When you remove tumors in the lower quadrants of the breast, cosmetic problems are possible. It may causebird beak deformity. However, the lower pole of the breast can be reconstructed by shifting the surrounding tissues into the lumpectomy (complete removal of the tumor) cavity. For this purpose
- Triangle resection, which allows wide excision (tumor removal) of the lesions at the 5-7 o'clock level of the breast, is used.
- Triangle incisions can be used for radial lesions or lesions close to the skin as well as deep lesions.
- Larger lesions located in this area can also be removed with this technique, which removes a full-thickness wedge-shaped skin specimen and glandular tissue.
How is Triangular Resection Performed?
Triangular resection is performed as follows;
- A triangular or wedge incision is made on the skin over the lesion in the breast.
- After the skin is crossed, the underlying glandular tissue is removed towards the chest wall.
- While closing the wound, the surrounding lower inner and lower outer quadrant glandular tissues are approximated full-fold.
- An inframammary fold is made to complete the procedure. It is closed by approximating the glandular and fibrous tissues of the breast with the fibrous tissues of the inframammary fold layer by layer.
- The skin is then closed with smaller suture material.
What should be considered in triangular resection?
Collateral blood circulation may be insufficient intriangular resection. Partial and full-thickness necrosis may occur. To cope with this, the following principles should be observed.
- In the corners, the textures should be treated gently,
- Reduce tension when closing wounds,
- Retractors that traumatize the skin and underlying tissues should be avoided in these corners,
- The round off technique can be used as an additional strategy in the corners to reduce the risk of perfusion disturbance in the distal corner. Skin defects that may occur in the skin can be filled to create space in the skin in the center of the inframammary fold to compensate for this.
What is Inframammary Resection?
It is a procedure suitable for the removal of cancers located in the lower and posterior parts of the breast. It is performed through an incision that fits the inframammary fold hidden under the breast. The skin over the lesion is preserved. Therefore, the inframammary approach is not recommended for the removal of superficial breast cancers to reduce the risk of positive surgical margins.
- Dissection is performed through the retromammary fatty plan at least 3 cm above the tumor. The position is determined by bimanual examination, skin markings, wire markings, ultrasound or a combination of these.
- In deeper lesions, the fascia of the muscle should be removed together with the surrounding tissues.
- Closure of the wound begins with approximation of the surgical margins to reduce or prevent skin retraction into the created cavity. This step is relatively easy in breasts that have been mobilized quite widely from the chest wall. However, if additional mobilization is required, dissection of the retromammary fat plane or subcutaneous tissue plane can be performed to achieve closure of the cavity.
- Finally, the wound closure is closed layer by layer with smaller numbered absorbable sutures.
- It is completed by approximating the inframammary tissues with 2-0 or 3-0 absorbable sutures.
What is Reduction Mammoplasty?
WithReduction Mammoplasty, both the tumor in the patient is removed and breast aesthetics are performed. The advantages of this procedure are as follows;
- Larger masses can be removed in a large way.
- The breast can be reconstructed. Partial defects are hidden and the breast is aesthetically corrected at the same time.
After planning the incision in the skin, the removal of the tumor in the breast is carried out by cutting the inframammary fold, the glandular parts of the affected skin towards the chest wall and continuing the dissection plan to the skin surface to the right side. Closure of the wound begins by approximating the incision with several staples, this is done especially in the inferior, medial and lateral incisions. The layering of the parenchyma, dermis and skin allows the final breast shape to be formed over time.
Problems that may occur in reduction mammaplasty
Skin and fat necrosis are the most common complications of reduction mammoplasty. It is especially seen in smokers and obese patients. Nipple areola necrosis occurs in approximately 3% of patients.
What is Inferior Pedicle Reduction?
It is an operation especially suitable for lesions located just above the nipple or in the lower inner or outer quadrant. It is a frequently used technique because it is simple and reliable. It is used in patients with various breast sizes from small to large. This technique can even be used in patients with macromastia and very severe ptosis. With this technique, the branches of the 3rd, 4th and 5th intercostal nerves extending to the skin are protected even in patients with macromastia.
What is Superior Pedicle Reduction?
This technique is especially suitable for cases where the lesions at the 5, 6 and 7 o'clock positions are removed extensively. “Comma-shaped mammoplasty” is recommended for small or medium-sized breasts, especially for lesions at 6 o'clock. Superior pedicled reduction and inferior pedicled reduction mammoplasty are methods used to achieve symmetry with the opposite breast.
