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N. S. Nair et al.
(v) Excess parenchyma is excised from both
medial and lateral pillars.
(vi) Once redundant breast tissue has been
resected, the medial and lateral pillars are
approximated and NAC anchored in place
with absorbable sutures to recreate the inferior pole of the breast and the skin is closed
over it (Fig.16.6c).
(vii) Once the breast mound has been formed, a
closed wound suction drain is placed in the
subglandular position and brought out
laterally.
16.3.2 Vertical Mammoplasty:
(Fig.16.1c)
The vertical reduction mammaplasty was initially popularized by Lejour [24]. The incision in
the vertical mammaplasty closes as a straight line
extending form the lower end of the nipple areola
complex to the inframammary crease and occasionally a cm below the inframammary crease. It
traditionally has no horizontal limb unlike an
Inverted T or Wise pattern excision. Vertical
mammaplasty are done on either superior pedicle
[24] or Medial [11]. The pattern of skin marking
is shaped like a snowman and the excision
depends upon the pedicle used. After marking the
landmarks (Fig.16.3), the medial and lateral vertical limbs are drawn as curvilinear lines towards
each other medially in a way that they meet
2–4 cm above inframammary crease thereby
completing the rough shape of a snowman.
Limiting the inferior point of the vertical scar to a
position above the inframammary crease, prevents crossing over across the IMF at the time of
closure. If needed at the inferior end of the vertical incision horizontal elliptical wings can be
excised to prevent dog ears. This is in contrast to
the technique described by Hall-Findlay. Vertical
mammoplasty is best suited for tumours located
in upper central, lower central positions.
However, with vertical techniques it is possible to
rotate the markings to orientate over tumours or
scars placed in other quadrants.
16.3.3 Lateral Mammoplasty
Lateral mammoplasty is a simple reproducible
technique and offered for tumours located in the
lateral portion of the breast. The lateral pedicle
was originally described by Skoog in 1963 [25].
It is basically a modied Strombeck (horizontal
bipedicle) reduction. The lateral pedicle is reliable and has excellent preservation of sensation
at the nipple-areolar complex However, it is not
as popular technique because it does not allow
for optimal shaping, as the dense tissue of the
upper outer quadrant cannot be resected and may
cause lateral fullness.
After the breast meridian is drawn, mark the
circumference of the new areola and the lateral
excision which is fusiform. At the time of surgery, a small disc of skin around the NAC is deepithelialized and every attempt is made to
preserve the subdermal plexus of veins for nipple
viability. The tumour is excised with a margin of
normal tissue all the way from skin to the muscle
fascia. The breast mound is then mobilized over
the muscle and undermined slightly around the
NAC to allow for relocation of the nipple.
Following the basic model of Lateral
Mammoplasty, the scar can be moved superiorly
or inferiorly as required based on the location of
the tumour. Most of the reduction is in the inferior and medial quadrants.
16.3.4 Periareolar Pattern
The periareolar (concentric/donut) pattern limits
the scar to the outline of the nipple-areolar complex and is useful for mastopexy, raising the nipple modestly (<2 cm) in small-to-moderate
reductions (up to 500 gm). The ratio of outside
diameter to areolar diameter should ideally not
exceed 2:1. Benneli [26] described criss-crossing
pillars in his mastopexy technique and using a
purse string of non-absorbable suture around the
areola. This approach results in the shortest possible scar, movement of the nipple is limited to
2cm; therefore, only useful in patients with very
16 Therapeutic Mammoplasty Surgical Techniques
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123
minor ptosis. This pattern is more for mastopexy
as opposed to reduction because minimal or no
resection of gland is performed.
16.4 Complications ofTherapeutic
Mammoplasty
Early complications include, hematoma,
ap necrosis, nipple areola Necrosis and
infection.
Late complications associated with TM are
breast asymmetry, improper shape or bottoming out, dog ears, unsightly scars and
fat necrosis.
