular pedicle in our reduction mammaplasty and mastopexy cases.

In the female patient, the skin envelope, degree of nipple ptosis, and deficiency in volume must all be considered in selecting the appropriate technique. In patients with excess residual volume as well as ptosis, a standard reduction mammaplasty may be effective. Many patients, however, have a deficiency in volume, particular in superior pole fullness, combined with excess ptotic skin. In these patients, mastopexy alone may be indicated, or mastopexy with “autologous augmentation” using a dermoglandular flap in continuity with a pedicle that is rotated into the superior pole of the breast, or a mastopexy combined with augmentation using a mammary prosthesis. The male breast generally requires a reduction of excess skin, typically with an inferior pedicle reduction.

Brachioplasty or Recontouring of the Arm and Axilla

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