Precision in breast reduction

Precision in the design and performance of a breast reduction can be enhanced by careful formulation of the criteria. The breast cone should incline about 15 degrees medialward. The intersection of the midshoulder (anterior iliac) spine line with the inframammary fold offers a reference point for horizontal localization of the nipple. The nipple-suprasternal notch length, the diameter of the areola, and the nipple-inframammary fold length are determined by the height of the patient and the size of the brassiere cup. On this basis, a table for breast reduction can be drawn up that gives these dimensions for a given height and size of brassiere cup. Other important factors include the stretch direction of the skin and the course of the nerve to the nipple. A distinction is made between radial segment conization and anterior tangential conization. Criteria and measurements were incorporated into a technique comprising anterior tangential excision of glandular tissue and limited inferior radial segment excision of skin.     

The pure posterior pedicle procedure for breast reduction

The inferior pedicle technique, which has already become classic, employs a glandular areola-bearing pedicle whose source of vascularization is primarily posterior. In fact, the inferior pedicle is a posterior pedicle with an inferior border. After systematically and progressively reducing this inferior border, I have completely eliminated it. The pure posterior pedicle that results is independent of the inframammary fold. It is vascularized by means of the pectoral muscle and fascia, as has been demonstrated by injection studies of the thoracoacromial artery in fresh cadavers. The resulting mammary reduction technique retains the advantages of the inferior pedicle technique while avoiding its major inconveniences: dependence on the inframammary fold, bulging at the inferior base of the pedicle, and the necessity of low positioning for the breast.     

Subglandular breast reduction: the evolution of a minimal scar approach to breast reduction

The authors describe a new modification of the breast reduction procedure. By means of an inframammary incision, the breast is mobilized from the chest wall, and a "doughnut" annulus of breast tissue is removed from the undersurface of the gland. No skin is excised. The nipple-areola complex is left attached to a central core of breast tissue that receives its blood supply from the subdermal plexus of vessels. When the resulting defect is closed within the breast by strategically placed sutures, the base of the gland is narrowed, the breast is projected forward, and the circumareolar and vertical scars of other techniques are eliminated. The authors report their results in a series of 37 patients.     

Current trends in breast reduction

Results of our study describe the long term effects of reduction mammaplasty. Many women with excessively small or large breasts have an altered personal self-image and often suffer from low self-esteem and other psychological stresses. This procedure is designed to reduce and reshape large breasts, and since the size, shape, and symmetry of a woman's breasts can have a profound effect on her mental and physical well-being it is important to observe the patient's long-term outcome. Currently, breast reduction surgery is safe, effective and beneficial to the patient. In Croatia, reduction mammoplasty is often excluded from the general health care plan. The distinction between "reconstructive" versus "cosmetic" breast surgery is very well defined by the American Society of Plastic Surgeons Board of Directors. Unfortunately, the Croatian Health Society has yet to standardize such a distinction. There is an imperative need for evidence-based selection criteria. We retrospectively analyzed data of 59 female patients suffering from symptomatic macromastia who underwent reduction mammaplasty over a 16 year period (1995 until 2011). Our aim was to compare and contrast the various techniques available for reduction mammaplasty and to determine, based on patient outcome and satisfaction, which technique is most suited for each patient. The results of our study generally reinforce the observation that reduction mammaplasty significantly provides improvements in health status, long-term quality of life, postsurgical breast appearance and significantly decrease physical symptoms of pain. A number of 59 consecutive cases were initially treated with the four different breast reduction techniques: inverted-T scat or Wisa pattern breast reduction, vertical reduction mammaplasty, simplified vertical reduction mammaplasty, inferior pedicle and free nipple graft techniques. The average clinical follow-up period was 6-months, and included 48 patients. The statistical analysis of the postoperative patient complications revealed a significant positive relationship in regards to smoking. The majority of these complications were wound related, with no significant relationship between patient complications and variables such as age, BMI, ASA score, resection weight of breast parenchyma, nipple elevation, duration of surgery, and type of pedicle. The higher number of complication correlated with a lower volume of parenchyma resection (rho=-0.321). Overall satisfaction with the new breast size (79%), appearance of the postoperative scars (87%), overall cosmetic outcome score (91%), overall outcome (100%), psychosocial outcome (46%), sexual outcome (85%), physical outcome (88%), satisfaction with preoperative information data (92%), and finally satisfaction with overall care process (96%) was calculated. As expected, the physical symptoms disappeared or were minimized in 88% of patients. Each method of breast reduction has its advantages and disadvantages. The surgeon should evaluate each patient's desires on the basis of her physical presentation. Breast reduction surgery increases the overall personal and social health; not only for the patient, but for their family and friends as well. It is an imperative that every surgeon is aware of this, in order to provide the highest level of care and quality to their patients.     

Characterization of the reduction steps of Fe(III) porphyrins

Polarographic studies have shown that Fe(III) porphyrins undergo successively three one-electron reduction steps in dimethylformamide. The first involves the Fe(III)/Fe(II) redox couple. The second step proceeds to a second reduction of the metal ion and is attributed to the Fe(II)/Fe(I)_couple. This new reduction state of iron porphyrins has been characterized by ESR spectra and by absorption spectra in various solvents. This compound is not axially liganded by strong nucleophilic bases but is sensitive to solvation, the lone electron being localised in the d_z2 orbital. The third reduction step is assumed to involve a reduction of the porphyrin π-electron system.All these results have been confirmed by chemical reductions in tetrahydrofuran.     

Efficient nickel based catalyst for the homogeneous reduction of aromatic nitro compounds

The reduction of aromatic nitro compounds under CO under relatively mild conditions in the presence of NiX₂L₂ (XCl, Br, I; LPR₃, RMe, Et, Ph) and NiI₂(PhNH₂)₄ as catalyst precursors is described. The nitrobenzene is quantitatively converted into N,N′ diphenylurea in aniline solution and into alkylcarbanylate with a good yield, in aniline-alcohol mixtures. Nitrobenzene derivatives (p-RC₆H₄NO₂; RCH₃, Cl) and 2,4-dinitrotoluene, are also reduced in aniline solution; diphenylurea and amine, corresponding to the nitroderivatives, are the reaction products in these cases. This different behaviour is explained in terms of aminolysis of the expected N-aryl-N′-phenylurea. Sufficient data are produced to say that the observed increase of the catalytic activity, increasing in the sequence Cl, Br, I by changing the NiX₂L₂ complex, is due to an additional co-catalytic effect of the halide. On the basis of the chemical behaviour and IR evidence, the true catalytic species and some intermediates of reaction are suggested and a possible catalytic cycle is discussed.     

Outcome study in liposuction breast reduction

Liposuction as a primary modality of treating breast hypertrophy has been reported in the literature; however, many of these reports are small series and personal experiences. This report is the first outcome study to attempt to validate the effectiveness of liposuction as a primary method of breast reduction surgery. Questionnaires were sent to 117 patients who had undergone liposuction breast reduction surgery in our office during a 4-year period. Seventy-eight questionnaires were returned (67 percent response rate). The patients were asked about their complaints, their surgical results, and their satisfaction with the operation. Complaints such as neck and back pain, shoulder ruts, and intertrigo were improved or eliminated in the vast majority of patients. Women returned to work in 5 days on average and resumed full exercise in 2 weeks. Eighty percent of patients were either very or completely satisfied with their outcomes, 87 percent would choose the liposuction method again, and 92 percent would recommend the liposuction method to a friend. This study demonstrates that liposuction breast reduction is an effective method of breast reduction surgery.