Losken etal. [27] performed a meta-analysis
of over 8600 patients comparing standard breast
conservation therapy with oncoplastic techniques, including reductions and aps, and
reported an overall complication rate of 16% in
the oncoplastic reduction group compared with
24% in the BCS group. Similar results were
found in a systematic review on oncoplastic surgery by Haloua et al. [28], in which both early
(<2months) and late (>2months) complications
across seven studies were noted. A systematic
review on outcomes following oncoplastic reduction mammoplasty [29], included papers on only
oncoplastic reduction mammoplasty techniques
wherein, the most frequent complication encountered was wound dehiscence or delayed wound
healing (4.6%), followed by fat necrosis (4.3%),
infection (2.8%), partial or complete nipple loss
(0.9%), hematoma (0.9%) and seroma (0.6%).
These rates of complications following oncoplastic reduction are comparable with other methods
of oncoplastic closure involving less signicant
tissue rearrangement and also those following
lumpectomy alone [29]. Fat necrosis can present
as an early as well as delayed complication that
can mimic local recurrence and impact quality of
life due to pain and results in poor cosmesis.
Various studies have reported an incidence of fat
necrosis ranging from 8 to 25% [13, 30] and
almost double that of non-oncoplastic cases [31].
The large prospective cohort data from the TeaM
study, reported on 880 women who underwent
899 TM procedures, with only 32% having
immediate contralateral symmetrization. The
overall complication rate here also was reported
as 23% [32].
16.5 Factors Associated
withIncreased Risk
ofComplications
Even though women who undergo breast reduction related procedures tend to generally be
young and healthy, post-operative complications
are seen in about 14–20% patients [13]. There are
several risk factors attributing to this complication rate, including, higher, smoking, uncontrolled diabetes, radiated skin, fatty breasts
density and older age. Increased BMI is the
strongest predictor of complications among
patients with breast reduction. The meta-analysis
by Zhang etal. reported that BMI >30kg/m2 was
highly associated with a signicant increase in
the overall incidence of complications after RM
(OR 0.73; 95% CI: 0.61 ± 0.89, p = 0.001).
Another strong risk factor is smoking, which also
results in delayed wound healing and increased
post-operative complications [33].
16.6 Oncological Safety
ofTherapeutic
Mammoplasty
The benets of therapeutic mammoplasty related
to cosmetic outcome have been well documented
across numerous studies. A recent meta-analysis
evaluating oncological aspects of breast reduction surgery have shown no signicant difference
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N. S. Nair et al.
among patients undergoing or not undergoing
therapeutic mammoplasty [34]. However,
because of the variability in technique and
amount of tissue mobilized, drawing conclusions
about the overall safety of this procedure has
been difcult [29]. Some of the common surrogates for oncological safety have been, margin
status, re-excision rates and local recurrence rate.
A meta-analysis [29] reported re-excision and
completion mastectomy rates ranging from 0 to
16.4%, positive margin rates from 0 to 21% and
local-regional recurrence rate of 3.1% and a distant recurrence rate of 3.0% at 2 years’ mean/
median follow-up. These results are comparable
to, reported rates for partial mastectomy without
reconstruction, and show positive effects of the
oncoplastic approach, even after 20years of follow- up[35]. Clough etal. [36] reported a 10year
follow-up of Level II OPS mammoplasties, with
a median follow-up of 55 months. The 5-year
cumulative incidence for a local recurrence was
2.2% (0.2–4.2%), 1.1% (0–3.6%) for a regional
recurrence, and 12.4% (8.2–16.4%) for a distant
recurrence. Similarly a study by Losken et al.
[27] reported on 356 patients who underwent
reduction mammoplasties and the recurrence rate
was 5.2% (n=10 of 192) at a mean follow-up of
2years (range,2months to 15years).
