Abstract
Background
Body contour deformities that develop following massive weight loss involve almost all areas of the body. Breast management after massive weight loss is performed for cosmetic and reconstructive purposes. It is critical to realize how these abnormalities affect the breast to handle those patients effectively.
Numerous studies demonstrated strategies to enhance breast projection, shape, and volume. These include breast reduction, augmentation using implants or local tissues of the chest wall, and/or the breast for breast auto-augmentation.
In this study, the efficacy of a superior pedicle for nipple-areolar complex (NAC) together with a spiral flap for breast auto-augmentation and elimination of back rolls in massive weight patients is evaluated.
Methods
This is a prospective case series study carried out on twenty female patients with massive weight loss and presenting for breast augmentation and/or lift. Breast auto-augmentation was done using a spiral flap harvested from the patient’s back and superior pedicle for the nipple-areolar complex (NAC). Results were evaluated according to the surgeon’s and patient’s satisfaction scores.
Results
The patients’ age ranged between 20 and 42 years old with a mean age of 35 years old. Their BMI ranged from 24 to 32 kg/m2 with a mean BMI of 28.9 kg/m2.Complications were all minor in nature and did not affect the overall results. Eighty percent of surgeons rated the results as excellent with a mean score of 8.25 (SD 0.77, score range is 0–9). Regarding patient’s satisfaction, the mean score was 13.15 with a maximum score of 15, which reflects the high satisfaction rate for the patients regarding the procedure and marked improvement in self-perception and body image.
Conclusions
Spiral flap represents a good option for breast auto-augmentation in massive weight loss patients. In addition to the upper body lift achieved, the use of a superior pedicle for NAC provides a better superior fullness for the breast mound. A longer follow-up, a larger sample size, and comparative studies are needed to achieve a stronger argument and a higher level of evidence.
Level of evidence: Level IV, Therapeutic.
Similar content being viewed by others
References
Surgeman H (2008) Pathophysiology of severe obesity and the effects of surgically induced weight loss. In: Pitombo C (ed) Obesity surgery the principles and practice. Mc Graw Hill; (Ch 2), pp 16–21
Sebastian J (2008) Bariatric surgery and work up of the massive weight loss patients. Clin Plast Surg 35:11–26
Shrivastava P, Aggarwal A, Khazanchi R (2008) Body contouring surgery in a massive weight loss patient: an overview. Indian J Plast Surg 41:114–125
Gusenoff J, Coom D, Rubin P (2009) Implication of weight method in body contouring outcomes. Plast Reconstr Surg 123(1):373–376
Losken A (2010) Rotation advancement superomedial pedicle mastopexy following massive weight loss. In: Shifmann M (ed) In body contouring. Springer; (Ch 73), pp 735–742
Colwell AS et al (2009) Mastopexy techniques after massive weight loss: an algorithmic approach and review of the literature. Ann Plast Surg 63(1):28–33
Hurwitz DJ, Golla D (2004) Breast reshaping after massive weight loss. Semin Plast Surg 18(3):179–187 PMID: 20574474; PMCID: PMC2884719
Coulman KD, MacKichan F, Blazeby JM, Owen-Smith A (2017) Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Rev 18(5):547–559
Labardi L, Gentile P, Gigliotti S, Marianetti M, Colicchia GM, Pascali M, Brinci L, Cervelli V (2012) Medial thighplasty: horizontal and vertical procedures after massive weight loss. J Cutan Aesthet Surg 5(1):20
Khouri R, Del Vecchio D (2009) Breast reconstruction and augmentation using pre-expansion and autologous fat transplantation. Clin Plast Surg 36(2):269–280
Hurwitz D, Mohammadi A (2006) Post bariatric surgery breast reshaping: the spiral flap. Ann Plast Surg 56(5):481–486
D’Ettorre M, Gniuli D, Bracaglia R, Tambasco D, Mingrone G, Gentileschi S, Massi G (2012) Micro- and macroscopic structural modification of subcutaneous adipose tissue after bariatric surgery. Aesth Plast Surg 36:213–214
Mahboub T, Ali RA, Badawi DM, Taha AA (2019) Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: an Egyptian experience. Eur J Plast Surg 42(3):259–264
Pierpont YN, Dinh TP, Salas RE, Johnson EL, Wright TG, Robson MC, Payne WG (2014) Obesity and surgical wound healing: a current review. Int Sch Res Notices 2014
Sapala JA, Wood MH, Schuhknecht MP, Sapala MA (2003) Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 13(6):819–825
Alvarez-Leite JI (2004) Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care 7(5):569–575
Wallace HJ, Fear MW, Crowe MM et al (2017) Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study. Burn Trauma 5:19
Funding
This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained by the local ethical committee of Cairo University, MD-PS-060322.
Informed consent
Verbal and written consents were obtained from all participating patients.
Conflict of interest
Ahmed Ali Taha, Ahmed Hussien, Hamed Kadry, Wael Abdel Nasser, and Amr Zaki declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
(MP4 513 kb)
(MP4 2467 kb)
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Taha, A.A., Hussien, A., Kadry, H. et al. The spiral flap for breast auto-augmentation revisited. Eur J Plast Surg 46, 1135–1142 (2023). https://doi.org/10.1007/s00238-023-02089-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-023-02089-7