2. INTRODUCTION
▪ Breast surgeries are a range of surgical procedures performed
on the breasts for either cosmetic or medical purposes.
▪ Breast surgery refer to any surgical operation done on the
breasts for any reason.
5. AUGMENTATION MAMMOPLASTY
▪ Breast augmentation was first recorded in 1895 when a German
surgeon transplanted a giant lipoma (encapsulated fat tissue)
from the back of a woman into her breasts.
▪ Contemporary breast augmentation involves a surgical
procedure designed to augment (enlarge) the size of a breast(s)
by devices described as ‘prostheses’.
6. AUGMENTATION MAMMOPLASTY
▪ This may be achieved by:
▪ The introduction of a silicone envelope inflated by injected
saline
▪ A double envelope which contains an inner silicone gel sachet,
contained within an outer wrapping inflated by injected saline
▪ Tissue expanding devices
▪ The combined use of tissue flaps alone, or with breast
prosthesis, or tissue expanding devices.
7. AUGMENTATION MAMMOPLASTY
▪ Four separate incisional sites—inframammary, periareolar,
axillary, and transumbilical—have been used for placement of
breast prostheses.
▪ Each location has its advantages and disadvantages, depending
on the individual surgeon’s experience and the positioning of
the implant in either a subglandular, subpectoral, or the more
recently described “dual-plane” position.
8. AUGMENTATION MAMMOPLASTY
▪ Inframammary crease incisions are preferred for patients with a
well-developed crease that conceals the scar, particularly when
it is placed slightly above the crease on the breast surface.
▪ In general, the periareolar incision provides excellent access to
all portions of the breast. For patients willing to accept a scar on
the breast surface, this approach permits meticulous
positioning of the implant, particularly along the lower pole.
9. AUGMENTATION MAMMOPLASTY
▪ If subpectoral augmentation is chosen, the pectoralis major
muscle is either divided along the obliquity of its fibers or the
lateral border of the muscle is elevated.
▪ Although unfavorable healing can occur at any operative site,
the periareolar incision tends to heal with minimal scarring.
▪ The periareolar incision facilitates revisional procedures
because it allows easier access to all portions of the breast.
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11.
12. INDICATION FOR BREAST AUGMENTATION
▪ Main indication is aesthetic.
▪ correction of ptosis in a small breast
▪ Used in the treatment of tubular shaped breast
▪ Used to achieve breast symmetry after breast reconstruction.
▪ Note that the primary goal of breast augmentation is to produce
natural fuller figure and maintain breast shape while maintaining
balance between the implant and native breast.
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13. AUTOLOGOUS AUGMENTATION
▪ Autologous tissue eliminates the risk of implant deflation,
contracture, infection, exposure, and, ultimately, exchange or
removal.
▪ However, autologous augmentation has not yet gained wide
popularity because of increased operative complexity, donor site
complications and scarring, prolonged recovery, and risk of flap
failure.
▪ Potential candidates for autologous augmentation include patients
unable to have a breast implant, patients after explantation of
implants because of complications, or women desiring either
abdominal or gluteal contouring in addition to breast augmentation.
De-epithelialized pedicled transverse
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14. AUTOLOGOUS AUGMENTATION
▪ De-epithelialized pedicled transverse rectus abdominis
musculocutaneous (TRAM) flaps have been used for breast
augmentation following abdominoplasty.
▪ Local perforator flaps from the lateral chest wall also can be used to
augment the breasts, which is particularly advantageous when
combined with contour surgery.
▪ Deep inferior epigastric perforator (DIEP), superior gluteal artery
perforator (S-GAP), and superficial inferior epigastric artery (SIEA)
perforator flaps have been used to augment the breast in patients
who desired simultaneous excision of abdominal or gluteal tissue.
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15. COMPLICATIONS OF BREAST AUGMENTATION
▪ Bleeding
▪ Hematoma
▪ Infection
▪ Nipple anesthesia
▪ Symmetry
▪ Deflation or rupture of implant
▪ Capsular contracture, if this happen implant is removed
▪ Cause late detection of breast cancer
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16. REDUCTION MAMMOPLASTY
▪ Reduction mammoplasty, also known as breast reduction surgery, is
a surgical procedure used to reduce the size and weight of the
breasts.
▪ The reduction mammoplasty procedure involves removing excess
breast tissue, fat, and skin from the breasts and repositioning the
nipples and areolas.
▪ Breast reduction is used as a treatment for mammary hypertrophy or
macromastia.
