José Humberto Cardoso Resende^1,2,3*, Lucilia Feliciano Marques di Carlantônio¹, Luiz Célio Martins Freitas^1,4, Teresa Tonini^5,6, Nébia Maria Almeida de Figueiredo⁷, Luiz Carlos Santiago⁷

Show more
¹ Nursing and Biosciences, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil.
² Member of the Brazilian Society of Plastic Surgery (SBCP), Rio de Janeiro, Brazil.
³ Brazilian College of Surgeons (CBC), Rio de Janeiro, Brazil.
⁴ President of the Catheters committee of the National Cancer Institute (INCa), Rio de Janeiro, Brazil.
⁵ Public Health from State of Rio de Janeiro University (UERJ), Rio de Janeiro, Brazil.
⁶ Coordinator of the Post-graduate Program in Nursing and Bioscience of UNIRIO, Rio de Janeiro, Brazil.
⁷ Nursing, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil.
Show less

Abstract: This is a retrospective study on gigantomastia correction in obesity facing the technique of nipple-areolar grafts and its complexity. The main question is the technical-surgical care during its execution aiming to achieve reparative results that can return to these women the desire to live with better quality of life and health. Method: We performed a retrospective study of all obese patients with severe gigantomastia who underwent reduction mammaplasty with an operative technique using the superior pedicle, with special care for the nipple-papillary grafts. The study was carried out at a single institution between 2001 and 2013, in a total of 30 cases. This operative technique was presented at first time in 1980, with no changes up to now. We emphasized the perfect decortication of the areola and nipples until they were translucent after the maneuvers of Schwartzman and subsequent grafts operated in both breasts. Results: Results were considered satisfactory, from the reparative and aesthetic point of view, emphasizing the degree of improvement observed in women undergoing technique. Discussion: We can say that during all this time of aesthetic and therapeutic-restorative surgery, due to its realization in a single surgical time, there was big impact on the aesthetics of patients and on their families, even taking into account possible complications in the post-operative. Conclusion: The superior pedicle technique, performed as described here, is a safe and reliable procedure in patients with severe gigantomastia.

Keywords: Mammoplasty, Gigantomastia, Resende’s Technique, Surgical Flaps, Bariatric Surgery, Obesity

Cite this paper: Resende, J. , Carlantônio, L. , Freitas, L. , Tonini, T. , Figueiredo, N. , Santiago, L. , (2015) Operative Technique for Correction of Gigantomastia, Using the Superior Pedicle, with Special Care for the Nipple-Papillary Grafts: A 13-Year Retrospective Study. Modern Plastic Surgery, 5, 34-46. doi: 10.4236/mps.2015.53007.

References

[1]   Gillies, M. and McIndoe, A.H. (1939) The Technique of Mammaplasty in Conditions of Hypertrophy of the Breast. Surgery, Gynecology & Obstetrics, 68, 658.

[2]   Pitanguy, I. (1960) Breast Hypertrophy. Transactions of International Society of Plastic Surgeous, Edinburgh, E.S. Livingstone, London.

[3]   Pitanguy, I. (1967) Surgical Treatment of Breast Hypertrophy. British Journal of Plastic Surgery, 20, 78.
http://dx.doi.org/10.1016/S0007-1226(67)80009-2

[4]   McKissock, P.K. (1972) Reduction Mammaplasty with a Vertical Dermal Flap. Plastic and Reconstructive Surgery, 49, 245.
http://dx.doi.org/10.1097/00006534-197203000-00001

[5]   Millard Jr., D.R., Devine Jr., J. and Warren, W.D. (1971) Breast Reconstruction: A Plea for Saving the Uninvolved Nipple. American Journal of Surgery, 122, 763-764.
http://dx.doi.org/10.1016/0002-9610(71)90441-7

[6]   Dufourmentel, C. and Mouly, R. (1961) Plastic mammaire por la méthode obliqúe. Annales De Chirurgie Plastique Esthetique, 6, 45-48.

[7]   Dufourmentel, L. (1927) La mastopéxie par deplacement souscutané avec transposition du mamelon. Bulletin Mensuel de la Société de Chirurgie de Paris.

[8]   Inforzato, J.C.B., et al. (2006) Gigantomastia—Técnica do pedículo inferior—Abordagem pessoal, Atualizacao em Cirurgia Plástica Estética e Reconstrutiva, Sao Paulo, Robe Editorial, 699.

[9]   Biesenberger, H. (1928) Blutversorgung und Zirkulare Umschnedung des Warzenhofes. Zentralblatt für Chirurgie, 55, 2385.

[10]   Morestin, H. (1903) De lablation esthétique des tumeurs du sein. Bulletin Mensuel de la Société de Chirurgie de Paris, 29, 562.

