Since January 2000, 80 patients have undergone breast reduction using a septum-based mammaplas-ty. The pedicle for the nipple-areola complex is based on a horizontal septum and is designed to incorporate the lateral branch of the fourth intercostal vessels and of the nerve. Breasts with a 45-cm nipple-to- sternum notch were operated successfully using the septum-based pedicle technique. Mean gland resection was 580 g (40 to 1980 g) per breast. Septum-based lateral mammaplasty was the most used (80%). I currently use the septum-based medial mammaplasty with increasing frequency. Clinical cases are shown in Figs. 9.7-9.9. Choice between the two pedicles is discussed in Chap. 10.
The complication rate is obviously related to the learning curve. Most of the complications occurred in the first 15 patients, in particular wound dehiscence in case of significant breast hypertrophy. However, the areola was congested in one of my last patients, so leeches were applied on the areola. An extensive infection unexpectedly developed after a few days, probably due to the leeches, and led to a major necrosis of the central part of the breast with the NAC. The patient had a high risk factor - she was diabetic and a smoker with a ptosis of 38 cm - but I believe this kind of complication can occur in almost any patient, and no technique is spared such an extremely annoying problem. A retroareolar hematoma occurred at the beginning of our experience and resulted in a partial areola necrosis in one breast. Careful hemostasis and drain placement behind the NAC will prevent this complication.
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.