Wineglass Pattern for Vertical Mammaplasty

The ideal reduction mammaplasty technique should create a pleasing breast shape with minimal scarring. The long and conspicuous scar associated with the classic inverted ``T' pattern mammaplasty techniques are not acceptable for many patients. Periareolar mammaplasty techniques cause less scarring, but they have major disadvantages such as scar widening, areolar distortion, and insufficient breast projection. We used a new pattern for vertical mammaplasty to overcome the insufficient breast projection caused by the round block technique and applied it to 51 patients during the last 3 years. This method results in a single vertical scar and a periareolar scar, allows sufficient volume reduction, and provides good breast shape and projection; the results are durable. This procedure is safe, causes few complications, and is easy to learn and perform.     

乳房重度下垂的直线切口法乳房成形术

目的 介绍应用直线切口法乳房成形术(Lejour法)治疗重度乳房下垂方法及效果.方法 按Lejour法设计手术切口.该类患者新乳头位置较正常人群可适当下移1～2 cm,新乳房下皱襞上移5～10 cm,通过适当下移新乳头位置及上移新乳房下皱襞达到缩短垂直切口距离.剥离乳腺组织,将下垂乳腺组织从乳腺深层固定于胸大肌第2、3肋水平.皮肤无张力缝合.结果 36例中乳房肥大者30例、体积基本正常者6例,经术后3个月至2年随访,无明显并发症,新乳房外形挺拔自然,患者满意.结论 本术式简便易行,远期效果好,可作为重度乳房下垂的术式之一.     

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。     

Mammaplasty: Shape,volume, and scar size

Recently many mammaplasty techniques have been presented with special attention paid to the resulting scar's size and its position. The surgeon should try to hid the scar, and if the inverted T incision is used, its horizontal branch should be as short as possible and kept in the breast area. Neverthelss, excessive concern about the final scar size should not interfere with the final results of the mammaplasty as far as shape, volume and lasting results are concerned. The author presents his experience in mammaplasty with respect to the volume, the shape, and the scar size interrelationships.     

Short scar reduction mammaplasty in the bariatric patient

Reduction mammaplasty may be necessary even after massive weight loss. Patients typically present with unfavorable breast features such as significant loss of upper pole volume, inelastic skin, and severe ptosis. The most common approach in the United States has been the Wise-pattern inferior pedicle technique, emphasizing skin excision. This report presents the short scar vertical reduction mammaplasty approach for the bariatric patient population. It aims to demonstrate improved outcomes with less scar burden. The study included 15 women (n = 29 breast reductions) with mean age of 41.8 years. All the patients had undergone gastric bypass surgery, with mean weight loss of 109 pounds and mean body mass index of 33.3 kg/m(2). A modified superomedial pedicle vertical mammaplasty technique was used. New nipple position was placed lower than the inframammary fold in accordance with vertical lack of upper pole fullness. Suction-assisted lipectomy was used to contour the inferior pole of the breast before glandular resection. A full-thickness superomedial pedicle and median incision of the upper pole maximized pedicle safety. The mean breast resection was 605 g on the right side (range, 352-945) and 592 g on the left side (range, 360-908). Patient satisfaction was high, with pleasing and stable breast shape at long-term, and a mean patient-related aesthetic ranking of 4.3 of 5.0. No major complications were noted. It is shown that superomedial pedicle vertical reduction mammaplasty can be an alternative approach in bariatric patients, achieving long-term pleasing and stable results with significantly decreased scar burden.     

改良Lejour法乳房缩小成形术

目的 介绍改良Lejcur乳房缩小成形术的临床应用。方法 手术以乳房上蒂瓣为基础,切除乳房下部肥厚组织,并将多余皮肤推向外侧,予以切除缝合,形成L形瘢痕。结果 2005年10月至2006年4月,我们应用该法治疗10例巨乳患者,共20只乳房。每只乳房组织切除量为200～500g,乳房塑形效果良好,仅在乳房下外侧遗留L形瘢痕,无乳头、乳晕坏死,乳头感觉减退不明显,切口愈合良好。术后随访3～12个月,仅1例双侧乳房轻度不对称,其余形态均良好,手术瘢痕隐蔽。结论 Lejour法乳房缩小成形术简便易行,避免了常用方法的倒T形瘢痕,值得推广。     

Dermafascial Fixation Suture: A Technique for a More Durable Projection with Short-Scar (Vertical) Reduction Mammaplasty