[11]   Cronin, E.D., Humphreys, D.H. and Ruiz-Razura, A. (1988) Nipple Reconstruction: The S Flap. Plastic and Reconstructive Surgery, 81, 783-787.
http://dx.doi.org/10.1097/00006534-198805000-00026

[12]   Banducci, D.R., Le, T.K. and Hughes, K.C. (1999) Long-Term Follow-Up of a Modified Anton-Hartranpf Nipple Reconstruction. Annals of Plastic Surgery, 43, 467-470.
http://dx.doi.org/10.1097/00000637-199911000-00001

[13]   Kraske, H. (1923) Die Operation der atroplischen und Hypertroplischen Hangebrust. Munchener Medizinische Wochenschrift, 60, 672.

[14]   Aufricht, G. (1949) Mamaplasty for Pendulous Breast. Empiric and Geometric Planning. Plastic and Reconstructive Surgery, 4, 13-29.
http://dx.doi.org/10.1097/00006534-194901000-00002

[15]   Gruber, R.P. (1979) Nipple-Areola Reconstruction: A Review of Techniques. Clinics in Plastic Surgery, 6, 71-83.

[16]   Sinder, R. (1963) Tese apresentada na Universidade Federal do Rio de Janeiro—Mamoplastia em “T” invertido. Technique of Breast Reduction; Transposition of the Nipple on a Cutaneous Vascular Pedicle. Acta Chirurgica Scandinavica, 126, 453-465.

[17]   Resende, J.H.C. (2003) Gigantomastia. In: Cirurgia Plástica Fundamentos e Arte: Cirurgia Estética, MEDSI, Sao Paulo, Vol. 1, 561.

[18]   Weiner, D.L., Aiache, A.E., Silver, L. and Tittiranonda, T. (1973) A Single Derman Pedicle for Nipple Transposition in Subcutaneous Mastectomy, Reduction Mammaplasty, or Mastopexy. Plastic and Reconstructive Surgery, 51, 115-120.
http://dx.doi.org/10.1097/00006534-197302000-00001

[19]   Thomas, T.G. (1985) On the Removal of Benign Tumors of the Mamma without Mutilation of the Organ. Plastic and Reconstructive Surgery, 76, 476.

[20]   Thorek, M. (1989) Possibilities in the Reconstruction of the Human Form. Aesthetic Plastic Surgery, 13, 55-58.

[21]   Regnault, P. (1967) Indications for Breast Augmentation. Plastic and Reconstructive Surgery, 40, 524-529.
http://dx.doi.org/10.1097/00006534-196740060-00002

[22]   Adams, W.M. (1949) Labial Transplant for Correction of Loss of the Nipple. Plastic and Reconstructive Surgery, 4, 295-298.
http://dx.doi.org/10.1097/00006534-194905000-00009

[23]   Farhadi, J., Maksvytyte, G.K., Schaefer, D.J., Pierer, G. and Scheufler, O. (2006) Reconstruction of the Nipple-Areola Complex: An Update. Journal of Plastic, Reconstructive & Aesthetic Surgery, 59, 40-53.
http://dx.doi.org/10.1016/j.bjps.2005.08.006

[24]   Tostes, R.O.G., Silva, K.D.A., Andrade Jr., J.C.C.G., Ribeiro, G.V.C. and Rodrigues, R.B.M. (2005) Reconstrucao do mamilo por meio da técnica do retalho C-V: Contribuicao à técnica. Revista Brasileira de Cirurgia Plástica, 20, 36-39.

[25]   Shestak, K.C. and Nguyen, T.D. (2007) The Double Opposing Periareola Flap: A Novel Concept for Nipple-Areola Reconstruction. Plastic and Reconstructive Surgery, 119, 473-480.
http://dx.doi.org/10.1097/01.prs.0000246382.40806.26

[26]   Rosique, M.J.F. and Arantes, H.L. (2011) Reconstrucao do Complexo Aréolopapilar e Refinamentos Técnicos. In: Mélega, J.M., Ed., Guanabara Koogan, 762-772.

[27]   Eskenazi, L. (1993) A One-Stage Nipple Reconstruction with the “Modified Star” Flap and Immediate Tattoo: A Review of 100 Cases. Plastic and Reconstructive Surgery, 92, 671-680.
http://dx.doi.org/10.1097/00006534-199309001-00017

[28]   Spear, S.L., Convit, R. and Little, J.W. (1989) Intradermal Tattoo as an Adjunct to Nipple-Areola Reconstruction. Plastic and Reconstructive Surgery, 83, 907-911.
http://dx.doi.org/10.1097/00006534-198905000-00027

[29]   Lamartine, D.J., Cintra Jr., R., Daher, C.J., Cammarota, M.C., Galdino, J., Pedroso, D.B. and Cintra, R.H. (2013) Nipple-Areola Reconstruction Using the Double Opposing Flap Technique. Revista Brasileira de Cirurgia Plástica, 28, 233-240.
http://dx.doi.org/10.1590/S1983-51752013000200011

[30]   Passo, T.R. (1925) La correction esthétique du prolapsus mammaire par Le procede de la transposition du mamelon. La Presse Medicale, 33, 317.

