Breast

Question 1

Types of Breast Augmentation/Reconstruction

Answer 1

Implant based
Mastopexy
Autologous (pedicled LD, free DIEP)

Question 2

Breast Augmentation (Implant): Consent

Answer 2

General: PBI, SSS, WAG
Pain, bleeding & haematoma, infection, scarring, seroma, damage to structures, wound dehiscence, allergic reactions, GA risk (VTE, MI, LRTI)

Specific: BANS BICC
Breast feeding
Asymmetry: nipples, scar, size
Necrosis: nipple, skin, fat
Skin (dog ears), shape (change over time), size (under or over preference)

BIA-ALCL
Implant: rupture, migration, removal
Capsule contracture
Cancer screening

Question 3

Breast Reduction Focused History

Answer 3

Age and relation to first menses

Oncological history
o Lumps in breast or armpit
o Skin changes
o Nipple discharge
o Personal or family history of breast cancer

Aesthetic history
o Back pain
o Skin changes: intertrigo, skin marking from bra staps, stretchmarks
o Psychological symptoms: anxiety, self-conscious
o Social: Work. Sport/exercise. Relationships
o Recent and stable weight loss

General Breast History
o Previous breast feeding
o Plans for further family

General history
o PMHx, previous surgical history and fitness to surgery
o DHx, allergies
o SHx
o Smoke or vape

Question 4

Criteria for breast reduction on NHS

Answer 4

NHS Breast Reduction Criteria (2019 NHS Evidence Based Interventions)

1. Full package of support from GP including physiotherapy assessment and treatment
2. Functional symptoms
   a. Skin: intertrigo, indentation at site of bra line
   b. MSK: back pain/kyphosis. Professionally fitted bra has not helped.
3. Breast size is disproportionate to chest wall circumference
4. Reduction is planned to be >500g bilaterally
5. BMI <27 and stable for 12 months
6. Provided written information about risk and benefits of surgery.

Question 5

Breast reduction focused examination

Answer 5

With chaperone

BMI

Oncological exam: Look, feel, move
o Inspect for: skin changes, nipple discharge
o Systematic palpation of bilateral breast parenchyma and axilla for lumps and lymphadenopathy

Aesthetic exam
o Inspect for size, symmetry, skin changes: intertrigo and bra stap indentation, trapezius hypertrophy
o Palpate for parenchymal quality fatty, fibrous or glandular
o Measure: SN – N. N – IMF. N – N.

Classification of ptosis (regnault)
Clinical photography with consent

Question 6

Classification of breast ptosis

Answer 6

Regnault Classification:

Grade 1: NAC at level of IMF
Grade 2: NAC is below IMF, but not most dependent part of breast parenchyma
Grade 3: NAC below the IMF and most dependent part of the breast
parenchyma along the inferior contour of the breast

Pseudoptosis: NAC is at/above IMF, but most breast parenchyma has descended below IMF

Question 7

Definition of mastopexy

Answer 7

Surgical procedure designed to correct breast ptosis without a significant
reduction in volume

Question 8

Goals of mastopexy

Answer 8

Reliable nipple-areolar transposition to an aesthetic position on the breast mound
Obtain pleasing breast shape
Reduce the skin envelope
Maintain breast volume (or add volume in the case of augmentation-mastopexy)
Achieve breast symmetry
Produce optimal scar quality: Short-scar techniques preferred when possible