Anatomy/Cosmetic Breast Flashcards
Blood supply to skin
Subdermal plexus which communicates through perforators with the underlying deeper vessels
Blood supply to breast parenchyma
Perforating branches of the internal mammary (thoracic) artery, lateral thoracic artery, thoracodorsal artery, intercostal perforators, thoracoacromial artery
NAC blood supply
Subdermal plexus and parenchymal blood supply (4th intercostal)
NAC sensation/nerve supply
anteromedial and anterolateral T3, T4, T5 intercostal nerve
Nerve injured in axillary dissection which gives sensation to upper inner arm
Intercostobrachial
Most common breast anomaly and description
Polythelia; 2% of population; supernumary nipples along the milk line
Mammography views used for augmented breasts
Eklund views
What age should early mammograms be ordered for breast surgery?
30-35, if younger order ultrasound if indicated
If N-IMF distance is greater than ___cm, concomitant mastopexy may be required with augmentation
9.5cm.
Mild ptosis can be corrected with augmentation
When is subglandular augmentation not recommended?
thin upper pole coverage (<2cm on pinch test)
Advantages of dual plane augmentation
- Takes advantage of extra upper pole pectoralis coverage
- Maximizes implant/parenchymal interface in the lower pole
- Prevents double bubble
Detrimental effects are increased when the implants are larger or smaller?
Larger
How do textured implants prevent capsular contracture?
Disorient collagen deposition and reduced mobility in the pocket
What is the main reason for capsular contracture?
bacterial contamination (can be seeded from NAC in periareolar placement)
What surgical techniques prevent capsular contracture?
Triple antibiotic solution
Changing gloves
Avoiding NAC-area incisions
What is the most sensitive test for implant rupture?
What is the “sign”?
MRI
Linguini sign
What is the risk for morbidity/mortality from breast cancer in relation to non-breast implant patients?
Same
Etiology of breast ptosis
parenchymal volume decreases and the skin envelope and supporting structures (Cooper’s ligaments) do not retract.
Regnault Classification of Ptosis
Pseudoptosis - NAC is at or above IMF but parenchyma is below IMF Grade 1 (mild) - NAC at IMF Grade 2 (moderate) - NAC below IMF but above majority of breast tissue Grade 3 (severe) - NAC below IMF and at most dependent portion of breast
Disadvantages of periareolar mastopexy
- only useful in mild ptosis with fibrous/glandular breasts
- can elevate NAC only 1-2cm
- scar and areola widen frequently
- can lack projection
Tuberous breast deformity
-deficient breast development in the vertical and horizontal dimensions, constricted base, high IMF, breast parenchyma herniated into the areola
When can augmentation be used to correct ptosis?
If skin excess is minimal, minimal gland below the IMF, minimal ptosis
can provide appropriate projection and adequately correct ptosis and minimal skin excess
Pathophysiology of macromastia
normal estrogen levels and number receptors, suggests excessive growth in response to circulating estrogens
