Long-term changes in nipple-areolar complex position and inferior pole length in superomedial pedicle inverted 't' scar reduction mammaplasty

Horizontal pillar technique: A single pedicle septum-based approach in reduction mammaplasty with a twist

Breast reduction surgery has proven to be a successful treatment for various conditions such as postural disorders, anxiety, dermatological problems, and body image disorders, and is tailored to accommodate each patient's needs and anatomical variations. The author presents a modified approach for reduction mammaplasty using a septum-based superomedial pedicled nipple-areola complex (NAC) flap combined with horizontal dermoglandular pillars. This adjustment enhances desired breast projection, potentially eliminating the need for alternative pedicles in most cases. The limitations and disadvantages of this new technique are discussed. Between July 2015 and July 2021, 85 patients underwent surgery using the horizontal pillar reduction mammaplasty. Clinical data obtained during follow-up visits were recorded. Patients were asked to answer the local version of the Breast-Q, version 2.0, reduction module postoperative scale questionnaire to evaluate breast shape contentment and patient satisfaction at the 1-year follow-up. Necrosis of the NAC was not observed in any patient. The most common complaints in the early postoperative period were pain along the inframammary fold and swelling that extended into the axillary region. The mean values and standard deviations of the postoperative Breast-Q scores were calculated. The postoperative satisfaction with breasts scale mean value was 84.11 ± 12.86, and the postoperative satisfaction with outcomes scale mean value was 81.08 ± 9.97. The horizontal pillar reduction mammaplasty technique is safe, reliable, and easy to perform in breast reduction. Although the initial findings are encouraging, future anatomical and clinical studies are necessary to fully explore this modified technique's functional limitations and long-term outcomes.

The "Arrow Flap" Technique in Reduction Mammaplasty: Combining Short Scars, Narrow Base, and High and Persistent Breast Projection

INTRODUCTION

Breast reduction is one of the most common procedures performed by plastic surgeons worldwide. Despite that several techniques have been proposed for management of ptotic or hypertrophic breasts, most of them often deal with too large breast bases, poor breast projection, persistent "dog ears," and a certain percentage of bottoming out. Lower-pole shaping of the breast remains one of the challenge of vertical mammoplasty.

MATERIALS AND METHODS

The authors report their 5-year-long experience with a modification of the vertical scar technique, the "arrow flap," in which they harvest a double lateral glandular and cutaneous flap, to tighten and better shape the base of the breast and to improve the breast projection with a "double-bra" effect. From April 2015 to February 2019, 75 patients with moderate to severe macromastia/breast ptosis underwent bilateral reduction mammoplasty.

RESULTS

Postoperative outcomes showed an overall satisfactory results and low incidence of complications. Two patients presented with an asymmetry between the 2 breasts, and no nipple-areola complex necrosis occurred. One patient reported a wider vertical scar, whereas no bottoming out was observed.

CONCLUSIONS

All patients reported a stable and durable projection of the breast, with pleasant cosmetic results. By combining short scars and narrow base, we can obtain a pleasant lower pole reshaping of the breast, even in that challenging cases of large and squared breast. The authors believe that this technique provides a useful surgical option, increasing the versatility of the superior pedicle vertical mammaplasty both for mastopexy and breast reduction, even in cases of severe macromastia.

Myo-Glandular Flap Breast Reduction: Preventing the Bottoming out Deformity-A Novel Technique

Large, heavy breasts are a common complaint among women causing various functional and aesthetic concerns. The plastic surgery community has offered a variety of surgical techniques to address this condition. Most of these operations developed during the 1970s-1980s cemented their place in history as fundamentals of breast reduction surgery and are still widely taught today. Despite ongoing plastic surgery advances, long-term complications surrounding breast reduction surgery remain a concern, even to experienced surgeons. Its apparent trends have shifted focus over time; from the basics of developing a patient-safe and easily replicable technique, toward developing more refined maneuvers allowing surgeons to reach desired and long-lasting outcomes while preventing known complications. The bottoming out phenomena, lack of nipple areola complex sensitivity, upper pole emptiness with low setting breasts and high revision rates still plague the breast reduction landscape. We present a novel technique involving a pectoralis major-based myo-glandular flap with breast parenchymal suspension to the upper chest wall to combat bottoming out and upper pole emptiness. These procedural elements allow the breasts to attain not only acceptable results, with smaller, round and well-projected breasts, but also to create an active opposing vector to resist the gravitational forces which otherwise pull breast tissue inferiorly creating the bottoming out deformity.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 .

Evaluation of long-term breast shape in inferior versus superomedial pedicle reduction mammoplasty: a comparative study

Background

Among breast reduction mammoplasty, the inferior pedicle-based (IFP) technique is considered the most performed by plastic surgeons. A growing interest for the supero-medial based pedicle (SMP) mammoplasty technique has been documented in literature and clinical practice. However, no real evidence exists on the superiority of one technique over another.

