Introduction. An increasing number of subjects, after bariatric surgery, resort to "body contouring" surgical techniques to restore the morpho-functional balance of their body. One of the most common problems in postbariatric patients is breast ptosis. The surgical procedure to correct breast ptosis is mastopexy. Rationale of the study. This study aims to evaluate the specific problems of the post-bariatric breast and the most suitable surgical interventions for its remodeling, providing for the use of autologous tissues. There are many suitable flaps. However, the use of the PAF flap can be considered a valid alternative. Through a combined procedure of brachioplasty and mastopexy, the contour of the arm and the volume and shape of the breast can be improved simultaneously. The use of the flaps has also led to the need for a more in-depth knowledge of the skin tissue. This study in particular aims to evaluate the quality of the skin tissue of post-bariatric patients, to highlight how histological changes in the skin can affect the result of breast remodeling. Materials and methods. After a systematic research on the flaps and their use, postbariatric breast remodeling surgery, with a combined technique of brachioplasty and mastopexy, carried out from 2019 to today, with the use of PAF, was studied. These are procedures where the adipocutaneous flaps, taken from the posteromedial sides of the arms, tunneled under a subcutaneous bridge of the axillary region, are fixed to the greater pectoral fascia and to the McKissock flap, as self-prosthesis, restoring the volume and contour of the breast. In addition, 5 body contouring interventions were identified, carried out between November 2021 and February 2022, during which skin samples were taken to carry out histological analyses, in collaboration with the Institute of Anatomy. Results. Breast remodeling interventions with combined brachioplasty and mastopexy technique and with the use of PAF have led to satisfactory and encouraging results. After one year of follow-up, the silhouette of both arms was documented as healthy and symmetrical and the breasts were soft. The histochemical analysis conducted on the skin samples showed alterations such as thickening of the collagen components in the dermis and the superficial subcutaneous layer, with a reduction in elastic fibers. Discussion. Combined surgical procedures of brachioplasty and mastopexy are widespread and privileging the use of autologous tissues allows excellent results. The use of the PAF, a novelty tested for the first time in 2019 at the Plastic Surgery Clinic of Padua, has proved to be a reliable and promising technique. In patients with a favorable body habitus, PAF can be considered a valid alternative to other flaps. The clinical features of postbariatric skin represent great challenges for the outcome of these surgical procedures. There are in fact clear signs of clinical deterioration, such as reduced elasticity and turgor, great laxity due to the remodeling and reabsorption of adipose tissue as well as direct changes on the extracellular matrix, consisting of alterations in the elastin and collagen fibers. Conclusions. The use of PAF has proved to be a valid technique for breast remodeling, allowing brachioplasty, with the certainty of minimal morbidity of the donor site, combined with a mastopexy, with good breast remodeling results. Further studies can provide valuable information for the improvement of surgical techniques. The study of skin samples highlighted the role of clinical features of post-bariatric skin on the response to surgery, but knowledge of the processes that occur in the skin after massive weight loss remains incomplete. Future therapeutic protocols, will certainly lead to an improvement in the condition of the skin after a significant weight loss, impacting the results of BC.
Introduzione.Numerosi sono i soggetti che, dopo un intervento di chirurgia bariatrica, ricorrono alle tecniche di “body contouring”, per ripristinare l’equilibrio morfo-funzionale del proprio corpo. Uno dei problemi più comuni nelle pazienti postbariatriche è la ptosi mammaria, per la cui correzione si ricorre alla mastopessi. Razionale dello studio.Questo studio si propone di valutare le problematiche specifiche della mammella post-bariatrica e gli interventi chirurgici più adatti al suo rimodellamento, con l’utilizzo di tessuti autologhi. L'uso del PAF può essere considerata una valida alternativa. Con una procedura combinata di brachioplastica e mastopessi, si può migliorare simultaneamente il contorno del braccio ed il volume del seno e limitare la recidiva di ptosi. L’impiego dei lembi ha portato, inoltre, alla necessità di una conoscenza più approfondita del tessuto cutaneo delle pazienti post-bariatriche, per evidenziare come variazioni istologiche della pelle possano incidere sul risultato del BC. Materiali e metodi.Sono stati oggetto di studio gli interventi di chirurgia postbariatrica di rimodellamento della mammella, con tecnica combinata di brachioplastica e mastopessi, effettuati dal 2019 ad oggi, con l’uso del PAF. Si tratta di procedure dove i lembi adipocutanei, prelevati sui lati posteromediali delle braccia, tunnellizzati sotto un ponte sottocutaneo della regione ascellare, vengono fissati alla fascia pettorale maggiore e al lembo di McKissock, come autoprotesi. Sono stati, inoltre, individuati 5 interventi di BC, effettuati tra novembre 2021 e febbraio 2022, durante i quali sono stati prelevati campioni di cute sui quali procedere ad analisi istologiche, in collaborazione con l’Istituto di Anatomia. Risultati.Gli interventi di rimodellamento della mammella con tecnica combinata di brachioplastica e mastopessi e con utilizzo del PAF hanno portato a risultati soddisfacenti. Dopo un anno di follow-up, la silhouette di entrambe le braccia è stata documentata come sana e simmetrica ed il seno è risultato morbido. L’analisi isto-chimica condotta sui campioni di cute ha evidenziato alterazioni quali addensamento delle componenti