[31]   Schwartz, A.W. (1976) Reconstruction of the Nipple and Aréola. British Journal of Plastic Surgery, 29, 230-233.
http://dx.doi.org/10.1016/S0007-1226(76)90062-X

[32]   Resende, J.H.C. (1980) Técnica cirúrgica para gigantomastia. Ver. CBS (Centro de Ciências Biológicas e da Saúde), Rio de Janeiro, 80-89.

[33]   Lugo, L.M., Prada, M., Kohanzadeh, S., Mesa, J.M., Long, J.N. and de la Torre, J. (2013) Surgical Outcomes of Gigantomastia Breast Reduction Superomedial Pedicle Technique—A 12-Year Retrospective Study. Annals of plastic surgery, 70, 533-537.
http://dx.doi.org/10.1097/SAP.0b013e31827c7909

[34]   Nadeau, M.H., Gould, D.J., Macias, L.H., Spring, M.A. and Stevens, W.G. (2015) Superior Pedicle Technique of Reduction Mammaplasty: A Stepwise Approach. Aesthetic Surgery Journal, 35, 94-104.
http://dx.doi.org/10.1093/asj/sju011

[35]   Hunter-Smith, D.J., Smoll, N.R., Marne, B., Maung, H. and Findlay, M.W. (2012) Comparing Breast-Reduction Techniques: Time-to-Event Analysis and Recommendations. Aesthetic Plastic Surgery, 36, 600-606.
http://dx.doi.org/10.1007/s00266-011-9860-3

[36]   Resende, J.H.C. (2009) Técnica de Resende para correcao de Gigantomastia–—Cirurgia de Alívio Corporal, Tratado de Cirurgia Plástica na Obesidade, Rio de Janeiro, Ed. Rubio, 357-365.

[37]   Resende, J.H.C. (1980) Técnica para gigantomastia. Apresentado no XVII Congresso Brasileiro de Cirurgia Plástica e V Congresso Brasileiro de Cirurgia Estética, Fortaleza, Novembro.

[38]   Strombeck, J.G. (1960) Mammaplasty: Report of a New Technique Based on the Two-Pedicle Procedure. British Journal of Plastic Surgery, 13, 79-90.
http://dx.doi.org/10.1016/s0007-1226(60)80014-8

[39]   Tamerin, J.A. (1951) A Mammaplastic Procedure. Plastic and Reconstructive Surgery, 7, 288-295.
http://dx.doi.org/10.1097/00006534-195107040-00003

[40]   Manahan, M.A., Buretta, K.J., Chang, D., Mithani, S.K., Mallalieu, J. and Shermak, M.A. (2015) An Outcomes Analysis of 2142 Breast Reduction Procedures. Annals of Plastic Surgery, 74, 289-292.
http://dx.doi.org/10.1097/SAP.0b013e31829d2261

[41]   Coriddi, M., Koltz, P.F. and Gusenoff, J.A. (2011) Reduction Mammaplasty, Obesity, and Massive Weight Loss: Temporal Relationships of Satisfaction with Breast Contour. Plastic and Reconstructive Surgery, 128, 643-650.
http://dx.doi.org/10.1097/PRS.0b013e318221da6b

[42]   Koltz, P.F., Sbitany, H., Myers, R.P., Shaw, R.B., Patel, N. and Girotto, J.A. (2011) Reduction Mammaplasty in the Adolescent Female: The URMC Experience. International Journal of Surgery, 9, 229-232.
http://dx.doi.org/10.1016/j.ijsu.2010.12.001

[43]   Forster, E.M. (2013) Plastic Surgery Nursing: A Profession and a Passion. Plastic Surgical Nursing, 33, 4.

[44]   Silinzieds, A., Simmons, L., Edward, K.L. and Mills, C. (2012) Nurse Education in Developing Countries—Australian Plastics and Microsurgical Nurses in Nepal. Plastic Surgical Nursing, 32, 148-155.
http://dx.doi.org/10.1097/PSN.0b013e3182728267

[45]   Hughes, S., Hughes, B. and Edward, K.L. (2011) Enhancing Nursing Practice Potential: Breast Free Flap Reconstruction Following Mastectomy.