Reduction mammaplasty by central pedicle flap with short submammary scar

Application of Liposuction and Superior Pedicle Vertical Mammoplasty for Severe Breast Hypertrophy

BACKGROUND

Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction.

METHODS

A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded.

RESULTS

Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications.

CONCLUSION

This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Review and Measurement Study of the Central Mound Pedicle for Breast Reduction

The central mound approach to breast reduction has been the subject of recent interest in the literature. However, quantitative evaluation using measurements is lacking. This review was undertaken to objectively evaluate changes in breast dimensions, and to compare the results to a popular alternative method, vertical mammaplasty.

METHODS

An electronic search was performed using PubMed to identify all publications endorsing the central mound technique. Published lateral photographs were matched for size and orientation, with computer assistance. Measurements included breast projection, upper pole projection, lower pole level, breast mound elevation, nipple level, and breast parenchymal ratio. Results were compared with published measurement data for the vertical technique.

RESULTS

Twenty-three manuscripts were identified. Ten included photographs suitable for analysis. On average, breast projection decreased 1.1 cm after central mound breast reduction (P < 0.05). Upper pole projection dropped 0.4 cm (not significant). The lower pole level was raised 2.6 cm (P < 0.05). The nipple level was over-elevated 0.6 cm, on average. The breast parenchymal ratio increased by 0.54. A central mound dissection decreased breast projection. In contrast, publications using a vertical breast reduction demonstrated maintenance of upper pole and breast projection and a modest (<1 cm) increase.

CONCLUSIONS

For each measurement comparison, the vertical method outperforms the central mound. Because of its anatomy and geometry, measurements show that the vertical method for breast reduction is more favorable than a central mound dissection. This method can also be used safely for secondary breast reductions.

Patient Satisfaction Following Inverted-T and Short-Scar Mammaplasty as Measured by the Breast Evaluation Questionnaire 55

BACKGROUND

Mastopexy combined with silicone implant placement is one of the most frequently performed plastic surgeries. Various techniques have been developed to increase the degree of patient satisfaction after surgery. The goal is to give the breasts a harmonious shape, generating the smallest scars possible. The Breast Evaluation Questionnaire 55 (BEQ 55) was developed in 2006 as a tool for assessing the satisfaction and comfort of patients with the general appearance of their breasts.

OBJECTIVES

The objective of this study was to compare the degree of satisfaction of patients undergoing mastopexy by the inverted-T technique vs the short-scar technique by the BEQ 55.

METHODS

The BEQ 55 was administered pre- and postoperatively to 200 patients who underwent mastopexy performed by the first author between October 2013 and September 2017. One hundred patients underwent the short-scar technique, and 100 patients underwent the inverted-T technique.

RESULTS

The first analysis used descriptive statistics. Relative frequencies were used to track the responses corresponding to each technique. There was an increase in the level of patient comfort and satisfaction with breast appearance after surgery in both groups. The short-scar technique was shown to be superior, with statistical significance (P < 0.05) found for the questions evaluating comfort with overall appearance naked, comfort with breast appearance naked, and satisfaction with breast appearance.

CONCLUSIONS

Both techniques improved the patients' satisfaction and comfort with their breasts. When the short-scar technique was used, patients were more comfortable with their breast appearance and with their overall appearance naked.

LEVEL OF EVIDENCE: 4

Vertical Mammaplasty with Retromammary En Bloc Breast Suspension

BACKGROUND

In a vertical mammaplasty, various types of pedicles have been proposed for the nipple-areola transposition. The preparation of any type of nipple-areola flap necessitates disconnecting the nipple-areola from the breast gland, except for the pedicle bearing glandular part. These flap-dependent techniques not only impair the functions of the breast but also do not provide enough fullness to the upper pole.

METHOD

No specific nipple-areola flap preparation is made. Reduction is obtained by a transverse excision from the lowermost part of the breast gland. Apart from this, no cut into the gland is needed. Liposuction, wide skin elevation and extended retromammary dissection permit the en bloc suspension of the breast.

PATIENTS AND RESULTS

The study enrolled a total of 85 patients with 170 breasts. Mastopexy or minor reduction less than 100 gr was applied for 49 breasts; moderate reduction, 100-399 gr, for 67 breasts; and a large reduction of more than 400 gr for 54 breasts. No complete or incomplete nipple-areola necrosis was seen. The success rate for achieving upper pole fullness was compared between groups for reduction amount, age and body mass index (BMI).

CONCLUSION

The functions of the breast organ are preserved in the en bloc suspension technique. In patients with dense breasts, a good upper pole fullness was achieved with a high success rate. Young patients and patients with a body mass index below 25 are suitable for this technique. However, the same success rate could not be achieved in elderly patients with fatty breasts.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

Reduction mammaplasty with the modified round block technique in Chinese patients and its anatomy study

BACKGROUND

Although reduction mammaplasty is one of the most common procedures in plastic surgery, it is associated with some serious complications, especially in cases of severe hypertrophy or advanced ptosis, including necrosis of the nipple and areola, absence of normal sensation of the nipple-areolar complex, and loss of lactational function for future nursing. A thorough understanding of the breast anatomy is vital for successful reduction mammaplasty. This article describes the blood supply and innervation of the breasts, and introduces a modified round block technique for reduction mammaplasty based on this anatomy.

