No-vertical-scar inferior pedicle breast reduction using the dermal suspension sling

Background

The authors previously presented favorable outcomes with the use of the horizontal dermal suspension sling and plication of the inferior pedicle in reduction mammaplasty surgical cases. We propose a modification to this technique tailored to patients with moderate to severe ptosis. The modification avoids the vertical scar inherent to the inverted T pattern.

Methods

The surgical technique utilizes portions of the dermal suspension and plication technique previously described by the authors. Minor modifications were made to take advantage of the vertical excess of skin found in patients with moderate to severe macromastia and ptotic breasts. The modification leads to a superior skin flap that drapes the inferior pedicle and newly constructed breast mound, resulting in a single inframammary scar.

Results

Thirty-eight women have undergone breast reduction using the vertical scarless inferior pedicle with horizontal dermal suspension and plication surgical technique. Breast projection and shape were sustained during follow-up with positive aesthetic results; the median follow–up time was 7 months.

Conclusions

The modifications to our surgical technique allowed for an improved appearance in the postoperative breast scar and in the overall cosmetic outcome in patients who underwent large-volume breast reductions. Level of Evidence: IV, therapeutic study     

Central Pedicled Breast Reduction Technique in Male Patients After Massive Weight Loss

Male patients after massive weight loss often suffer from redundant skin and soft tissue in the anterior and lateral chest region, causing various deformities of pseudogynecomastia. Techniques with free or pedicled nipple–areola complex (NAC) transposition are widely accepted. The authors present their approach to male breast reduction with preservation of the NAC on a central dermoglandular pedicle and a wide elliptical tissue excision of breast and lateral thorax tissue in combination with liposuction. Male breast reduction was performed on patients after moderate to massive weight loss due to diet or bariatric procedures. Former procedures included free nipple–areola grafts or inferior pedicled techniques for NAC preservation. As a modification, we performed a central pedicled breast reduction on nine male patients with excessive liposuction of the pedicle and a horizontal elliptical skin removal, allowing for sufficient tissue removal at the lateral thorax. From October 2010 until June 2011, nine male patients had central pedicled breast reconstructions after massive weight loss. Mean age was 29.1 years, mean preoperative body mass index was 29.2, and mean preoperative weight loss was 63.9 kg. The chest wall improvement was rated “very good” by eight patients. No major complications occurred in all nine patients. Male chest deformities after massive weight loss can be dealt by several approaches. The optimal scar positioning and the preservation of NAC may be the most challenging aspects of these procedures. Therefore, the preservation of the NAC on a central dermoglandular pedicle with a horizontal submammary scar course may optimize the esthetic outcome.     

Aesthetic Breast Surgery with Inverted-T Scar Placed above the Inframammary Sulcus

This article describes the inverted-T incision technique with the scar placed above the inframammary sulcus for cases of pexy, breast reduction, and augmentation–reduction mammaplasty. This technique preserves the inframammary fold as an important factor in natural breast suspension; the breast mound is easily shaped independent of the skin tension. The gland- and skin sutures are placed separately and independently. This technique has been used on 380 patients in the last 13 years.     

Central pedicle reduction mammaplasty with a vertical scar: a technical modification

Background: This study introduces a central pedicle reduction mammaplasty with a vertical scar technique.

Objectives: This study is aimed to create a more conical breast shape and long-lasting better projection by modifying reduction mammaplasty by central pedicle flap.

Method: Preoperative markings were made including the meridian line of breast and the new location of the nipple-areola complex (NAC). The new location of the inframammary fold was marked ～2?～?4?cm above the original inframammary fold. An incision was made around the areola, the area between the resection margins and NAC was excised en bloc. The breast parenchyma was excised circumferentially, so that a cone shaped central mound was formed. An inferior and inferolateral glandular resection was performed to reduce the area of the breast base by elevating the position of the inframammary fold. After completion of dissection, the central pedicle surmounted by the NAC was transposed to its new location.

Result: Fifty-six patients were operated with our modified central pedicle technique. The mean amount of resection was 475?g (range?=?130–1080?g). The mean length of follow-up was 18?months (range?=?12–53?months). The mean postoperative satisfaction score was 4.23 (SD?=?0.81). The breast parenchymal ratio significantly increased from 1.2 preoperatively to 3.9 postoperatively.

Conclusion: The modified central pedicle reduction mammaplasty with a vertical scar technique is a versatile breast reduction technique for all shapes and tissue conditions, by providing an attractive conical shape of the breast with minimum scar burden and maximum preservation of breast function.     