16.7 Quality ofLife After
Therapeutic Mammoplasty
Therapeutic mammoplasty is a good option even
with large tumours requiring a considerable portion of the breast to be removed, with good cosmetic outcome. However, patient selection is an
important factor in all oncoplastic surgery, and
the indications should therefore be clearly dened
to optimize outcome [37]. Quality of life and
patient satisfaction reports have been shown to be
improved signicantly by the use of therapeutic
mammoplasty in managing early breast cancer
[38] and is associated with improvement in
patient self-esteem and mental health when compared with patients undergoing breast-conserving
surgery without reconstruction [39]. Studies
aimed to compare surgical and patient-reported
outcomes between breast cancer patients treated
with TM and those who had mastectomy with
immediate reconstruction, reported fewer major
complications and revision surgery, as well as
better patient-reported outcomes in the TM group
[40]. Losken etal. [29] reported that after 1year
post-operatively, women reported increased emotional health, body acceptance, feelings of attractiveness, satisfaction with how their breasts
looked unclothed and satisfaction with sex life.
Veiga etal. [41] too showed a positive impact on
quality of life and self-esteem when comparing
patients who had oncoplastic surgery compared
with breast conservation therapy alone. Overall,
mammoplasties have good cosmetic outcome
and majority of the patients are satised.
Acknowledgment Diagrams courtesy Ms. Pallvi Jhingran.
References
1. Fisher B, Anderson S, Bryant J, et al. Twenty-year
follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl
J Med. 2002;347:1233–41.
2. Al-Ghazal SK, Falloweld L, Blamey RW. Does
cosmetic outcome from treatment of primary breast
cancer inuence psychological morbidity? Eur J Surg
Oncol. 1999;25:571–3.
3. Gold HT, Do HT, Dick AW.Correlates and effect of
suboptimal radiotherapy in women with ductal carcinoma in situ or early invasive breast cancer. Cancer.
2008;113:3,108–15.
4. Hershman DL, Wang X, McBride R, et al. Delay in
initiating adjuvant radiotherapy following breast
conservation surgery and its impact on survival. Int J
Radiat Oncol Biol Phys. 2006;65:1,353–60.
5. Clough KB, Lewis JS, Couturaud B, etal. Oncoplastic
techniques allow extensive resections for breastconserving therapy of breast carcinomas. Ann Surg.
2003;237:26–34.
6. Losken A, Pinell XA, Eskenazi BR.The benets of
partial versus total breast reconstruction for women
with macromastia. Plast Reconstr Surg. 2010 Apr
1;125(4):1051–6.
7. Currie A, Chong K, Davies GL. Using therapeutic
mammoplasty to extend the role of breast-conserving
surgery in women with larger or ptotic breasts. Ann R
Coll Surg Engl. 2013 Apr;95(3):192–5.
8. Grimm K, Fritsche E. Reduction of breasts...
Hans Schaller and the rst mammaplasty in 1561.
Contribution to history of medicine. Handchirurgie,
16 Therapeutic Mammoplasty Surgical Techniques
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125
Mikrochirurgie, Plastische Chirurgie: Organ
der Deutschsprachigen Arbeitsgemeinschaft fur
Handchirurgie: Organ der Deutschsprachigen
Arbeitsgemeinschaft fur Mikrochirurgie der
Peripheren Nerven und Gefasse: Organ der
V. Handchir Mikrochir Plast Chir. 2000 Sep
1;32(5):316–20.
9. Newman LA, Kuerer HM, McNeese MD, Hunt
KK, Gurtner GC, Vlastos GS, Robb G, Singletary
SE. Reduction mammoplasty improves breast conservation therapy in patients with macromastia. Am J
Surg. 2001 Mar 1;181(3):215–20.
10. Clough KB, Kroll SS, Audretsch W. An approach
to the repair of partial mastectomy defects. Plast
Reconstr Surg. 1999;104:409–20.
11. Hall-Findlay EJ. Pedicles in vertical breast
reduction and mastopexy. Clin Plast Surg.
2002;29(3):379–91.
12. Hall-Findlay EJ. A simplied vertical reduction
mamma-plasty: shortening the learning curve. Plast
Reconstr Surg. 1999;104(3):748–63.
