Breast Amputation Workup

  • Author: Curtis S F Wong, MD; Chief Editor: James Neal Long, MD, FACS   more...
 
Updated: Nov 6, 2011
 

Laboratory Studies

Perform a complete blood count to ensure anemia (hemoglobin < 10 g) or thrombocytopenia are not present. (As blood loss with this procedure should be minimal, the author does not recommend autogenous banking of blood.)

Provide photographic documentation to the insurance company for authorization and for comparison of before and after photos to help the patient appreciate what has changed.

Other laboratory tests may be indicated depending on the additional health problems the patient may have or the medications she may be taking. This includes prothrombin time, activated partial thromboplastin time, complete or basic metabolic profiles, and urinalysis. An ECG is performed if indicated by the patient's history or if required by the surgical facility.

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Imaging Studies

Mammography is indicated in any patient who is 40 years or older and has not undergone one in the prior 6-9 months. This is in compliance with the guidelines established by the American Cancer Society. The author also considers mammography in patients older than 30 years when they have a strong family history of breast cancer. Mammography (and possibly ultrasound or other imaging studies) is also used in the evaluation of palpable masses noted on physical examination. Postoperative baseline mammograms are obtained approximately 6 months after the surgery or at the discretion of the surgeon. This is to provide a baseline for comparison with future mammograms and document what changes may have occurred following surgical intervention.

Obtain chest radiographs if indicated by examination findings or the patient's history.

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Other Tests

An ECG is performed if a patient's history warrants. In addition, some surgical facilities have guidelines requiring ECGs at certain patient ages.

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Diagnostic Procedures

Manual lifting of the breasts may result in considerable relief or resolution of symptoms. This is a strong indicator that the procedure will result in relief for the patient.

Progression of symptoms over the course of the day when upright and wearing a bra also support the probability of a health benefit following reduction surgery.

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Histologic Findings

Tissue is sent for pathologic examination to rule out carcinoma or other atypia.

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Contributor Information and Disclosures
Author

Curtis S F Wong, MD  Clinical Instructor, Department of Family Practice, Division of Surgery, Mercy Medical Center

Curtis S F Wong, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and California Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Pankaj Tiwari, MD  Assistant Professor, Division of Plastic Surgery, Ohio State University College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, FACS  Associate Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, Children's Hospital and Kirklin Clinics, University of Alabama at Birmingham School of Medicine; Chief of Plastic, Reconstructive, Hand, and Microsurgery, Birmingham Veterans Affairs Medical Center

James Neal Long, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape gratefully acknowledge the contributions of previous editor Saleh M Shenaq, MD, to the development and writing of this article.

References

  1. McKissock P. Color Atlas of Mammaplasty. Thieme Medical Publishers;1991:47-78.

  2. Hawtof DB, Levine M, Kapetansky DI, Pieper D. Complications of reduction mammaplasty: comparison of nipple-areolar graft and pedicle. Ann Plast Surg. Jul 1989;23(1):3-10. [Medline].

  3. American Society of Plastic and Reconstructive Surgeons. Clinical Practice Guidelines for Female Breast Hypertrophy/Breast Reduction. 1993.

  4. Robbins TH. Reduction mammaplasty by the Robbins technique. Plast Reconstr Surg. Feb 1987;79(2):308-9. [Medline].

  5. Jackson IT, Bayramicli M, Gupta M, Yavuzer R. Importance of the pedicle length measurement in reduction mammaplasty. Plast Reconstr Surg. Aug 1999;104(2):398-400. [Medline].

  6. Koger KE, Sunde D, Press BH. Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation. Ann Plast Surg. Nov 1994;33(5):561-4. [Medline].

  7. Abramson DL. Increasing projection in patients undergoing free nipple graft reduction mammoplasty. Aesthetic Plast Surg. Jul-Aug 1999;23(4):282-4. [Medline].

  8. Fredricks S. Re: Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation. Ann Plast Surg. May 1995;34(5):559. [Medline].

  9. Matarasso A, Wallach SG, Rankin M. Reevaluating the need for routine drainage in reduction mammaplasty. Plast Reconstr Surg. Nov 1998;102(6):1917-21. [Medline].

  10. Bostwick J. Plastic and Reconstructive Breast Surgery. 2nd ed. Quality Medical Publishing; 2000.

  11. Casas LA, Byun MY, Depoli PA, Gradinger GP. Maximizing breast projection after free-nipple-graft reduction mammaplasty. Plast Reconstr Surg. Apr 1 2001;107(4):961-4. [Medline].

  12. Farina R, Villano JB. Reduction mammaplasty with free grafting of the nipple and areola. Br J Plast Surg. Oct 1972;25(4):393-8. [Medline].

  13. Letterman G, Schurter M. A comparison of modern methods of reduction mammaplasty. South Med J. Oct 1976;69(10):1367-71. [Medline].

  14. Netscher D. Mammography and Reduction Mammaplasty. Aesthetic Surg J. 1999;19(6):445.

  15. Schnur PL, Hoehn JG, Ilstrup DM, et al. Reduction mammaplasty: cosmetic or reconstructive procedure?. Ann Plast Surg. Sep 1991;27(3):232-7. [Medline].

 
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Preoperative status of breasts with lateral nipple displacement. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Preoperative status of breasts, oblique view. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Marking breast meridians: medial to laterally displaced nipples. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Obstetric caliper used to measure distance from clavicle to inframammary fold. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Transposing caliper-measured distance to front of breast along meridian. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Positioning nipple 1-2 cm below caliper-measured distance to compensate for recoil uplift after amputation of tissues. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Opened keyhole pattern centered around new nipple position. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Intermammary webbing in extremely large breasts. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Patterns marked. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Pattern marking completed with lateral/medial extensions. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Appearance of patterns when supine. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Inferior pyramid of tissue to be de-epithelialized for improving nipple projection. Image courtesy of Curtis Wong, MD.
Removal of nipple and deepithelialization of graft site (ie, new nipple site). Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Through the inframammary incision, the breast tissue is dissected off the pectoralis muscle up to the medical and lateral extensions of planned upper incisions. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Resection by "staircasing" the breast tissue or beveling away from the skin edges preserves breast tissue that may help with improving nipple projections. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Direct closure results in dog ears in the graft bed and at the ends of the incisions; circular excisions of dog ears with purse-string closure dramatically reduces or eliminates dog ear. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Plication of graft bed with fine chromic sutures to flatten graft site prior to grafting. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Appearance after bolster secured with method of surgeons choice. Leave it on for 10-14 days to maximize take of nipple. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Images 19-26: Sequence of photos to display management of medial webbing in extremely large breasts if incisions need to be carried across midline. Image used with permission from McKissock, Paul K. Color Atlas of Mammaplasty. Thieme Publishers. 1991:47-78.
Preoperative photograph of the breasts of patient A. Image courtesy of Curtis Wong, MD.
Postoperative photograph of the breasts of patient A. Image courtesy of Curtis Wong, MD.
Preoperative photograph of the breasts of patient B. Image courtesy of Curtis Wong, MD.
Postoperative photograph of the breasts of patient B. Image courtesy of Curtis Wong, MD.
 
 
 
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