Background Short-scar reduction mammaplasty has several advantages over the traditional technique, mainly reduced scarring and superior long-term breast shape. Multiple modifications of the short scar reduction mammaplasty technique have been made in an effort to decrease the learning curve while improving the results. The authors present another modification of the short-scar technique for a more durable projection without reliance on a skin envelope. Methods The perimeters of the medial pedicle and the nipple–areola complex are marked, and the medial pedicle is deepithelialized. A 2 × 5-cm skin area at the inferior border of the pedicle is further deepithelialized, then pexied to the pectoralis fascia in a superomedial direction using a nonabsorbable monofilamanet suture with a horizontal mattress suturing technique. Results Taking the suture bites from the dermis rather than the breast parenchyma for the pexy aims to spare the pedicle’s circulation. This durable internal rearrangement of the breast parenchyma with dermafascial pexy further decreases the tension at the nipple–areola complex because the final breast shape no longer relies on the skin closure. Suture spitting at the nipple–areola complex also is prevented with elimination of the purse-string suture because there is no need for a further decrease in the tension with the purse-string suture after the dermafascial pexy. Conclusions The authors believe that the dermafascial pexy is a concept more than a technique. It incorporates the two strongest structures, the dermis and the fascia, to achieve more durable results not only with reduction mammaplasty, but also with any aesthetic breast surgery that uses the pedicles.     

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.     

Modification of Vertical Scar in Vertical Mammaplasty Technique

Vertical mammaplasty is a simple and safe procedure that relies on an upper pedicle to the areola with lower central breast reduction and glandular shaping. We applied this technique to six patients adding a modification of the vertical scar which distributed skin tension both to the areola and vertical suture line. It prevented an unacceptable puckering vertical scar and enlargement of areola. This modification also provided satisfactory breast shape with a good vertical scar especially at the early postoperative period.     

无垂直瘢痕的下蒂瓣法乳房缩小整形术

目的:介绍一种适用于中、重度乳房肥大的矫正术,探索乳房缩小手术的最佳术式。方法:回顾总结2001年以来对21例中、重度乳房肥大患者采用无垂直瘢痕的下蒂瓣法行乳房缩小整形术的情况,分析其效果。结果:21例患者术后双乳对称,下垂状况纠正,体积缩小,乳头乳晕感觉良好,术后瘢痕隐蔽。2例合并副乳,1例合并乳头内陷的患者同时手术切除矫正。2例乳晕表皮营养不良、部分坏死,经换药愈合。结论:无垂直瘢痕的下蒂瓣法乳房缩小整形术是治疗中、重度乳房肥大症的良好选择。     

“L” Technique compared with others in mammaplasty reduction

With more than 20 years' experience with using my L method in reduction mammaplasty, I realize that very little has changed in my philosophy. With the L technique one can achieve a perfect shape with a minimal scar and avoid a medial scar toward the sternum. I use only the lower access with upper vascular protection, abandoning the inferior vascular base of the flap. This procedure has new competition including techniques that yield a simple vertical scar or only a periareolar scar. However, up to now it is not possible, with any technique, to achieve a satisfactory shape for exigent patients. When I explain to potential patients the advantages and disadvantages of the different methods, in most cases they choose the L technique.     

A new technique of reduction mammaplasty: dermis suspension and elimination of medial scars.

In the last decades new techniques of reduction mammaplasty significantly improved the results obtained and led to a reduced incidence of complications. However, some important problems like the loss of a natural submammary fold and alteration in the shape of the breast with time still remained mostly unsolved and the medial scars in the inverted T techniques are aesthetically unsatisfying. A new strategy for reduction mammaplasty has been developed based on a combination of advantages of other techniques. The principle of using de-epithelialized infra-areolar skin for dermis suspension prevents sagging of the remaining breast tissue behind the inframammary fold to create a long-lasting, natural shape of the reduced breast with an accentuated submammary fold. The central pedicle is favoured because of good modelling even in big reductions. Better vascular and nerve supply of the nipple-areola complex and the continuity of the lactiferous ducts are further advantages of the central pedicle. Secondary operations after reduction mammaplasty or augmentation usually dictate the use of a superior pedicle together with the dermis suspension technique. B-shaped skin incisions prevent medial submammary scars and can be used up to a 10 cm transposition distance of the nipple without disadvantage. The operative technique is described in detail. Examples are given for the primary procedure and the technique as a secondary correction. The principle of dermis suspension in combination with the prevention of a medial scar is applicable to reduction mammaplasty as well as mastopexy.     