Another Look at Breast Projection After Breast Reduction

A controversy exists between vertical mammoplasty and the “traditional” keyhole\inferior pedicle method of breast reduction. This article examines factors affecting breast projection by considering the difference in concept between vertical mammaplasty (using the modification proposed by Hall-Findley as an example) and the inferior pedicle\keyhole pattern. This article is not about “how to do” but rather about “why” things are done in a certain way. The emphasis is on understanding what is done and its effects rather than on technique. The breast can be considered a cone. Breast projection then is the ratio between the nipple projection and the breast base. Two key concepts need to be considered: the orientation of the ellipses during excision of breast tissue in breast reduction and the role of the breast base\inframammary fold. Breast projection is not determined by the scars. After an examination of each technique, methods to enhance projection are discussed.     

The horizontal breast reduction: Surgical tips for maintaining projection

Reduction mammoplasty is one of the most common procedures performed by plastic surgeons in Canada. The Wise and vertical scar techniques are two of the most commonly published and performed. Although the horizontal breast reduction is a less commonly used technique, it offers added benefits over other procedures. These include elimination of the vertical scar and a consistently round nipple. However, one of the criticisms of the horizontal technique is the loss of projection of the breast mound. The present article outlines several important points that can aid in achieving an optimal aesthetic result when performing a horizontal breast reduction.     

Reduction of mammaplasty scars: from a short inframammary scar to a vertical scar]

A better understanding of the vascular anatomy of the breast has drastically reduced the risk of postoperative necrosis in breast reduction. Scars however remain a major concern, and techniques to reduce these have often been considered to be less satisfactory in terms of the shape and stability of the result. Our experience with more than 1,000 breasts operated on between 1984 and 1989 with a short inframammary scar technique has proved the contrary. The next step was to eliminate the inframammary scar, as proposed by Lassus, and to leave just a periareolar scar and a lower vertical scar which does not cross the inframammary fold. One hundred and four breasts, in sixty four patients--17 to 60 years old--have been operated on according to this vertical technique between April and September 1989. Twenty seven cases of ptosis correction in seventeen patients, and seventy seven reductions in forty seven patients, with a median excision weight of 460g, have been performed. By means of an individualized preoperative drawing and several technical devices, the results have proved that vertical mammaplasty is an excellent technique particularly indicated for women with elastic skin and a firm gland. Recent experience with liposuction at the beginning of the operation, has given new possibilities for breast modelling. In fatty juvenile hypertrophies, liposuction alone may even be adequate to reduce the volume, retaining a satisfactory shape for the breast with minimal scarring.     

Breast Reduction Performed by Liposuction

BACKGROUND: Large breasts and their functional sequelae can be remedied via breast reduction. This procedure has undergone frequent modification to decrease complications inherent in the large flap-based procedures. Liposuction has fewer complications than traditional incisional approaches and less scarring. OBJECTIVE: It is our hope that dermatologic and plastic surgeons reevaluate the role of liposuction breast reduction based on our results and consider it as an alternative to incisional techniques. METHODS AND MATERIALS: Medical charts, photoimaging, and mammography were used to assess outcomes. Statistical data were calculated using the Fisher exact test (two-sided). RESULTS: Patients reported a satisfaction rate of 93%. Nipple elevation was measured to be at a mean of 2.57 cm compared to preoperative values. Older patients (>60 years of age) were noted to have a significantly larger nipple elevation (3.16 cm vs. 1.79 cm). Changes in volume ranged between 695.57 and 712.71 mL per breast. Radiographic changes induced by liposuction were not statistically different from those found in traditional reduction techniques. Patients with a normal body mass index (BMI) were more likely to have a larger breast reduction compared via the dip test. CONCLUSIONS: This study illustrates the efficacy of liposuction-based breast reduction for the properly selected patient.     

Minimal-Scar Breast Reduction and Mastopexy

Background Classic breast reduction and mastopexy techniques leave a vertical scar, but are difficult to apply in cases requiring a large amount of breast tissue removal. This report describes a new breast reduction technique using a vertical incision for resections involving less than 600 g of tissue removal and an inverted T incision for larger resections. Results for the new technique are reported.Methods For 800 women, the reported technique was used for reduction mammaplasty (n = 640) and mastopexy (n = 160). Peridural anesthesia was used for 90% of the patients, and general anesthesia for 10%. The minimum follow-up period was 6 months for 90% of the patients. All the patients underwent mammary x-ray and ultrasonography before surgery.Results A short scar was obtained for all the patients. A new intervention for breast reduction was chosen by 16 patients (2%). For all the patients followed, the immediate results (projection of the areola and upper pole) remained unaltered at a late follow-up evaluation. There were no cases of infection or seroma. Hematoma occurred in 8 patients who underwent unilateral breast reconstruction, and 16 patients experienced temporary reduced sensitivity.Conclusions The new technique was effective in leaving a short scar and maintaining immediate results in the long term. Liposuction limited to the lateral chest wall prevented complications associated with breast tissue.     

