Anatomy/Cosmetic Breast

Question 1

Blood supply to skin

Answer 1

Subdermal plexus which communicates through perforators with the underlying deeper vessels

Question 2

Blood supply to breast parenchyma

Answer 2

Perforating branches of the internal mammary (thoracic) artery, lateral thoracic artery, thoracodorsal artery, intercostal perforators, thoracoacromial artery

Question 3

NAC blood supply

Answer 3

Subdermal plexus and parenchymal blood supply (4th intercostal)

Question 4

NAC sensation/nerve supply

Answer 4

anteromedial and anterolateral T3, T4, T5 intercostal nerve

Question 5

Nerve injured in axillary dissection which gives sensation to upper inner arm

Answer 5

Intercostobrachial

Question 6

Most common breast anomaly and description

Answer 6

Polythelia; 2% of population; supernumary nipples along the milk line

Question 7

Mammography views used for augmented breasts

Answer 7

Eklund views

Question 8

What age should early mammograms be ordered for breast surgery?

Answer 8

30-35, if younger order ultrasound if indicated

Question 9

If N-IMF distance is greater than ___cm, concomitant mastopexy may be required with augmentation

Answer 9

9.5cm.

Mild ptosis can be corrected with augmentation

Question 10

When is subglandular augmentation not recommended?

Answer 10

thin upper pole coverage (<2cm on pinch test)

Question 11

Advantages of dual plane augmentation

Answer 11

1. Takes advantage of extra upper pole pectoralis coverage
2. Maximizes implant/parenchymal interface in the lower pole
3. Prevents double bubble

Question 12

Detrimental effects are increased when the implants are larger or smaller?

Answer 12

Larger

Question 13

How do textured implants prevent capsular contracture?

Answer 13

Disorient collagen deposition and reduced mobility in the pocket

Question 14

What is the main reason for capsular contracture?

Answer 14

bacterial contamination (can be seeded from NAC in periareolar placement)

Question 15

What surgical techniques prevent capsular contracture?

Answer 15

Triple antibiotic solution
Changing gloves
Avoiding NAC-area incisions

Question 16

What is the most sensitive test for implant rupture?

What is the “sign”?

Answer 16

MRI

Linguini sign

Question 17

What is the risk for morbidity/mortality from breast cancer in relation to non-breast implant patients?

Answer 17

Same

Question 18

Etiology of breast ptosis

Answer 18

parenchymal volume decreases and the skin envelope and supporting structures (Cooper’s ligaments) do not retract.

Question 19

Regnault Classification of Ptosis

Answer 19

Pseudoptosis - NAC is at or above IMF but parenchyma is below IMF
Grade 1  (mild) - NAC at IMF
Grade 2 (moderate) - NAC below IMF but above majority of breast tissue
Grade 3 (severe) - NAC below IMF and at most dependent portion of breast

Question 20

Disadvantages of periareolar mastopexy

Answer 20

• only useful in mild ptosis with fibrous/glandular breasts
• can elevate NAC only 1-2cm
• scar and areola widen frequently
• can lack projection

Question 21

Tuberous breast deformity

Answer 21

-deficient breast development in the vertical and horizontal dimensions, constricted base, high IMF, breast parenchyma herniated into the areola

Question 22

When can augmentation be used to correct ptosis?

Answer 22

If skin excess is minimal, minimal gland below the IMF, minimal ptosis
can provide appropriate projection and adequately correct ptosis and minimal skin excess

Question 23

Pathophysiology of macromastia

Answer 23

normal estrogen levels and number receptors, suggests excessive growth in response to circulating estrogens