Early experience with Lejour vertical scar reduction mammaplasty technique

The study contains 163 patients who underwent a reduction mammaplasty at the Karolinska Hospital during 1991–1992. Seventy patients were operated on using the Lejour short scar technique (superovertical pedicle) and 93 using the Strömbeck method (medial pedicle). The aim of this study was to compare the results of these two different methods with regard to scar formation, position and sensation in the nipple areola complex, postoperative complications, healing conditions, shape and volume symmetry of the breasts and patient satisfaction. An objective method [20] was used for assessment of postoperative breast asymmetry. Advantages and disadvantages of both methods are presented. The incidence of early complications was low in both groups, compared with the data presented in the literature, but Strömbeck's method was found to be superior in some respects because of fewer early postoperative complications, shorter healing period and better breast symmetry postoperatively.     

Reduction Mammaplasty and Mastopexy Using the Vertical Scar and Thoracic Wall Flap Technique

Breast surgery has been greatly modified in the past few years as surgeons sought to shorten scars and improve and maintain of breast shape in the late postoperative period. Working with both the periareolar technique and vertical scar technique, it is possible to reduce scar length, avoiding the area below the inframammary crease by compensating skin excess around the areola. From January 2001 to July 2002, 53 patients underwent reduction mammaplasty and/or mastopexy using the vertical scar technique associated to a thoracic-based flap kept under a bipedicled flap of the pectoralis major muscle. The goal of this combination is to achieve a good aesthetic result: a reduced scar, minimal breast descent, and good upper pole fullness.     

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.     

乳房神经血管解剖学研究及在乳房缩小成形术中的意义

目的　探讨乳房的血供模式和神经支配走向 ,寻找适合各型乳房肥大的短小瘢痕乳房缩小成形术术式。方法　应用血管铸型、标本透明技术和大体解剖对 12具成年女性尸体的胸壁乳房血供模式和乳房的神经支配进行研究 ,并设计出改良的双环形切口乳房缩小成形术 ,用于 2 8例乳房肥大患者。结果　成年女性前胸壁软组织乳房或为两层血管构筑或为三层血管构筑 ,各层间均通过垂直穿支形成吻合并首先在胸肌筋膜表面形成致密的血管网 ,这些垂直穿支在乳房下部粗大 ,上部细小。乳头乳晕的神经支配以第 4肋间神经外侧皮支的深支为主 ,在下垂乳房于腺体内呈S形走行。 2 8例患者行乳房缩小成形术后外形满意 ,乳头乳晕完全成活 ,仅 1只乳房感觉减退或消失。结论　改良的双环形切口乳房缩小成形术是较为理想的术式 ,除具有原术式瘢痕不明显、乳房突出度好、效果持久等优点外 ,还最大限度地保留了剩余腺体的血供和乳头乳晕的神经支配     

Preoperative breast marking in reduction mammaplasty

A simple method of preoperative marking for reduction mammaplasty is described. This method may be used in macromastias when the technique chosen implies a postoperative scar with the shape of an inverted T. The marking sequence follows standard steps, but the drawing is always different because it is a consequence of the shape of the breast. This marking method reduces the chance of making mistakes due to excessive personal evaluations or to the use of standard drawing patterns that may be not suitable for all breast shapes.     

Reduction mammaplasty by central pedicle flap with short submammary scar

Reduction mammaplasty was performed in 30 patients by combining the central pedicle flap method with the short submammary scar (3-S) technique to avoid the common drawbacks of currently popular dermoglandular procedures. Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyme instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. Only the periphery of the breast parenchyme was resected circumferentially, with the exception of the inferolateral portion, so as not to injure the sensory nerve. The remaining breast parenchyme was preserved in an inverted cone shape. The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively, and lactation is possible because of preservation of the lactiferous ducts. The length of postoperative scars was reduced by using the short submammary scar technique. We believe this combined method is ideal in patients requiring resections ranging from 200 to 600 g per breast with good skin elasticity and moderate degree of ptosis.Presented at the Sixth Asian Pacific Congress of the International Confederation for Plastic and Reconstructive Surgery, in Seoul, Korea, October 1993.     

"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.     

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.