▪ It has the highest satisfaction rates among all plastic surgery
procedures
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17. INDICATIONS FOR REDUCTION MAMMOPLASTY
▪ Women seek to reduce the size of their breasts for reasons both
physical and psychological.
▪ Heavy, pendulous breasts cause neck and back pain as well as
grooves from the pressure of brassiere straps.
▪ The breasts themselves may be chronically painful, and the skin in
the inframammary region is subject to maceration and dermatoses.
▪ From a psychological point of view, excessively large breasts can be a
troublesome focus of embarrassment for the teenager as well as the
woman in her senior years.
▪ Unilateral hypertrophy with asymmetry heightens embarrassment.
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18. REDUCTION MAMMOPLASTY TECHNIQUES
▪ The procedure can be performed using a variety of techniques, including
the anchor, vertical, and liposuction techniques.
▪ The anchor technique involves making an incision around the areola and
down to the breast crease, and then horizontally along the crease.This
creates an anchor-shaped incision that allows the surgeon to remove
excess breast tissue and skin and reposition the nipple and areola.
▪ The vertical technique involves making an incision around the areola and
down to the breast crease, but without the horizontal incision along the
crease.This creates a lollipop-shaped incision that allows the surgeon to
remove excess breast tissue and skin and reposition the nipple and areola.
▪ The liposuction technique involves making small incisions in the breast and
using a cannula to remove excess fat from the breast tissue.This technique
is typically used for women with mild to moderate breast enlargement and
is not suitable for women with large, sagging breasts.
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20. MASTOPEXY
▪ Mastopexy is a procedure designed to elevate breast tissue and
the nipple–areola complex to correct breast ptosis.
▪ Mastopexy procedures are derived from breast-reduction
procedures except that only skin is removed with little or no
parenchymal resection.
▪ Mastopexy is almost always a cosmetic procedure.
▪ Mastopexy is done to correct breast ptosis.
21. BREAST PTOSIS
▪ Breast ptosis was originally staged by Regnault.
▪ Minor ptosis (first degree) occurs when the nipple is at the level
of the inframammary fold (IMF).
▪ Moderate ptosis (second degree) is when the nipple is below
the IMF but above the lowest breast contour.
▪ Severe ptosis (third degree) is when the nipple is at the lowest
breast contour and below the level of the IMF.
▪ Glandular ptosis is characterized by a nipple above the IMF with
breast tissue hanging below the fold.
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23. MASTOPEXY PROCEDURES
▪ The type of mastopexy procedure performed is dictated by the
nature of the deformity.
▪ Patients with minor degrees of ptosis are frequently treated with
periareolar mastopexy procedures.
▪ Periareolar mastopexy is also often the procedure of choice when
breast augmentation is combined with mastopexy. As the volume of
the breast is increased by the implant, the need and degree of the
mastopexy procedure becomes less.
▪ As the ptosis worsens, vertical mastopexy with a lollipop-type
incision or conventional mastopexy with an inverted-T–type
incision might be indicated.
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25. MASTECTOMY
▪ Mastectomy is surgical removal of the breast
▪ Indication include:
▪ Cancer of the breast
▪ Prevention of breast cancer in women with high risk of breast cancer.
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26. TYPES OF MASTECTOMY
▪ Conventional mastectomy, here further subdivided into:
– Simple mastectomy where the breast is simply removed either divide or
remove the pectoralis minor muscle. with or without Axillary clearance
– Radical mastectomy where the breast ,pectoralis minor and pectoralis
major muscles and most of the axillary lymph nodes are removed.
– Modified radical mastectomy where the breast is removed, the axilla is
cleared with either division or removal the pectoralis minor muscle.
– Extended radical mastectomy implies removal of breast, pectoralis
minor,pectoralis,major,axillary clearance with clearance of internal
mammary group of lymph node.
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27. OTHER TYPES OF MASTECTOMY
▪ Nipple sparing mastectomy-all of the breast tissue is removed
sparing the nipple.
▪ Skin sparing mastectomy
▪ Partial mastectomy is the removal of the cancerous part of breast
tissue and some normal tissue around it.
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28. ASSOCIATED PROBLEMS OF MASTECTOMY
▪ Depression
▪ Loss of sexual interest
▪ Negative body image
▪ Fear of re-ocurrence
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29. GYNEACOMASTIA OR ENLARGED MALE BREAST
▪ This is a condition that is peculiar to men or boys. Mostly seen in
teenage boys and older men. it is a condition that causes boys and
men’s breast to swell and become larger than men. seen in 100,000
thousand men yearly in Nigeria.
