A Study On Etiology Of Mammary Hypertrophy And Reduction Mammaplasty

The First Part: Expression of the ER, cyclinD1, ps2 and P450arom in the Glandular Tissue of the Pubertal Mammary HypertrophyObjective To investigate the expression status of the ER, cyclinD1, ps2, P450arom in breast tissue of pubertal mammary hypertrophy and then explore the possible etiology of pubertal mammary hypertrophy. Methods 18 patients were selected for pubertal mammary hypertrophy group. Breast hypertrophy tissue specimens were collected from the gland excised during reduction mammaplasty. The selection criterion was weight of the excised breast gland greater than 350 g. Patients were excluded if they had any of the following conditions: irregular menstrual cycle; history of pregnancy; hormonal treatment within at least 2 months; nipple discharge from either breast; cyst or fluid and milk concentration in the gland; family history of breast cancer; history of unilateral breast cancer, fibroadenoma or pathologically atypical hyperplasia. 12 patients with micromastia were used as a control group. The tissue specimens were obtained during the augmentation mammaplasty. These patients also met the conditions mentioned above. The patients in two groups were strictly selected. Their menstrual cycles were normal. The reduction mammaplasty and augmentation mammaplasty procedures were performed during the follicular phase of the menstrual cycle. Patient approval of participation in this study was obtained preoperatively. The expression of ER, cyclinD1, ps2, P450arom was detected by SP immunohistochemistry in 18 cases of pubertal mammary hypertrophy and 12 cases of micromastia. Results The expression rates of ER, cyclinD1, ps2, P450arom within breast tissue were respectively 88.89％, 83.33％, 55.56％, 44.44％in pubertal mammary hypertrophy; and 16.67％, 16.67％, 8.33％, 0％in micromastia. There was significant difference between the two groups(P＜0.01). Conclusion The expression of ER, cyclinD1, ps2, P450arom in pubertal mammary hypertrophy are higher significantly than in micromastia. The pubertal mammary hypertrophy may be related to the expression status of ER, cyclinD1, ps2, P450arom within breast tissue.The Second Part: Reduction Mammaplasty with Superomedial Glandular PedicleObjective To explore a new technique that keep function and good aesthetic shape after reduction mammaplasty. Methods The superomedial glandular pedicle technique was applied with differing patterns of skin incision according to the degree of the mammary hypertrophy. The extra glandular tissue was removed from the lateral and inferior segment of the breast. The remaining superomedial glandular tissue was remodeled a conical shape. The skin incision was sutured after excision of excess skin Results 36 cases(72 breasts) were treated with this technique. The results were satisfactory and there were no complications. The breasts maintained a lasting and aesthetically pleasing shape and the nipple-areola preserved good sensation. Conclusion The superomedial glandular pedicle is a safe, simple and effective technique that can provide long-lasting outcome. The design of the procedure can be adapted to a variety of skin incision patterns and breast morphologies.