3. Mastopexy

1.A 57-year-old lady, with breast atrophy, ptosis, and significant breast asymmetry, left side more ptotic [5].

Mastopexy with dissecting medial and lateral flaps from the underlying breast tissue was brought together with upward mobilization of the nipple-areolar complex to build up more esthetic and symmetric breasts. The operation was carried out under local anesthesia (Figures 23 and 24).

#### Figure 23.

Atrophic and ptotic breasts with significant asymmetry and disfigurement of nipple-areolar complex. Front view; left, pre-op; right, post-op.

#### Figure 24.

Atrophic and ptotic breasts with significant asymmetry and disfigurement of nipple-areolar complex. Threequarter view; left, pre-op; right, post-op.

## 4. Postmastectomy breast reconstruction

Nowadays, breast cancer patients are increasing, and different breast cancer treatment modalities are evolving, which may result in miscellaneous breast deformities, asymmetry, and disfigurements [6–9].

The patients may suffer from breast deformities, asymmetries, radiation injuries, loss or deformities of nipple-areolar complex, scar contracture, or even lymphedema of the affected side upper extremity.

Breast cancer of different stages may need different reconstruction modality. Postmastectomy breast reconstruction is another big issue for plastic surgeons.

1.This 38-year-old lady had modified radical mastectomy on her right breast. She received postmastectomy breast reconstruction 3 years later. Transverse rectus abdominis myocutaneous flap [6, 9] was harvested from lower abdomen to reconstruct the right breast defect. The photo showed the breast figure 25 years after operation (Figure 25).


Intractable funnel chest in this 16-year-old young adult was treated with revascularization of the turnover sternum. The sternum and costal composite tissue were

Figure 25. Twenty-five years after postmastectomy breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap.

Figure 26. Secondary breast reconstruction with free DIEP flap, followed by nipple-areolar reconstruction.

Figure 27.

Front view. Differential augmentation of the breasts with gel implant (Mentor Memory gel) (right side 250 ml, left side 300 ml). Left, pre-op; right, post-op.

Figure 28.

Right three-quarter view. Differential augmentation of the breasts with gel implant (Mentor Memory gel) (right side 250 ml, left side 300 ml). Left, pre-op; right, post-op.

#### Figure 29.

Left three-quarter view. Differential augmentation of the breasts with gel implant (Mentor Memory gel) (right side 250 ml, left side 300 ml). Left, pre-op; right, post-op.

#### Figure 30.

Mastopexy, capsulectomy, change of prosthesis at right breast and capsulectomy, change of prosthesis, and areolar graft at left breast. Left, pre-op; right, post-op. 2.5 years.

#### Figure 31.

Release of scar contracture with differential augmentation and nipple areolar sharing. Mastopexy at right breast. Right three-quarter view; left, pre-op; right, post-op.

#### Figure 32.

Release of scar contracture with differential augmentation and nipple areolar sharing. Left three-quarter view; left, pre-op; right, post-op.

#### Figure 33.

Left, ptosis of right breast; deformity of left breast after partial mastectomy with R/T; left, pre-op; right, right breast corrected with mastopexy; left breast with modified mastopexy with subsequent fat graft.

Figure 34. Correction of right breast with mastopexy.

#### Figure 35.

Deformity of left breast after partial mastectomy with R/T, corrected with modified mastopexy with subsequent fat graft. Left, pre-op; right: Post-op. 5 months.

Figure 36. Intractable funnel chest.

Figure 37. CT showed compression of sternum on heart.

Figure 38. Resected sternal block.

Figure 39. Sternal turnover with revascularization.

Figure 40. Post-op front view.

Figure 41.

Sequential CT follow-up showed definitive improvement of function, stability, and configuration of reconstructed sternum.

resected at the outskirt of the depressed area. Special attention was paid to the dissection of the vascular pedicle at both sides of the internal mammary vessels. The recipient vessels at one side were left long, so were the donor vessels at the other side. A segment of the rib at the exit of the recipient internal mammary vessels had to be removed to accommodate the vessels and to facilitate vascular anastomosis. Vascular anastomosis was accomplished with loupes (Keeler, sixfold magnification). Revascularization of the turnover sternum was performed successfully without vascular compromise. The patient recovered well with much improved physical condition. Postoperative three-dimensional computed tomographic (CT) scan revealed increment of thoracic cage volume for 9–17%. A follow-up CT scan 2 years later revealed even more improved thoracic cage expansion (Figures 36–41).