13. McCulley SJ, Macmillan RD. Planning and use of
therapeutic mammoplasty–Nottingham approach. Br
J Plast Surg. 2005;58:889–901.
14. Rohrich RJ, Gosman AA, Brown SA, Tonadapu P,
Foster B. Current preferences for breast reduction
techniques: a survey of board-certied plastic surgeons 2002. Plast Reconstr Surg. 2004;114(7):1724–
33. discussion 34–6
15. Penn J. Breast reduction. Br J Plast Surg.
1955;7(4):357–71.
16. Sapino G, Haselbach D, Watfa W, Baudoin J,
Martineau J, Guillier D, di Summa PG.Evaluation of
long-term breast shape in inferior versus superomedial pedicle reduction mammoplasty: a comparative
study. Gland Surg. 2021;10(3):1018–28.
17. Purohit S. Reduction mammoplasty. Indian J Plast
Surg. 2008;41(Suppl):S64–79.
18. Ribeiro L. A new technique for reduction mammaplasty. Plast Reconstr Surg. 1975;55:330–4.
19. Courtiss EH, Goldwyn RM.Reduction mammaplasty
by the inferior pedicle technique. An alternative to free
nipple and areola grafting for severe macromastia or
extreme ptosis. Plast Reconstr Surg. 1977;59:500–7.
20. Robbins TH. A reduction mammaplasty with the
areola- nipple based on an inferior dermal pedicle.
Plast Reconstr Surg. 1977;59:64–7.
21. Munhoz AM, Montag E, Gemperli R.Current aspects
of therapeutic reduction mammaplasty for immediate
early breast cancer management: an update. World J
Clin Oncol. 2014 Feb 10;5(1):1–18.
22. Strombeck JO.Mammaplasty: report of a new technique based on the two-pedicle procedure. Br J Plast
Surg. 1960;13:79–90.
23. Wong C, Vucovich M, Rohrich R. Mastopexy and
reduction mammoplasty pedicles and skin resection
patterns. Plast Reconstr Surg Glob Open. 2014 Sep
8;2(8):e202.
24. Lejour M. Vertical mammaplasty and liposuction of
the breast. Plast Reconstr Surg. 1994;94:100.
25. Skoog T. A technique of breast reduction.
Transposition of the nipple on a cutaneous vascular
pedicle. Acta Chir Scand. 1963;126:453–65.
26. Benelli L. A new periareolar mammaplasty: the
“round block” technique. Aesthet Plast Surg.
1990;14(2):93–100.
27. Losken A, Dugal CS, Styblo TM, Carlson GW. A
meta-analysis comparing breast conservation therapy
alone to the oncoplastic technique. Ann Plast Surg.
2014;72(2):145–9.
28. Haloua MH, Krekel NMA, Winters HAH, Rietveld
DHF, Meijer S, Bloemers FW, et al. A systematic
review of oncoplastic breast conserving surgery. Ann
Surg. 2013;257(4):609–20.
29. Piper ML, Esserman LJ, Sbitany H, Peled
AW. Outcomes following oncoplastic reduction
mammoplasty: a systematic review. Ann Plast Surg.
2016;76(Suppl 3):S222–6.
30. Tenofsky PL, Dowell P, Topalovski T, Helmer SD.Am
J Surg. 2014;207(3):398–402.
31. De La Cruz L, Blankenship SA, Chatterjee A,
Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher
CS.Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature
review. Ann Surg Oncol. 2016 Oct;23(10):3247–58.
32. O’Connell RL, Baker E, Trickey A, Rattay T, et al.
On behalf of the TeaM Steering Group, on behalf
of the Mammary Fold Academic and Research
Collaborative, Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study. Br
J Surg. December 2018;105(13):1778–92.
33. Zhang MX, Chen CY, Fang QQ, Xu JH, Wang XF, Shi
BH, Wu LH, Tan WQ.Risk factors for complications
after reduction mammoplasty: a meta-analysis. PLoS
One. 2016 Dec 9;11(12):e0167746.
