Breast Reduction

Question 1

The breast is a subcutaneous structure with the strongest attachments
to the chest wall medially along the sternum and at the inframammary
(IM) fold

Answer 1

T

Question 2

The primary blood supplyoriginates from the internal mammary system and its arteries perforate the breast from deep to superficial.

Answer 2

T

Question 3

The superior pedicle approach relies on internal mammary
perforators from the second rib intercostal space

Answer 3

T

Question 4

whereas the blood supply to the superomedial pedicle originates from the third rib intercostal space

Answer 4

F whereas the blood
supply to the superomedial pedicle originates from both the second
and third rib intercostal space

Question 5

The blood supply to the inferior pedicle
is based upon the fourth rib intercostal space

Answer 5

T

Question 6

All skin and subcutaneous flaps rely on a network of subdermal venous drainage.

Answer 6

T

Question 7

Lymphatic drainage of the breast

Answer 7

Include cutaneous, internal mammary, posterior intercostal, and axillary routes

Question 8

NAC sensory supply

Answer 8

The lateral branches of the fourth, fifth, and sixth intercostal nerve
supply the primary sensation to the NAC

Question 9

Preoperative mammography is not necessary for elective breast
reduction before the age at which screening mammography is generally recommended

Answer 9

T

Question 10

Youthful and elastic skin appears to have a greater
risk for hypertrophic scarring postoperatively. A vertical approach
may reduce this risk

Answer 10

T

Question 11

Complete nipple inversion may be dealt with at the time of the
breast reduction ifneeded

Answer 11

T

Question 12

Extend the IM fold
markings laterally to a point that corresponds with the anterior
axillary line, approximately where the breast ends. Avoid extending
this mark toward the back chasing skin folds laterally.

Answer 12

T

Question 13

How you can locate the location of the new nipple?

Answer 13

The distance from the sternal notch to the nipple (woman who is a 34/36 C will be about 23 to 24 cm)
the hypothetical line that connects laterally to ~2 cm below the midpoint of the upper arm
2 cm above the projected IM folds onto the anterior breast.

Question 14

INFERIOR PEDICLE TECHNIQUE may be considered for breasts in which the NAC falls significantly below the triangle formed by the planned vertical flaps

Answer 14

T

Question 15

limit the resection from the medial flap, as this area is
frequently already deficient.

Answer 15

T

Question 16

. Drains is a must in breast reduction surgery

Answer 16

F usuall not necessary
Drains are placed prior to closure
for 24 hours only if large amounts of tumescent fluid were used for
lateral SAL or if a large potential dead space persists.

Question 17

The inferior pedicle is considered the primary approach for many surgeons in moderate-size breasts.

Answer 17

F SUPEROMEDIAL PEDICLE

Question 18

The resection in the superior and superomedial pedicle approach is mostly
from the lower and lateral poles where many volumetric issues exist
with breast hypertrophy

Answer 18

T

Question 19

bottoming out are more with superomedial pedicle

Answer 19

F more with inferior pedicles
as more lower and lateral pole tissues are resected with superomedial pedicle

Question 20

The increase in the upper pole fullness is more with inferior pedicles

Answer 20

F There is minimal resection of upper and
medial breast tissue, which, along with the rotation of the pedicle cephalic ally, may help to increase upper breast fullness.in superomedial pedicles

Question 21

any undermining of the pedicle should be avoided

Answer 21

T

Question 22

the position of the
nipple-areolar complex is generally within or just below the vertical limbs of
the keyhole pattern in superomedial pedicle technique

Answer 22

T

Question 23

In SUPEROMEDIAL PEDICLE WITH VERTICAL
SKIN RESECTION Resection of breast tissue under
the skin flaps is identical to the resection of breast tissue performed for the superomedial pedicle with a keyhole pattern

Answer 23

T

Question 24

The
vertical approach can significantly decrease the risk for hypertrophic scarring medially and laterally

Answer 24

T

Question 25

What is the ghost areas in superomedila with vertical tech ?

Answer 25

dot the transverse incisions at the IM fold and the
medial and lateral flaps. These marks create a reference on the surface
where the resection will be performed underneath the thin skin flaps
(also called ghost areas)

Question 26

The vertical limbs will continue caudally to ~3 to 4 cm above the
IM fold and join in a gentle curve.

Answer 26

T

Question 27

less skin resection occurs in vertical supoeromedial tech

Answer 27

T

Question 28

The vertical incision is closed in three layer

Answer 28

F The vertical incision is closed in either a single or a double layer

Question 29

Do
not attempt to shorten the incision during the closure for the first
2 cm below the NAC

Answer 29

t This will place the 6-o’clock position of the
NAC under tension caudally and distort its shape

Question 30

The final resulting caudal fullness
that persists in many cases can be purse stringed or just closed. This
redundant tissue can be dressed with a small temporary bolster of
Vaseline gauze held by tape for 7 to 10 days

Answer 30

T

Question 31

Indication for breast amputation

Answer 31

Refers to patients with a nipple to IM fold distance >20 cm.
breast scars that cross planned skin flaps or pedicles.
previous reduction mammoplasty of known or unknown technique
a history of radiation
patients with systemic vascular connective tissue disorders,
extensive smoking
history, or autoimmune disorders

Question 32

Occurs with breast imputation

Answer 32

T

Question 33

Because this technique is
usually performed in the setting of very heavy breasts, remember to
correct for the elasticity of the upper skin by lowering the final nipple
position markings as needed

Answer 33

T

Question 34

the width of the vertical portions of the
keyhole may change once the resection is completed in breast imputation

Answer 34

T

Question 35

Measurement to increase the survival of the nipple-areola graft

Answer 35

Also consider amputation of the tip of the nipple papule in circumstances where the length of the papule exceeds
1 cm to help it to survive as a full-thickness graft.

Question 36

patients who
have undergone previous reductions of unknown techniques and are
not candidates for amputation with free nipple grafts SUCTION-ASSISTED LIPECTOMY

Answer 36

T

Question 37

Acute Complications

Answer 37

Hematoma 4%
Delayed Wound Healing (T-junction) in 10% of cases
Seroma
Vascular Compromise

Question 38

Treatment of vascular compromise

Answer 38

release sutures as needed to avoid necrosis and loss of the NAC.
Assess the NAC for proper rotation or consider additional reduction
of the breast to decrease intrinsic pressure.
Removal of the NAC
as a full-thickness graft and regrafting can be done but has limited
results

Question 39

Long-term Complications

Answer 39

Asymmetry
Fibrosis and Fat Necrosis
Inability to Breastfeed(successful breastfeeding ranges from <5% for techniques with no preservation of subareolar parenchyma such as an amputation/ free nipple graft to 75% to 100% for techniques with full preservation of the subareolar parenchyma.)

Inverted Nipples
Loss of Nipple Areolar Sensation
Hypertrophic Scarring
High NAC Position
Discovery of Breast Cancer

Question 40

Measurement to preserve Nipple Areolar Sensation

Answer 40

Avoid injury to the pectoralis
fascia and if possible, leave small amounts of soft tissue over the muscle, design a wider inferior pedicle base, and avoid undermining the superomedial pedicle

Question 41

keloid scarring is common complication in breast surgery

Answer 41

F keloid scarring is a rare complication in breast surgery

Question 42

It is important to know that breast rereduction
can be performed safely, even when the previous technique is
unknown.

Answer 42

T