Breast CA Prevention with 5 th Generation Mastopexy Augmentation Technique

In 2008 we published a premonitory article for Spanish language readers; almost 5 years later we provide the knowledge and the follow-up of this amazing and gratifying technique [1]. This paper is based in the primary authors after First World War 1914, to date: Weinzenberguer, Thoreck, Passot, Strombeck, Aufricht, Noel, Mckissock, Goulian, Regnault, Perras, Hinderer, Arie, Pitanguy, Peixoto, Ribeiro, Pontes, Fellicio, Benelli, and many other important modern authors like Ceydelli, Graef, Gasperoni, Gulyas, Puckett, Sampaio, Goes, Tariki, etc. Upper areolar incision has always been considered taboo due to fear of areola enhancement, disruption and widening. This super areolar approach has been dismissed [2]. At this time, we present more than 90 evolved cases to date with successful results and grateful standpoints for both patient and surgeon. The main objective for writing this paper is to highlight an important difference: not only this technique provides a better shape, avoids numbness, and ugly scars, but it is also a preventative method against breast cancer by partially re-sectioning upper external breast-quadrants [3].


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Material and Method 94 female patients were operated for this reason from 2004 to 2018. The ages were from 19 to 61 y.o. All of the extracted tissue was sent to pathology in separate ways-right, left and edges. Surprisingly 98% of pathological results showed cystic and micro fibroadenomes, and only in one case, multiple intraductal papilomatosis [13]. Finally, oral or IV anti-coagulation therapy is provided if needed ( Figure 5). Mastography was chosen only when the patient had 40 y.o or more, and exceptionally in younger women when direct relatives had been diagnosed with BREAST CA [14]. The key point in these cases is to draw and mark the thoracic key points with patients always standing up, but not sitting down, and previous preparation for this kind of surgery supplying oral ferrum and vit K 50 mgrs ingestion( if needed), 1 week before and after surgery, and besides getting intra operatory at least 3 cc of fresh autoplastma to apply at the end of the surgery, behind and inferiorly of suprareolar incision, and also behind both areolar tissues previously reduced in diameter with the technique that you are going to see on the following explanation, in order to improve quality and speed of wound healing [16][17][18][19][20]. Also of paramount importance is the use of the "soft silicon fastener" around the areola and incision, in order to have the whole new weight and pressure of complex breast-implants, rest over this and not over the wounds (Figures 6 & 7).

C.
A hole resulting. To remove the tissues and doing the sub facial cavity for next.
Implantation; taking care to leave bath upper lateral pilar breasts tissues to completely cover the breast over the implants.

D.
Try always to put 5th generation implant (smaller, lighter, narrow west but with great projection 5 -6) E. Tobacco -string purse closing with Straight 2 -0 prolene needle.

Technique
It should be a triangle where our complex areola-nipple is going to be in a short future, following the vertical lines projections over the middle clavicles points to nipples [21]. Leaving a 5 cm thick distance from nipples to this last cut, in order to respect principal galactophorus ducts, after that we dissect always sub-facially the cavity for preparation to introduce an also 5th generation implant [22][23][24][25][26]. In order to keep the empty breasts filled and looks fine ( Figure 8). Each extirpated breast-tissue should be sent to pathology in different receptacles with very clear marking of the side and position it is from [27].

Results
With this experience we see results early, before 1 month, after 6 month and after several years [28][29][30][31]. It results in a little discomfort at the beginning with the garment and wound care but finally patients stay quite satisfied and most importantly without recurrence, and may be applied primarily to pre-menopause patients and also celibate patients, besides the technique may be applied to asymmetrical breasts, tuberous, pendulous but not for cancer reconstruction (Figures 9 & 10), 99% of pathological results were cystic fibrous mastopathy bilaterally, only one intraductal multiple papilomatosis unilateral and no in situ ca [32][33][34][35][36][37].

Complications
At first cases were getting one partial disruption, two elongated complex areola nipples, some infections, 2 prosthesis reported broken after 4 years later detected trough a tomography, some recurrence, two thick and wider upper areolar scars, some partial or total numbness but to this date from several few years ago none of these previously described complications have occurred [38].

Summary
The importance given to this new technique, prevents breast cancer because we eliminate ¾ of upper breasts tissue where normally hits 60% of breast cancer, versatility, security and with excellent results solves at the same time a.-ptosis, b.-flatness, prevents cancer, avoids widening recurrence, and the possibility to execute one or two other procedures at the same time, improves self-confidence, the breasts stay in good position and wonderful shape in young women feeding babies is preserved because we do not touch the principal galactophorus conducts. Besides areolar numbness is avoided by upper incisions rejecting the lateral nerves' entrance to areolar zones and that is quite important for sexuality [39][40]. It is important to take always into account that most women would not wish big breast implants when they have had a size c before, but it results quite important to explain that it will result in much better shape with a small, 5th generation implant with less volume, less weight and higher projection 5 to 6, and it is only to avoid looking empty or flat after mastopexy [41].
In other words, we are not looking for volume or weight , we are looking for projection with a 200 cc vol (Figures 11 & 12). any 5th generation implants will surely look and feel like 300 cup c by the high projection with a lower weight.