▪ Signs vary from a small amount of extra breast tissue around the
nipples to more prominent breasts. it can be unilateral or bilateral.
▪ Sometimes breast tissue can be tender or painful
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30. TYPES OF GYNEACOMASTIA
▪ Pubertal gyneacomastia-a physiological response to increase
in testerone fuelled by marked increases in growth hormone
at puberty, estrogen increases in threefold.
▪ Physiologic gyneacomastia-a physiological response to the
decrease in free testerone and the increase in adipose tissue
that often accompanies ageing
▪ Idiopathic gyneacomastia
▪ Residual gyneacomastia
▪ New born gyneacomastia-a physiological response to high
levels of maternal and placenta oestrogen transferred in utero
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31. SIMON’S CLASSIFICATION OF GYNEACOMASTIA
▪ Group 1-minor but visible breast enlargement
▪ without skin redundancy
▪ Group 2A- moderate breast enlargement without skin redundancy
▪ Group 2B-moderate breast enlargement with minor skin redundancy
▪ Group3-gross breast enlargement with skin redundancy that looks
like a pendulous female breast.
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33. CAUSES OF GYNAECOMASTIA
▪ Hormone imbalance
▪ Obesity
▪ Newborn baby boys may be because mother’s estrogen passes trough the placenta
from mother to baby
▪ Puberty
▪ Older age
▪ Side effects of medication such as anti ulcer
▪ Illegal drugs such as cannabis
▪ Lumps or infection in the testicles
▪ Klinefelter syndrome
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34. TREATMENT OF GYNEACOMSTIA
▪ Surgery-breast reduction is the most effective known treatment for
gyneacomastia,removal of excess fat through liposuction.
▪ Medication to correct hormonal imbalance. Drugs like clomiphene an
antiestrogen can be administered
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35. SOME PROBLEM OF PATIENT WITH
GYNEACOMASTIA
▪ Loss of self confidence
▪ Social isolation
▪ Depression
▪ Body shaming
▪ Loss of interest in socialization
▪ Decreased libido
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36. PRE-OPERATIVE MANAGEMENT
▪ Admission
▪ Investigations
▪ History taking
▪ Physical Examination
▪ Observation
▪ Counseling
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▪ Psychological support
▪ Physical care
▪ Clinical photograph
▪ Informed consent
▪ Breast marking
▪ Preop medications
37. PRE-OPERATIVE MANAGEMENT
▪ Because of the distribution of the sensory nerve, patients must be alerted to the
potential postoperative partial, temporary or random loss of innervation in
particular nipple zones
▪ Preoperatively, many surgeons use digital imaging to demonstrate and document
the patient’s preference for size and shape, and in some cases, to demonstrate the
unrealistic nature of the patient’s expectations
▪ Following patient assessment, psychiatric or psychological opinions may be sought
should it be considered that the patient expectations are unrealistic
▪ Patients will be instructed on the brassière (bra) type (without underwire),
appropriate size, and number they should bring with them more than one bra is
required in case of slight wound edge bleeding, and for hygiene purposes
▪ Preoperatively, methods of applying and removing the bra should be
demonstrated to patients to ensure that the arms are not moved inappropriately in
the early stages after the surgery.
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38. POST-OPERATIVE MANAGEMENT
▪ Preparation to receive the
patient:
▪ Reception
▪ Pain relief:
▪ Psychological care
▪ Clinical photograph
▪ Wound care including drains,
bandaging
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▪ Medications
▪ Physiotherapy
▪ Health education
▪ Discharge
▪ Follow up
39. POST-OPERATIVE MANAGEMENT
▪ Principal complication in the immediate postoperative phase is
haematoma that includes pain, exponential to the degree of
bleeding/swelling.
▪ • Observation/monitoring is by gently gliding the hands across the
upper surface of the breast for any abnormal or compact swelling
greater than the existing firmness of the prosthesis itself
▪ • If the procedure is bilateral, both sides should be checked and
compared for any increasing swelling
▪ • Internal vacuum pressure therapy drainage systems are rarely used
(potential for infection) but, if inserted, are commonly removed
within 24 hours in the absence of any excess drainage
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40. CREDITS: This presentation template was created by
Slidesgo, including icons by Flaticon and infographics
& images by Freepik.
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