34. Chan LK, Withey S, Butler PE.Smoking and wound
healing problems in reduction mammaplasty: is the
introduction of urine nicotine testing justied? Ann
Plast Surg. 2006;56:111–5.
35. Kosasih S, Tayeh S, Mokbel K, et al. Is oncoplastic breast conserving surgery oncologically safe?
A meta-analysis of 18,103 patients. Am J Surg.
2020;220(2):385–92.
36. Sanchez AM, Franceschini G, D’Archi S, et al.
Results obtained with level II oncoplastic surgery
spanning 20 years of breast cancer treatment: Do
we really need further demonstration of reliability?
Breast J. 2020;26(2):125–32.
37. Clough KB, van la Parra R, Thygesen HH, et al.
Long-term results after oncoplastic surgery for breast
cancer: a 10-year follow-up. Ann Surg. 2017;268:165.
38. Gulis K, Rydén L, Bendahl PO, etal. Cosmetic outcomes and symmetry comparison in patients undergoing bilateral therapeutic mammoplasty for breast
cancer. World J Surg. 2021;45:1433–41.
39. Patel KM, Hannan CM, Gatti ME, Nahabedian
MY. A head-to-head comparison of quality of
life and aesthetic outcomes following immediate, staged- immediate, and delayed oncoplastic
126
https://t.me/medicina_free
N. S. Nair et al.
reduction mammaplasty. Plast Reconstr Surg.
2011;127:2,167–75.
40. Stein MJ, Karir A, Arnaout A, Roberts A, Cordeiro
E, Zhang T, Zhang J.Quality-of-life and surgical outcomes for breast cancer patients treated with therapeutic reduction mammoplasty versus mastectomy
with immediate reconstruction. Ann Surg Oncol.
2020 Oct;27(11):4502–12.
41. Veiga DF, Veiga-Filho J, Ribeiro LM, et al. Qualityof- life and self-esteem outcomes after oncoplastic breast-conserving surgery. Plast Reconstr Surg.
2010;125:811–7.
Batwing Mastopexy
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PankajKumarGarg
17
A batwing mastopexy lumpectomy is an ideal
approach for resection of breast lesions that are
located deep or adjacent to, without the direct
involvement of the nipple–areola complex
(NAC). The rst well-documented description of
the batwing technique is present in the landmark
paper by Silverstein etal. who described various
volume displacement oncoplastic techniques following partial mastectomy [1].
The batwing mastopexy involves resection of
two crescent-shaped areas of skin and parenchyma superior to the NAC and two adjacent triangles of the skin and parenchymal tissue
extending from both sides of the NAC.These are
suitable for the lesions that are located in the
upper hemisphere between the 9 0’clock and 3
0’clock positions [1, 2].
The technique allows the breast lesions to be
generously removed, weighing as much as 200g
or more depending upon the breast volume while
allowing the re-contouring of the breast in an aesthetically desirable manner. The technique also
permits the correction of breast ptosis by elevating the lower half of the breast and NAC [3, 4]. In
a prospective analysis of 35 patients undergoing
batwing mastopexy, 86% of the women rated the
cosmetic outcome as good; 91% of the women
P. K. Garg (*)
Department of Surgical Oncology, Shri Guru Ram
Rai Institute of Medical and Health Sciences,
Dehradun, Uttarakhand, India
were satised with the position of NAC following surgery. None of the patients was unsatised
with the cosmetic outcome following batwing
mastopexy [5].
The Hemi-batwing is a modication of the
batwing mastopexy. As the name indicates, the
Hemi-batwing involves resection of only one
crescent and one adjacent triangle of the skin and
parenchymal tissue.
17.1 Patient Selection
This approach is suitable for breast lesions that
are located in the upper hemisphere from 9
o’clock to 3 o’clock position especially in those
patients who would benet from mastopexy
because of the large pendulous breast
(Fig.17.1a).
