Mastopexy Autoaugmentation by Using Vertical and Triangular Flaps of Mammary Parenchyma Through a Vertical Ice Cream Cone-Shaped Approach

A Different Method to Increase Breast Projection-Tunnelized Glandular Flap

BACKGROUND

Breast ptosis may occur with increasing age, after pregnancy, after breastfeeding, or after weight loss. Understanding the vascular structure of the breast and nipple-areolar complex has guided the reshaping of the breast and thus paved the way for the emergence of different techniques. This study aimed to evaluate the results of tunneled glandular flaps used to increase projection in patients undergoing breast lift surgery.

METHODS

Patients who underwent breast lift and breast reduction between January 2020 and January 2022 were examined through their files and included in the study. Deepithelialization of the superomedial pedicle was performed. A tunnel was created under the pedicle. A medial or lateral based glandular flap was prepared from the inferir. The prepared glandular flap was passed through the tunnel and fixed to the pectoral muscle.

RESULTS

A total of 32 patients were included in the study. The average age of the patients was 44.31. Thirteen patients were smokers. Diabetes mellitus was present in 5 patients. To increase projection, medial glandular flap was used in 20 patients and lateral glandular flap was used in 12 patients. The average amount of tissue excised from the patients was 785.31 g. The average follow-up period was 14 months.

CONCLUSIONS

Tunneled glandular flaps prepared on a lateral or medial basis will be useful in increasing the projection in breast lift surgery.

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 .

The Versatility of the Lateral-based Mammary Flap as an "Auto-implant" for Enhancing Breast Mound for Patients Undergoing Primary Mastopexy

Background

The demand for augmentation-mastopexy surgery without using implants has significantly increased over the years. Fat transfer offers an alternative method, but some patients do not favor this procedure either. The purpose of this study was to evaluate the versatility of using a lateral-based mammary flap as an "auto-implant" for enhancing the breast mound for patients undergoing primary mastopexy.

Method

This retrospective study was performed between February 2016 and April 2019, including 36 female patients (72 breasts). Our technique involves using the inferior breast tissue by elevating the lateral-based dermoglandular flap that was moved cranially with a 90 degree rotation in a conical shape within the created pocket to refill the superior and central mound.

Result

The mean nipple projection was 11.2 after 36 months postoperative compared with 5.2 before surgery. The mean ± SD of pre- and postoperative measurements for the lower pole zone were 80.2 ± 10.5 and 50.1 ± 6.4, and those for the upper pole zone were 40.3 ± 9.5 and 63.9 ± 6.5, respectively. The distance of breast mound elevation after the surgical procedure ranged from 5.30 to 9.55 cm, with a mean of 7.90 cm.

Conclusions

The lateral-based mammary flap acts like an implant that helps shape and augment the breast, enhances the mammary projection, and restores the breast contour without requiring a synthetic implant or fat grafting. It is a reliable technique with high patient satisfaction but is unsuitable for patients with insufficient breast volume.

A Modified Superior Pedicle Mastopexy Technique With an Inferolateral-Based Auto Augmentation Flap

BACKGROUND

Current mastopexy techniques have evolved to decrease scar length and maintain a more consistent upper pole fullness, improving the breast shape. Many different approaches have tried to suspend breast tissues to achieve a more attractive upper pole. Most of the auto-augmentation mastopexy techniques use inferior-based breast parenchymal tissues to fill the upper part.

METHODS

This paper presents a modified approach to fill the breast's upper pole, with an inferolateral-based breast flap. The advantages of changing the inferior-based auto-augmentation technique to the inferolateral comprise improving blood supply and increasing repositioned breast flap's mobility. In our technique, the breast tissue used to auto-augment the upper pole receives its blood supply from pectoral perforators and lateral breast tissue. When surgeons need more flap mobility, they can raise the medial edge of this flap from the pectoral fascia to mobilize this flap higher on the chest wall, depending on the lateral blood supply. One other advantage is that when the inferolateral-based breast tissue is pulled in a superomedial direction to fill the upper part, the lateral ptotic breast tissues come closer to the breast meridian to meet with medial breast parenchyma easily. The tension on the vertical parenchymal suture line is reduced with this approach.

CONCLUSION

Our technique can be used in most mastopexy operations and for all types of ptosis except for cases with insufficient breast volume. It brings safety to the auto-augmentation procedure and is also time-saving. The stability of breast shape and upper pole fullness lasts as long as other auto-augmentation procedures; therefore, it can be an excellent alternative to other techniques.

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 .

Mastopexy Autoaugmentation by Using Vertical and Triangular Flaps of Mammary Parenchyma Through a Vertical Ice Cream Cone-Shaped Approach

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 .