Axillary reduction mammaplasty

Abstract

The first description of reduction mammaplasty in the literature was in the seventh century when Durstin [1], in 1669, described breast reduction surgery. Beisenberg [2] treated gynecomastia, but it was only at the beginning of the past century that the major contributions related to the issue began to be cited in the literature such as studies by Arié [3], Mouly and Dufourmentel [4], Strombeck [5], Pitanguy [6], Andrews [7], and Peixoto [8]. These authors brought new contributions to the development of breast reduction techniques. According to many authors, the surgical techniques for treating breast hypertrophy and ptosis should be the ones the surgeon is best at. The negative aspects pointed out for classical reduction mammaplasty are the size of the scars, a fact with which most patients agree. The results of an interactive survey on mastoplasty carried out at the XXI Sao Paulo Plastic Surgery Day in Campos do Jordao, Sao Paulo, June 2001 showed that patients' major complaints referred to inappropriate scars (59.4%), late postoperative ptosis (16.5%), inadequate shape (11.4%), and breast asymmetry (7.6%); 5.1% did not have any one of the given complaints. In January 1984, the author began using a less-aggressive reduction mammaplasty with an areolar access technique that preserves a larger number of central mammary lobules and presents only an areolar scar. The experience with this technique by the author has been described elsewhere in literature [9-14]. Over a period of 9 years, the technique was performed on five hundred patients (one thousand breasts). Aft er this, the conclusion was that the breast could be submitted to a mammaplasty utilizing the axillary route without any visible scar. The experience with the technique was initially described in 1993 [15] and then in other articles [16-20]. The problem most common to all mammary reductions is the patient dissatisfaction due to breast scarring or lateralization of the breast. Despite whether the resected tissue is in the upper, lateral, or inferior pole, many operated breasts in a late postoperative phase started showing excessive tissue with ptosis in the extreme lateral quadrant of the breast. Axillary access to breast reduction surgery was described in the literature as early as 1924 by D rtigues [21]. Many other reports have described it, although the technique has not become popular to date. A high satisfaction rate was obtained in one research study with two hundred breasts operated on by the axillary route reduction technique (Tables 44.1-44.5). © 2009 Springer-Verlag Berlin Heidelberg.