17.2 Surgical Technique
17.2.1 Preoperative Markings
andIncision
• The preoperative marking should be drawn
while the patient is either standing or sitting.
The IMF, midsternal line, the paramedian line
should be drawn. A batwing-shaped incision
means two similar half-circle incisions are
made with angled wings on each side of the
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
S. V. S. Deo (ed.), Breast Oncoplasty and Reconstruction,
https://doi.org/10.1007/978-981-99-5536-7_17
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P. K. Garg
a
b
c
d
Fig. 17.1 (a) Possible tumor locations for Batwing mastopexy (b) Surface marking of the Batwing mastopexy (c)
Surgical defect created following excision, (d) result after closure of the incision
17 Batwing Mastopexy
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129
areola with the breast positioned centrally on
the pectoralis muscle (Fig.17.1a). With due
consent of the patient, it is a good practice to
have preoperative photographs for comparison with postoperative cosmetic outcomes.
17.2.2 Patient Position
• Following induction of anesthesia, the patient
is placed in the supine position. Both arms
should be secured to the side armrests so that
the patient can be made in an upright seated
position to delineate the IMF, nipple position,
and breast shape and symmetry.
17.2.3 Steps ofProcedure
• Local anesthetic (2% lignocaine with 1:80000
adrenaline) should be inltrated along the
incision line.
• The initial incision should be given over the
superior border of the NAC along the half of
the circumference from 3 0’clock to 9 0’clock
positions. The second incision is made above
and to the parallel to the rst incision. The
distance between the two incisions should be
decided by the size of the breast lesion and the
degree of mastopexy required (Fig.17.1b).
• Two batwings (isosceles or scalene triangles)
should be created at the two ends—medial and
lateral—of the crescent between the two
circum- areolar incisions. Again, the width and
the vertical height of the triangle will depend
upon the area of skin to be resected,
• After the skin incisions are made, oncologically sound resection of the breast lesion is
carried out having a minimum of 1cm gross
three-dimensional margin. Depending upon
the tumor location, the extent of dermoglandular resection may be more in one direction
(Fig.17.1c). A balance needs to be maintained
between oncological safety and cosmetic out-
comes while doing resection. Needless to say,
oncological safety always gets precedence
over the aesthetic outcome.
• After the resection of the breast lesion, the
tumor bed must be marked with clips for postoperative radiotherapy boost.
• Superior and inferior glandular tissue should,
then, be sutured together using interrupted
absorbable sutures. Superior glandular tissue is
usually thinner than inferior glandular tissue,
this discrepancy between the thickness of glandular tissue can be addressed by suturing fullthickness superior glandular tissue with the
anterior half of the inferior glandular tissue.
• Subcuticular sutures using a ne monolament suture should be applied to approximate
the skin edges (Fig.17.1d).
• A gentle pressure dressing should be applied
over the breast. This avoids the requirement of
draining the cavity. However, a tube drain may
be placed in selected cases if required.
17.2.4 Modications ofBatwing
Resection
• Hemi-batwing mastopexy: As the name indicates, only one isosceles triangle is drawn at
one end of the crescent depending upon the
tumor location (Fig.17.2). It is suitable for the
lesion that is located in the 9–10 o’clock (right)
or 2–3 o’clock (left) axis. However, this should
be avoided in a medially located breast lesion
as it would leave a scar that can be visible.
However, it provides mild correction of ptosis.
As there is only one triangle of skin resected at
one end, hemi-batwing mastopexy may result
in deviation of the NAC to one direction.
• In case of NAC found to be displaced upwards
following resection of a large amount of skin
from the upper half, de-epithelization of the
skin in the infra-alveolar region may help pull
the NAC downwards for better aesthetic outcomes [6].
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Fig. 17.2 Surface marking of the incision for
Hemi- batwing mastopexy
P. K. Garg
17.3 Complications
Batwing or Hemi-batwing mastopexy does carry
a similar risk of complications as all other oncoplastic procedures do have; they are discussed in
another chapter. An excessive undermining of the
NAC should be avoided as it may result in ischemia or necrosis.