Breast Reduction with Inferior Pedicle Fascial Suspension

The ultimate aim of breast reduction surgery is to reduce breast tissue with long-term maintenance of good breast shape. A technique using interwoven fascial flap suspension of the inferior pedicle through the pectoralis muscle and fascia is described. For this study, 25 patients were followed for 1 year after surgery. The vertical length of the breast between the lower midline of the areola and the new inframammary fold was measured 10 days after surgery and compared with a follow-up measurement 1 year later. These measurements were expressed as a ratio and compared with visual impressions. A ratio of more than 1.3 or a 2-cm difference in length or more was considered representative of breast “bottoming out.” This was the case with two patients, both of whom had put on substantial weight after the procedure. The author contends that a consistently reliable technique that maintains good breast shape with more extensive scarring is preferable to a technique that occasionally “gets it right” with less scarring. Good scar management and variations in technique such as the fascial flap suspension described in this report have been of considerable benefit to the author’s patients undergoing breast reduction surgery.     

直线法乳房成形术的临床应用

目的介绍直线法乳房成形术(Lejour法)及其改进方法。方法按Lejour法设计手术切口,剥离乳腺组织,仅保留上部蒂营养乳头、乳晕,去除部分肥大下部及基底乳腺组织,将剩余腺体组织的乳腺基底层固定于第2、3肋水平。重新塑形乳腺组织,皮肤无张力缝合。对于部分乳房肥大明显患者可以首先抽吸脂肪,主要减少乳房腺体内、外侧及侧胸部皮下脂肪。结果采用此法矫治巨乳症、单纯乳房下垂共48例,其中辅助脂肪抽吸13例,术后乳房外形美观,术后3个月随访,3例有修整乳晕瘢痕或乳房下皱襞瘢痕。结论本术式简便易行,且远期效果好,乳房外形挺拔,可作为乳房缩小悬吊术的可行术式之一。     

Vertical Scar with the Bipedicle Technique: A Modified Procedure for Breast Reduction and Mastopexy

Background Reduction mammaplasty and mastopexy are commonly performed aesthetic procedures. One such procedure, the vertical scar technique, has gained popularity in recent years, and various types of pedicles have been designed and associated with it. The vertical scar with the bipedicle technique is one such combination that ensures nipple safety and minimizes scarring, with a good aesthetic result. Method With the vertical scar marked on the outside and the bipedicle flap marked on the inside, the procedure was performed for 23 patients. Results Between 2004 and 2006, 17 reduction mammoplasties and 6 mastopexies were performed. The average tissue resection was 360 g, and the average blood loss was 70 g. The average preoperative nipple–areolar complex was 28 cm (range, 23–41 cm). Good results were achieved for the majority of the patients, with no nipple loss or loss of sensation. Conclusion The vertical scar bipedicle technique, a combination that meets the requirement of minimum scarring and a robust blood supply to the nipple–areolar complex, is a suitable option for selected reduction mammaplasty and mastopexy.     

Breast Reduction by Liposuction in Females

Background  

Breast reduction by liposuction alone is an appealing technique that has failed to gain widespread acceptance. Despite numerous studies on liposuction, the majority of surgeons remain skeptical. This study aimed to review the indication and limitations of this procedure.     

Modified Wise-Pattern Reduction Mammaplasty, a New Tool for Upper Quadrantectomies: A Preliminary Report

Background  Quadrantectomy is an oncological safe procedure for early breast cancer, but it often results in poor aesthetic results such as breast shape deformity, more visible if the tumor is located in the upper pole. We suggest the use of a modified Wise-pattern breast reduction in patients with moderate to severe breast hypertrophy and tumor located in upper quadrants that keeps the oncological advantages of the quadrantectomy but with better aesthetical results. Material and Methods  Quadrantectomy of the upper quadrant, immediate breast reconstruction and contralateral breast reduction to obtain symmetry was performed on 11 patients affected by early breast cancer with bra cup size from C to E. To replace the skin area removed with mastectomy from the upper quadrants, a similar-size area from the lower pole was preserved. Results  All patients healed uneventfully within 15 days, and no local or distant recurrences occurred with mean follow-up of 26.5 months (range 19–39 months). In all cases natural breast shape was achieved. The scars were similar to a reduction mammaplasty, and the medial or lateral scar on the upper quadrant did not aesthetically disfigure the décolleté. Conclusions  Modified Wise-pattern reduction mammaplasty is a valid technique as immediate breast reconstruction to obtain a natural breast mound after upper quadrantectomies on patients with medium/large breasts.     

