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Breast reducing operation

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Experience in USA, California

Experience in USA, California
Dr.Bunkis private clinic at orange county

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Breast reducing operation Breast reducing operation Presentation Transcript

  • Breast reducing operation EXPERIENCE IN USA, CALIFORNIA DR.BUNKIS PRIVATE CLINIC AT ORANGE COUNTY RIGAS STRADINA UNIVERSITY 6TH YEAR MEDICAL STUDENT MARA SNEIDERE
  • You may be good candidate for breast reduction if you have one or more of the fallowing conditionsBreast that are too large in propotion to your body frameHeavy, pendulous breast with nipples and areolas that point downwardOne breast is much larger than the otherBack, neck or shoulder pain caused by the weight of your breastsSkin irritation beeath your breastsIndentations in your shoulders from tight bra strapsRestriction of physical activity deu to the size and weight of your breastsDissatisfaction or self- consciousness about the largeness of your breasts
  • Risks associated with breast reductionPossible asymmetrySensation problemsFuture breast feeding issuesassociated with breast reduction surgery View slide
  • Breast reduction complicationsPoor reaction to anesthesiaBleedingInfectionHeatomaBreast reduction scars View slide
  • Female breast anatomyThe breasts of an adult women are tear- shaped glands, supported by and attached to the front of the chest wall on either side of the breast bone or sternum by ligaments. They rest on the major chest muscule, the pectoralis major.
  • Female breast anatomy The breast has no muscule tissue. A layer of fat surrounds the glands and extends throughout the breast. Each breast contains 15 to 20 lobes arranged in a circular fashion. The fat (subcutaneous adipose tissue) that covers the lobes gives the breast its size and shape. Easch lobe is lobe is comprised of many lobules, at the end of which are tiny bulb like glands, or sacs.
  • Female breast anatomyThe breast is responsive to a complex interplay ofhormones that cause the tissue to develop, enlarge andproduce milk. The three major hormones affecting thebreast areEstrogen,Progesterone andProlactinWhich cause glandular tissue in the breast and theuterus to change during the menstrual cycle.
  • Female breast anatomyLYMPH NODES1. Cubital2. Apical axillary3. Lateral axillary4. Lateral axillary5. Central axillary6. Brachial axillary7. Interpectoral8. Paramammary9. Parasternal
  • Female breast anatomy VASCULAR SYSTEM A.thoracica interna ( aa. Intercostales anteriores) A. thoracica lateralis (rr. mamarii) aa. Intercostales posteriores V. thoracica interna-> v.subclavia, V.thoracica lateralis-> v.axillaris vv.intercostales-> v.azygos
  • Female breast anatomy NEURAL SYSTEMPlexus braehialis-> nn.intercostales
  • Types of breast reductionPedicle MethodFree Nipple GraftInverted T resection (Anchor incision pattern)LeJour incisin patternLiposuction
  • Pedicle MethodPedicle method- it means surgeon leaves a pedicle with nerves and vessels what supplies breast. Superior, lateral, medial, inferior and central pedicule can be chosen
  • Inferior pedicleInferior pedicle proved tobe sufficient to sustain thenipple areola complex andalso had other advantages– good circulation, goodsensation and possibility ofbreastfeeding. As a result,it replaced the verticalbipedicle
  • Superior pedicleSuperior pedicle has goodcirculation but is not veryeasy to inset and has to bethinned for better inset.Being a dermal pediclebreast feeding is no longerpossible
  • Lateral pedicleThis pedicle is half thepedicle of Strombeck’smethod and it is easier toinset, also has goodviability and is based onthe lateral thoracic arteryperforators; this pedicle isnot as commonly used asthe rest
  • Medial pedicleSimilar to the lateralpedicle, it has becomepopular following therealization that it has goodsensation and good bloodsupply and can be insetrelatively easily
  • Central pedicleThe Central pedicle is amodification of the Inferiorpedicle with the removal ofthe dermal bridge. The bloodsupply is the same -perforating branches of theintercostal arteries. Thevenous drainage follows theartery so a dermal bridge isnot required. However onemust be very careful aboutshear injuries to the pedicleat its base on the pectoralmuscles
  • Free nipple- graft techniqueThe breast reduction performed with the free nipple- grafttechnique transposes the nipple- areola complex (NAC) asa tissue graft without a blood supply, without a skin andglandular pedicle. The therapeutic advantage is the greatervolume of breast tissues that can be resected to produce aproportional breast. The therapeutic disadvantage is abreast without a sensitive nipple- areola complex, andwithout lactation capability. The medical indicatedcandidates are: the women whose health presents a highrisks of ischemia of the nipple- areola complex, whichmight cause tissue necrosis, the diabetic woman, thewoman who is a tabacco smoker, the women whoseoversized breasts., and the women who has macromastiorequires much resecting of the breast tissue.
  • Free nipple graft
  • Anchor incision pattern
  • LeJour incisin pattern
  • Experience at dr.Bunkis private clinic. USA, California, Orange County Breast reducing operation Inverted T resection (Anchor incision pattern) Accompanied by Rigas Stradina university 6th year medical student Mara Sneidere
  • Operative techniqueWith the patient in a sitting position, suprasternal notch, midclavicular points are markedA vertical line joining the suprasternal point to the xiphoid is marked.The breast meridian is marked next, it may or may not go through the nipple.
  • Operative techniqueThe proposed nipple level is marked by the marking of the inframammary crease onto the breast surface by the finger method, this is a point A.
  • Operative techniqueThe angle of the vertical limbs is marked next, by placingthe thumb and index finger of one hand and pinching thebreast about 6.5 cms from point A
  • Operative techniqueThese are B (lateral) and C (medial) and they should be equidistant from the breast meridian
  • Operative techniqueThe medial limit of resection (point E) is marked by gently displacing the gland laterallyThe lateral limit of resection (point D) is marked by gently displacing the gland medially, it should be placed on the gland itself
  • Operative technique New shape of areola was made. In point A as a central point of new areola was chosen and using round shaped instrument, new place for areola was made. After de- epithelialisation skin around old and new marked areola, new form of breast are created by excision of the breast tissues. Superior pedicle was left.
  • Operative techniqueAn adequate opening for the nipple areola complex is created and the suturing is done with 4-0 monocryClosure is performed by using 3-0 monocryl
  • HONORARY CONSULATE OF THE REPUBLICOF LATVIA IN SAUTHERN CALIFORNIA USA
  • Paldies par uzmanību!