17.4 Conclusion
Several advanced volume displacement oncoplastic techniques are currently available for
breast conservation in complex cancer cases.
Batwing/Hemi-batwing mastopexy is an appropriate oncoplastic surgical technique for tumors
located from 3 0’ clock to 9 0’clock positions in
the upper half especially when mastopexy is
required.
References
1. Anderson BO, Masetti R, Silverstein MJ.Oncoplastic
approaches to partial mastectomy: an overview of
volume-displacement techniques. Lancet Oncol.
2005;6(3):145–57.
2. Cantürk NZ, Şimşek T, Özkan GS.Oncoplastic breastconserving surgery according to tumor location. Eur J
Breast Health. 2021;17(3):220–33.
3. Almasad JK.Breast reconstruction in conserving breast
cancer surgery. Saudi Med J. 2008;29(11):1548–53.
4. Yang JD, Bae SG, Chung HY, Cho BC, Park HY, Jung
JH. The usefulness of Oncoplastic volume displacement techniques in the superiorly located breast cancers for Korean patients with small to moderate-sized
breasts. Ann Plast Surg. 2011;67(5):474–80.
5. Matkowski R, Szynglarewicz B, Kasprzak P, Forgacz
J, Skalik R, Zietek M, et al. Batwing mastopexy as
oncoplastic surgical approach to periareolar tumors in
upper quadrants. Tumori. 2012;98(4):421–7.
6. Rahman NKF, Kumar H, Ramesh R, Raghunandan
GC. Adding bit of esthetics with science modication of batwing mastopexy for breast conservation
in a young patient with giant broadenoma breast. J
Cancer Res Ther. 2019;15(5):1173–6.
Grisotti Mastopexy
https://t.me/medicina_free
(B-Flap Resection)
NaveenKumar, S.V.S.Deo, JyotiSharma,
andNavneetKaur
18
18.1 Introduction
The management of centrally located tumors is a
challenge for the surgeons and surgical options
are either mastectomy or central excision with
reconstruction. The Grisotti mastopexy is an
excellent approach of oncoplasty for centrally
located tumor especially when nipple–areolar
complex (NAC) resection is required in a woman
with adequate breast volume and moderate breast
ptosis. The Grisotti ap is also known as B-ap
resection because of the “B” shaped incision. The
circumareolar incision makes the upper portion
of B-ap, whereas the lower portion of B-ap is
made by a part of the lower breast adjacent to the
NAC that is transposed at the resected NAC site.
However, this oncoplastic technique is not an
ideal procedure for a patient with a short distance
between NAC and inframammary crease.
Herein, we are going to describe the surgical
technique of Grisotti mastopexy for central quadrant tumors.
18.2 Patient Selection
This incision is suitable for lesions that are
located in central quadrant and involving the nipple–areola complex.
18.3 Surgical Technique
18.3.1 Patient Position
• Patient is placed in supine position and breast
is positioned centrally.
18.3.2 Marking andIncision
• Margin of the areola is marked and the diameter
of the areola is measured. A disc of skin almost
equal diameter of areola is marked just inferior
to the NAC that will form the new areola.
• From lateral and medial edges of the native
areola and skin disc, two curvilinear lines are
drawn and these line pass beyond the skin kin
disc and converge at the lateral aspect of inframammary fold.
N. Kumar · S. V. S. Deo (*) · J. Sharma
DR BRAIRCH, All India Institute of Medical
Sciences, New Delhi, India
N. Kaur
UCMS and GTB Hospital, New Delhi, India
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
S. V. S. Deo (ed.), Breast Oncoplasty and Reconstruction,
https://doi.org/10.1007/978-981-99-5536-7_18
18.3.3 Steps oftheProcedure
(Fig.18.1)
• Grisotti ap resection starts with incision
around the areolar margin and dissection is
131
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