collageniche a livello del derma e dello strato sottocutaneo superficiale, con riduzione delle fibre elastiche. Discussione.Le procedure chirurgiche combinate di brachioplastica e mastopessi sono molto diffuse. L’uso del PAF, novità sperimentata per la prima volta nel 2019 presso la Clinica di chirurgia plastica di Padova, si è rivelato una tecnica affidabile e promettente. Nelle pazienti con habitus corporeo favorevole, il PAF può essere considerato una valida alternativa ad altri lembi. Le caratteristiche cliniche della pelle postbariatrica rappresentano grandi sfide per l’outcome di queste procedure. La cute presenta ridotta elasticità e turgore, grande lassità dovuta al rimodellamento del tessuto adiposo nonché cambiamenti sulla matrice extracellulare, costituiti da alterazioni nelle fibre di elastina e di collagene. Conclusioni.L’uso del PAF si è dimostrata una tecnica valida per il rimodellamento mammario, consentendo una brachioplastica, con la sicurezza di una minima morbilità del sito donatore, combinata con una mastopessi, con buoni risultati di rimodellamento del seno e riduzione dell’incidenza della ptosi mammaria. Ulteriori studi potranno fornire preziose indicazioni per il miglioramento della tecniche chirurgiche. Lo studio sui campioni di cute ha evidenziato il ruolo delle caratteristiche cliniche della pelle post-bariatrica sulla risposta alla chirurgia, ma la conoscenza dei processi che si verificano nella pelle dopo una massiccia perdita di peso rimane incompleta. Protocolli terapeutici futuri, pertanto, porteranno ad un miglioramento delle condizioni della pelle dopo un importante dimagrimento, impattando sui risultati dell'intervento di rimodellamento corporeo.
Innovazioni Anatomo-Chirurgiche nel Rimodellamento Autologo Mammario Post-bariatrico
MIGLIORE, FRANCESCA
2021/2022
Abstract
Introduction. An increasing number of subjects, after bariatric surgery, resort to "body contouring" surgical techniques to restore the morpho-functional balance of their body. One of the most common problems in postbariatric patients is breast ptosis. The surgical procedure to correct breast ptosis is mastopexy. Rationale of the study. This study aims to evaluate the specific problems of the post-bariatric breast and the most suitable surgical interventions for its remodeling, providing for the use of autologous tissues. There are many suitable flaps. However, the use of the PAF flap can be considered a valid alternative. Through a combined procedure of brachioplasty and mastopexy, the contour of the arm and the volume and shape of the breast can be improved simultaneously. The use of the flaps has also led to the need for a more in-depth knowledge of the skin tissue. This study in particular aims to evaluate the quality of the skin tissue of post-bariatric patients, to highlight how histological changes in the skin can affect the result of breast remodeling. Materials and methods. After a systematic research on the flaps and their use, postbariatric breast remodeling surgery, with a combined technique of brachioplasty and mastopexy, carried out from 2019 to today, with the use of PAF, was studied. These are procedures where the adipocutaneous flaps, taken from the posteromedial sides of the arms, tunneled under a subcutaneous bridge of the axillary region, are fixed to the greater pectoral fascia and to the McKissock flap, as self-prosthesis, restoring the volume and contour of the breast. In addition, 5 body contouring interventions were identified, carried out between November 2021 and February 2022, during which skin samples were taken to carry out histological analyses, in collaboration with the Institute of Anatomy. Results. Breast remodeling interventions with combined brachioplasty and mastopexy technique and with the use of PAF have led to satisfactory and encouraging results. After one year of follow-up, the silhouette of both arms was documented as healthy and symmetrical and the breasts were soft. The histochemical analysis conducted on the skin samples showed alterations such as thickening of the collagen components in the dermis and the superficial subcutaneous layer, with a reduction in elastic fibers. Discussion. Combined surgical procedures of brachioplasty and mastopexy are widespread and privileging the use of autologous tissues allows excellent results. The use of the PAF, a novelty tested for the first time in 2019 at the Plastic Surgery Clinic of Padua, has proved to be a reliable and promising technique. In patients with a favorable body habitus, PAF can be considered a valid alternative to other flaps. The clinical features of postbariatric skin represent great challenges for the outcome of these surgical procedures. There are in fact clear signs of clinical deterioration, such as reduced elasticity and turgor, great laxity due to the remodeling and reabsorption of adipose tissue as well as direct changes on the extracellular matrix, consisting of alterations in the elastin and collagen fibers. Conclusions. The use of PAF has proved to be a valid technique for breast remodeling, allowing brachioplasty, with the certainty of minimal morbidity of the donor site, combined with a mastopexy, with good breast remodeling results. Further studies can provide valuable information for the improvement of surgical techniques. The study of skin samples highlighted the role of clinical features of post-bariatric skin on the response to surgery, but knowledge of the processes that occur in the skin after massive weight loss remains incomplete. Future therapeutic protocols, will certainly lead to an improvement in the condition of the skin after a significant weight loss, impacting the results of BC.| File | Dimensione | Formato | |
|---|---|---|---|
|
Migliore_Francesca.pdf
accesso riservato
Dimensione
3.6 MB
Formato
Adobe PDF
|
3.6 MB | Adobe PDF |
The text of this website © Università degli studi di Padova. Full Text are published under a non-exclusive license. Metadata are under a CC0 License
https://hdl.handle.net/20.500.12608/10474