Internal Pedicle Shaping to Improve Aesthetic Results in Reduction Mammaplasty

The dermal suspension sling: shaping the inferior pedicle during breast reduction

BACKGROUND

Complaints following reduction mammaplasty using the inferior pedicle include the migration of the deep tissue, a lack of medial fullness, poor projection, and bottoming-out. These are attributed to the lack of deep tissue suspension and skin envelope relaxation. We address these issues through horizontal dermal suspension and plication of the inferior pedicle.

METHODS

The inferior pedicle is designed with medial and lateral triangular flaps in the areas, which would normally be excised. These triangular flaps are deepithelialized and defatted. The flaps are attached to the chest wall above the inferior pedicle to create a dermal sling. The breast mound is further contoured by horizontally plicating the dermis below the nipple-areola complex (NAC), which creates projection and rotates the NAC into the desired position in relation to the chest wall.

RESULTS

Sixty-six women have undergone breast reduction using the horizontal dermal suspension sling modification to the inferior pedicle breast reduction technique. Breast projection and shape were sustained during follow-up, of which the median interval was 16 months.

CONCLUSION

Dermal suspension and horizontal dermal plication provides a structural foundation to the inferior pedicle. The sling-like effect from the dermal suspension maintains a defined inframammary fold and maintains medial and lateral borders of the breast. Horizontal dermal plication shortens the length of the inferior pedicle while generating improved breast projection by rotating the NAC anteriorly. The firmly shaped inferior pedicle breast mound allows the skin flap to drape over the breast mound with minimal tension.

Keyhole Pattern for Preoperative Marking for Reduction Mammaplasty

BACKGROUND

There are many techniques used for reduction mammaplasty; however, the most frequently performed procedures result in an inverted T scar. Preoperative marking is an important step for the success of the procedure, especially for surgeons at the initial learning stage. However, there is no consensus regarding the best method. In 1981, Strömbeck designed a pattern for preoperative marking for reduction mammaplasty. This pattern provides stable parameters that promotes an acceptable symmetry marking.

OBJECTIVE

To evaluate the use of the Strömbeck pattern for preoperative marking for reduction mammaplasty.

METHODS

Fifty-seven patients who underwent reduction mammaplasty between April 2006 and April 2007 were prospectively evaluated. Patient ages ranged from 17 to 61 years; the mean body mass index was 22.2 kg/m2. After defining the standard landmarks of the breast, preoperative markings were made using the Strömbeck pattern. Breast reduction surgery was performed under local anesthesia with sedation. Postoperative results were evaluated according to a numerical visual analogue scale, at the seven-, 15-and 30-day follow-up periods. The Student's t test and the Kruskal-Wallis test were used for statistical analysis (P<0.05).

RESULTS

The mean weight of resected breast tissue was 317.5 g for the right breast and 305.8 g for the left breast (P=0.17). Scores obtained using a visual analogue scale showed a progressive increase in the scores during the postoperative follow-up period (P<0.0001).

CONCLUSION

The use of the Strömbeck pattern enabled surgeons to perform reduction mammaplasty with good postoperative results as seen in the follow-up periods.