scholarly journals Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

2021 ◽  
Vol 27 (1) ◽  
pp. 39-42
Author(s):  
Joseph Kyu-hyung Park ◽  
Yujin Myung
Keyword(s):  
Reduction Mammoplasty ◽  
Venous Congestion ◽  
Nipple Areolar Complex ◽  
Areolar Complex

Experience and outcomes of nipple-sparing mastectomy following reduction mammoplasty.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 193-193
Author(s):  
Michael Alperovich ◽  
Keith M. Blechman ◽  
Fares Samra ◽  
Richard Shapiro ◽  
Deborah M. Axelrod ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Medical Center ◽  
Cancer Recurrence ◽  
Reduction Mammoplasty ◽  
Nipple Areolar Complex ◽  
Implant Complications ◽  
Areolar Complex ◽  
History Of ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

193 Background: Breast cancer resection strives for less radical approaches that offer superior aesthetic results without compromising oncologic safety. Nipple-sparing mastectomy (NSM) has gained popularity, but usually has been offered to smaller breasted and minimally ptotic women without history of extensive breast surgery. We present a series of nine nipple-sparing mastectomies following reduction mammoplasty. Methods: Charts of patients who underwent NSM following reduction mammoplasty at the NYU Medical Center from 2006 through 2011 were reviewed. Outcomes measured include post-operative complications, breast cancer recurrence, presence of cancer in the nipple-areolar complex, and nipple-areolar complex viability. Results: In total, the records of 235 (145 prophylactic, 90 therapeutic) NSM patients at NYU Medical Center were reviewed. Six patients for a total of 9 breasts had NSM following reduction mammoplasty. This subset of patients had a mean age of 46.2, mean BMI of 25.1, no history of diabetes and 1 smoker. Seven of 9 breasts were therapeutic resections and 2 of 9 were prophylactic. Time elapsed between reduction mammoplasty and NSM ranged from 33 days to 11 years. The majority of resections were in Stage 0 patients (6/9) with 1/9 in Stage I and 2/9 in Stage IIA. In all cases, prior reduction mammoplasty incisions were utilized for NSM. Eight patients were reconstructed immediately with tissue expanders, and 1 patient had a latissimus dorsi flap with immediate implant. Complications included 1 hematoma requiring evacuation and 1 displaced implant requiring revision. There were no positive subareolar biopsies and 100% nipple viability. Mean follow-up time was 9.4 months. Conclusions: Our experience demonstrates that NSM can be offered following reduction mammoplasty with comparable reconstructive outcomes to NSM alone. Reduction mammoplasty followed by NSM has potential as a reconstructive tool in prophylactic cases unsuited for primary NSM.

scholarly journals Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

2021 ◽  
Vol 17 ◽  
pp. 174550652110314
Author(s):  
Pamela Douglas
Keyword(s):  
Candida Albicans ◽  
Human Milk ◽  
Signs And Symptoms ◽  
Breast Pain ◽  
Breastfeeding Support ◽  
Candida Spp ◽  
Healthy Human ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
The Relationship

Background: Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications. Aim: This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome. Method: The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review. Results: There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes. Discussion: Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance. Conclusion: Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.

The Safety of Operating on Breasts With a History of Prior Reduction Mammoplasty: Dynamic Magnetic Resonance Imaging Analysis of Angiogenesis

2021 ◽  
Author(s):  
Joseph Kyu-hyung Park ◽  
Seokwon Park ◽  
Chan Yeong Heo ◽  
Jae Hoon Jeong ◽  
Bola Yun ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Three Dimensional ◽  
Venous Drainage ◽  
Reduction Mammoplasty ◽  
Magnetic Resonance Images ◽  
Areolar Complex ◽  
Internal Mammary ◽  
Initial Procedure ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Background Vascularity of the nipple-areolar complex (NAC) is altered after reduction mammoplasty, which increases complications risks after repeat reduction or nipple-sparing mastectomy. Objectives To evaluate angiogenesis of the NAC via serial analysis of breast magnetic resonance images (MRIs). Methods Breast MRIs after reduction mammoplasty were analyzed for 35 patients (39 breasts) using three-dimensional reconstructions of maximal intensity projection images. All veins terminating at the NAC were classified as internal mammary, anterior intercostal, or lateral thoracic in origin. The vein with the largest diameter was considered the dominant vein. Images were classified based on the time since reduction: <6 months, 6-12 months, 12-24 months, >2 years. Results The average number of veins increased over time: 1.17 (<6 months), 1.56 (6–12 months), 1.64 (12–24 months), 1.73 (>2 years). Within 6 months, the pedicle was the only vein. Veins from other sources began to appear at 6–12 months. In most patients, at least two veins were available after 1 year. After 1 year, the internal mammary vein was the most common dominant vein regardless of the pedicle used. Conclusions In the initial 6 months after reduction mammoplasty, the pedicle is the only source of venous drainage; however, additional sources are available after 1 year. The internal thoracic vein was the dominant in most patients. Thus, repeat reduction mammoplasty or nipple-sparing mastectomy should be performed ≥1 year following the initial procedure. After 1 year, the superior or superomedial pedicle may represent the safest option when the previous pedicle is unknown.

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