Methods

This study represents a retrospective multimodal analysis, using a prospectively maintained database, comparing wise pattern breast reduction techniques (IFP vs. SMP) over a 24-month follow-up. From January 2015 to July 2017, all patients undergoing wise pattern bilateral reduction mammoplasty, using either an IFP or a SMP technique, were included in the study and divided in two groups. Pre-operative breast measurements included sternal notch-to-nipple distance (SN-N), infra-mammary fold to inferior border of Nipple Areolar Complex (NAC) distance length and ptosis. The same measurements were recorded at 2 weeks, 6 months and 24 months post-op. Complications were recorded and aesthetic outcomes were evaluated.

Results

A total of 58 patients were included in the study, among which 36 (62%) were treated with a SMP technique and 22 (38%) with an IFP technique. At the 24-month follow-up timepoint, the SN-N distance was significantly shorter (*P<0.05) in the SMP group, with a significantly smaller elongation of the lower pole arc (29.5% increase in length in the SMP group and 40.9% in the IFP group). Aesthetic result gave significantly higher mean VAS score for SMP patients compared to IFP patients.

Conclusions

The SMP technique provides stable and satisfactory results in term of breast shape, overcoming some of the major concerns related to the use of an IFP technique (lower pole elongation and ptosis recurrence), maintaining a superimposable complication rate.

Photometric Evaluation of Long-term Changes in Breast Shape after Breast Augmentation and Vertical Mammaplasty

Background

Little information is presently available regarding the long-term effects of breast augmentation and mammaplasties on breast shape. Existing studies typically use 1-dimensional measurements and mean follow-up times seldom exceed 1 year.

Methods

Twenty women were studied: breast augmentation (n = 5), mastopexy (n = 5), augmentation/mastopexy (n = 5), and breast reduction (n = 5). For mammaplasties, a vertical method using a medial pedicle and intraoperative nipple siting was used in all cases. A 2-dimensional measurement system was used, with computer-assisted matching of lateral photographs of the right and left breasts. Measurements were evaluated at 3 times: before surgery, 1 year after surgery, and 10 years after surgery.

Results

Breast implants significantly increased breast projection and upper pole projection. The nipple level was unchanged. The lower pole level dropped. These changes were preserved at 10 years. Vertical mastopexy provided a modest increment in breast projection and upper pole projection. The nipple level and lower pole level were raised significantly. Augmentation/mastopexy boosted breast projection and upper pole projection, and also elevated the nipple and lower pole level. Breast reduction changes were similar to mastopexy, but with greater elevation of nipple level and lower pole level, which were usually lower to start with. Implants increased upper pole convexity. Nipple overelevation was avoided by intraoperative nipple siting just below the breast apex.

Conclusions

These measurements provide new information regarding the long-term effects of breast augmentation and vertical mammaplasties. This information may be used by plastic surgeons in procedure selection and patient counseling.

Objective evaluation of nipple position after 336 breast reductions

Throughout different eras and cultures what is considered the cosmetically ideal breast has varied greatly. There is no broadly accepted standardised method that objectively evaluates aesthetic outcome after breast reduction mammoplasty. The primary aim of this study was to evaluate the result of breast reduction regarding nipple position, comparing it to an objective previously described standard. Secondary aims were to determine symmetry and examine predictors for achieving an aesthetically pleasing breast. The position of the nipple was measured in postoperative pictures and compared to a previously described standard. Three-hundred and thirty-six breast were included in the study. Compared with the previously described standard, 26% (89/336) of the nipples were within the optimal position in mediolateral direction, and 44% (147/336) in craniocaudal direction. The majority of women had the nipple in the same position in the two breasts. Age at surgery seems to significantly influence the possibility of achieving an optimal nipple position. No other predictors were found. Improvements can be made in placement of the nipple during reduction mammoplasty. Further studies are needed on how knowledge of the ideal nipple position can be used to optimize surgical planning and technique, and reduce variability in outcomes, in breast reduction mammoplasties.

Inferior Pedicle Reduction Mammoplasty with or without Tourniquet: A Comparative Study

OBJECTIVE

To compare the perioperative findings of inferior pedicle reduction mammoplasty (IPRM) performed with or without a tourniquet.

METHODS

This study was carried out in the plastic and reconstructive surgery department at a tertiary care center on a total of 42 consecutive women scheduled for IPRM. Patients in Group I (n = 21) underwent surgery using a tourniquet, whereas patients in Group II (n = 21) were operated on without a tourniquet. Levels of hemoglobin (Hb), hematocrit (Hct), Hct/Hb ratio, and platelet counts were noted preoperatively and on postoperative 24th and 48th h. Numbers of surgical pads and gauze sponges completely used and dripping with blood were recorded. Duration of operation, the amount of breast tissue excised on both sides, and fluid collected in hemovac drains on 48th h after operation were documented.

RESULTS

In Group I, the operative time was significantly shorter (p < 0.001), and numbers of gauze sponges and surgical pads were fewer (p < 0.001 for both). Hemoglobin levels were significantly higher in Group I on postoperative 24th (p = 0.002) and 48th h (p = 0.007). Similarly, hematocrit levels in Group I were higher than those of Group II on postoperative 24th (p = 0.004) and 48th h (p = 0.009).

CONCLUSION

We determined that use of a tourniquet significantly reduced the operative time and blood loss during IPRM. Therefore, our preliminary results support that tourniquet usage is practical and safe, and it may also improve the cost-effectiveness of the procedure.

LEVEL OF EVIDENCE III

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 .