"Vertical, triangular mammaplasty technique". Description, indications, six year retrospective study

The authors present a new mammaplasty technique with a vertical scar: the vertical triangular technique (VTT). A retrospective study was carried out on 82 patients, for six years, with a minimal hindsight of one year, an average glandular resection of 190 g and average liposuction of 60 mL. The technical principles are based on mammary liposuction of the basis, the inferior pole and the axillary extension, the glandular cavity of the inferior pole of the breast, the conical shape of the breast and the lower scar cutaneous bursa. The pitfalls and traps to avoid are described: the liposuction must be large enough except concerning segment IV, the cutaneous pinch must be hyper-corrected, the lower subcutaneous mastectomy must be complete, while a perfect suture of the glandular pillars conditions the shape of the future mammary cone. Short-term complications (7.5%) are the slackening of the bursa and seroma. Medium-term complications (< 10%) are the residual distortion of the bursa, an insufficiently tightened pinch, and a glandular resection defect. Analysis of the results of the VTT makes it possible to determine the long-term stability of the shape of the breasts, and to notice that the scar gain does not affect the morphological quality.     

A New Personal Surgical Procedure for Breast Reduction and Lifting

A series of 40 patients operated from 1995 through 1997 is reviewed. The women ranged in age from 18 to 40 and were seen in either a university- or a private-hospital setting. Thirty-eight of the patients underwent reduction mammaplasty, which was performed using an inferior pedicle technique with a straight-line incision; two patients underwent mastopexy only. The reduction procedure depends on the formation of a cap from medial, lateral, and superior flaps. Following resection of breast tissue the cap is joined to a cone—the nipple–areola complex carried on a subcutaneous inferior pedicle. The cone is fixed to the chest wall with simple vertical stitches, minimizing the recurrence of ptosis. This technique is safe and versatile, avoids a submammary scar, and offers an aesthetic and long-lasting result.     

Breast reduction: evolution of a technique--a single vertical scar

In the past 20 years, patients have become more critical about the result of a breast reduction operation. Natural lasting shape and minimal residual scarring are now expected by most of the candidates to that surgery. In 1969 the author described a vertical technique that achieved reduction and good shape but the end of the vertical scar could be seen below the brassiere line. In 1977 the author modified the technique by adding a small horizontal scar that eliminated the visible part of the vertical scar. In this article the author demonstrates that the same technique he described in 1969 and modified in 1977 can produce a single residual vertical scar if properly used.     

单纯抽吸法巨乳缩小术

目的以往巨乳缩小术以倒“T”形手术为代表，术后遗留明显的瘢痕，为了减少手术瘢痕，应用抽吸法进行巨乳缩小术。方法 选择合适的患者，采用肿胀麻醉，经乳房下皱襞5mm小切口，用细管抽吸整个乳房和皮下脂肪组织，进行乳房缩小。结果 采用抽吸法巨乳缩小术治疗11例，手术效果满意，乳房形态良好，质地有所改善。1例发生血清肿，经多次穿利抽吸治愈。结论 抽吸法巨乳缩小术，对乳房下垂不明显以脂肪增生为主的中、轻度巨乳患者，是一种操作简便、效果良好的手术方法，特别适用于未婚女性，手术后瘢痕不明显，值得推广应用。     

Treatment with Ultrasound-Assisted Liposuction of Accessory Axillary Breast Tissues

Supernumerary nipples and breast tissue often are dismissed as cosmetic curiosities. These structures have the potential for pathologic degeneration and may be associated with significant congenital abnormalities. In a prospective comparison of 100 Native American women with 100 non-Native American women, these accessory organs were found much more commonly among Native American women. Careful attention should be given to thorough evaluation and long-term follow-up evaluation of any patient with this anomaly. This study investigated a patient who underwent surgical removal of her axillary breast tissue with ultrasound-assisted liposuction. The advantages of this method include a minimal incision scar from the liposuction cannula and the ability to detect residual axillary breast by ultrasound.