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BACKGROUND

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Reduction mammaplasty for women with breast cancer has become a reliable option and adjunct following partial or total mastectomy.1-3 In the setting of partial mastectomy, reduction mammaplasty can be performed on the ipsilateral and contralateral breast and is commonly referred to as oncoplastic breast surgery. In the setting of unilateral total mastectomy followed by autologous or prosthetic reconstruction, reduction mammaplasty can be performed on the contralateral breast for symmetry. In the setting of breast conservation, reduction mammaplasty following radiation therapy can be performed safely and effectively albeit with some technical modification.

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Reduction mammaplasty in the setting of breast cancer has been demonstrated to enhance patient satisfaction and to improve reconstructive outcomes by achieving symmetry, contour, and desired shape.4 This chapter reviews the indications and salient aspects of reduction mammaplasty in the setting of breast conservation, oncoplastic surgery as well as ipsilateral total mastectomy with contralateral mammary hypertrophy.

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TYPES OF DEFECTS

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In patients that are candidates for partial mastectomy, oncoplastic reconstruction is commonly used to preserve breast shape and contour. For some women, a volume displacement procedure will suffice and for other women, a volume replacement procedure will be necessary.3,5 Volume displacement procedures include adjacent tissue rearrangement, mastopexy, and reduction mammaplasty. Reduction mammaplasty is generally considered in women with large or excessively ptotic breasts. The author's indications for a reduction mammaplasty following partial mastectomy include women with mild, moderate, and severe hypertrophy who are typically defined as requiring excision of 300 to 600 g, 600 to 1200 g, and greater than 1200 g of tissue, respectively.

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Following partial mastectomy, a reduction mammaplasty can be performed on the ipsilateral as well as contralateral breast. Oncoplastic reduction mammaplasty can be performed immediately or as a staged-immediate procedure that typically occurs 1 to 2 weeks following the ablative procedure that coincides with the discovery of the final pathology. The goal of immediate and staged-immediate reduction mammaplasty is to optimally contour the breast prior to the initiation of radiation therapy in order to minimize the incidence of contour abnormalities.

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Another group of patients that may benefit from reduction mammaplasty are those that have had breast conservation in the setting of mammary hypertrophy.6 Performing a reduction mammaplasty in a previously radiated breast poses additional challenges because the radiated tissues have compromised vascularity, increased fibrosis, and are more prone to adverse events such as fat necrosis and delayed healing. Technical modifications are necessary to ensure predictable outcomes.

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In patients who have had unilateral total mastectomy with reconstruction, the desire to achieve symmetry with the opposite breast is common.7-9 In situations where the opposite breast is hypertrophic, a reduction mammaplasty is usually indicated. In a review of the various symmetry procedures following unilateral mastectomy and reconstruction, the performance of a contralateral reduction mammaplasty was the most common.7,9...

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