BREAST SURGERIES.pptx

breast

1. BREAST SURGERIES BY RAJAH AMINA SULEIMAN (RN, RM, RNE, RBPN, BNSc, PGDE, MSc)

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.

3. TYPES 1. Augmentation mammoplasty 2. Reduction mammoplasty 3. Mastopexy 4. Mastectomy 5 . Gynaecomastia

4. REVIEW OF ANATOMY AND PHYSIOLOGY

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.

10. 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. 12

11. 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 13

12. 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 . 14

13. 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 15

14. 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 16

15. 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 . 17

16. 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 . 18

17. REDUCTION MAMMOPLASTY TECHNIQUES 19

18. 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.

19. 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 .

20. 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 . 23

21. MASTOPEXY PROCEDURES 24

22. 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. 25

23. 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. 26

24. 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. 27

25. ASSOCIATED PROBLEMS OF MASTECTOMY Depression Loss of sexual interest Negative body image Fear of re- o currence 28

26. 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 29

27. 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 30

28. 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. 31

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30. 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 33

31. 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 34

32. SOME PROBLEM OF PATIENT WITH GYNEACOMASTIA Loss of self confidence Social isolation Depression Body shaming Loss of interest in socialization Decreased libido 35

33. PRE-OPERATIVE MANAGEMENT Admission Investigations History taking Physical Examination Observation Counseling 36 Psychological support Physical care Clinical photograph Informed consent Breast marking Preop medications

34. 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. 37

35. POST-OPERATIVE MANAGEMENT Preparation to receive the patient: Reception Pain relief : Psychological care Clinical photograph Wound care including drains, bandaging 38 Medications Physiotherapy Health education Discharge Follow up

36. 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 39

37. Thanks for Listening ANY QUESTIONS ?