METHODS

Six adult female cadavers were used to assess the vasculature of the anterior thorax and the nerve distribution of the breasts according to vascular perfusion and autopsy. Based on this anatomical study, a modified round block technique was designed for reduction mammaplasty, which was performed in 40 Chinese patients with breast hypertrophy.

RESULTS

Würinger's horizontal septum was observed in all six cadavers. In the superficial layer, the main sources of blood are the second and third intercostal perforating branches of the internal thoracic artery, which run along the medial ligaments, and the branches of the lateral thoracic artery, which run along the lateral ligaments. In the deep layer, the main sources of blood are the fourth and fifth intercostal artery perforators, which run along Würinger's horizontal septum. Innervation of the nipple-areolar complex is achieved mainly by the lateral branches of the fourth intercostal nerve, which also run along Würinger's horizontal septum toward the nipple-areolar complex. The 40 patients with breast hypertrophy underwent successful reduction mammaplasty using our modified round block technique, except for one case, which developed necrosis of the nipple-areolar complex.

CONCLUSIONS

Reduction mammaplasty using our modified round block technique can maximally preserve the blood supply to the remaining gland as well as the innervation to the nipple-areolar complex, while maintaining the advantages of the traditional technique, such as an invisible scar and good projection.

Superomedial pedicle reduction with short scar

Reduction mammaplasty combining a superomedial pedicle with a circumareolar/vertical pattern skin excision avoids an inferior pedicle that can interfere with vertical scar technique, yet it is flexible enough to allow for a short transverse skin excision. This technique is suitable for small to moderate-size reductions.

Thin superior medial pedicle reduction mammaplasty for severe mammary hypertrophy

BACKGROUND

There are multitudes of procedures in plastic surgery used to correct hypertrophic and pendulous breasts in patients with heavy and ptotic breasts who need great resections of breast tissue, where the suprasternal notch-to-nipple distance is long and the use of nipple-areola transposition techniques is a challenge for the plastic surgeon. The purpose of this study is to present a technique of reduction mammaplasty that could solve these problems based on the following principles: mammary reduction utilizing a thin superior medial pedicle (0.8-1.5 cm thick) and the resection performed in two steps: (1) the base excess at a plane perpendicular to the breast (this determines the cone's height) and (2) central half keel (this determines the breast diameter reduction).

METHODS

Ninety patients with mammary hypertrophy were operated on at the "Hospital das Clínicas," São Paulo University Medical School, between January 2000 and November 2005. Inclusion in this study required a minimum of 12-cm change in nipple position and a 750-g breast resection.

RESULTS

The mean change in nipple position was 16 cm (range = 12-21 cm). The mean weight of each breast was 1400 (range = 750-3000 g). Considering the great amount of volume removed and the size of the operated breasts, few complications were observed and were similar to those reported following other techniques described in the literature. Patient satisfaction following this procedure was high.

CONCLUSION

The results of this study clearly demonstrate that thin superior medial pedicle reduction mammaplasty is a safe and reliable technique in cases of severe mammary hypertrophy.

No-vertical-scar technique versus inverted T-scar technique in reduction mammoplasty: a two-center comparative study

Currently, a reverse T-shaped scar remains in the infraareolar area after most of the frequently used techniques for reduction mammoplasty. A two-center study was performed for an understanding of the effects from the amount of scars on the aesthetic satisfaction of patients. Long-term follow-up results for 24 patients who underwent the McKissock (inverted T-scar) technique (group 1) in a university hospital were compared with the results for 29 patients who underwent a "no-vertical-scar technique" (group 2) at another hospital in terms of aesthetic results. With this aim, a questionnaire was designed to assess the patients' degree of aesthetic satisfaction with different aspects. Additionally, the most current photos of each patient were evaluated for aesthetic results by four physicians and four medical students. Areola-fold and nipple-notch distances were measured as an objective evaluation. The significance of the results was tested using dependent or independent sample t tests. Notch-nipple and areola-fold distances both were greater in group 2 than in group 1, both preoperatively and postoperatively (p < 0.001). The personal satisfaction questionnaire showed that the group 2 patients rated scar satisfaction and postoperative activity levels higher (p < 0.001) than the group 1 patients (p < 0.05), but that group 1 rated nipple position higher (p < 0.05). There was no significant difference between the two groups in terms of general aesthetic satisfaction. Physicians who evaluated patient photos ranked the scars of group 2 as significantly superior to those of group 1 (p < 0.01), whereas they did not rate other features as significantly different. However students could not determine any superiority of any feature between the two groups. The no-vertical-scar technique gives the impression of a breast that has not undergone surgery because it leaves no scars in the infraareolar area and invisible scars in other areas. This situation improves the degree of satisfaction for patients in the postoperative period. When the general aesthetic success and the ratio of complications were evaluated, the no-vertical-scar technique was found to be just as successful as the T- scar technique, which is practiced widely.