Breast augmentation combined with a transposed glandular flap for prevention and correction of lower pole deformities



Lower pole deformities constitute the most complex problem encountered during and after breast augmentation. If the procedure is not accurately planned, the choice of techniques to correct lower pole deformity intraoperatively can be limited, leading to the possibility of additional scarring or the necessity of a second surgery.


Volume deficiencies of the lower pole after implant placement, such as flatness and double bubble, are indications for the proposed technique. A glandular flap is created by bisecting the lower pole of the gland and is transposed inwards and downwards to fill the deficient area. It is not necessary to fix the flap in place.


Between January 2011 and December 2014, 30 patients underwent breast augmentation or augmentation-mastopexy combined with a transposed glandular flap. A desired lower pole was achieved in all the cases. No major complications were observed.


The transposed glandular flap herein described was proven to be useful to correct volume deficiencies of the lower pole after implant placement in cases of primary and secondary cases of breast augmentation.

Level of Evidence: Level IV, therapeutic study

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  1. 1.

    van Straalen WR, Hage JJ, Bloemena E (1995) The inframmamary ligament: myth or reality? Ann Plast Surg 35(2):237–241

  2. 2.

    Boutros S, Kattash M, Wienfeld A, Yuksel E, Baer S, Shenaq S (1998) The intradermal anatomy of the inframammary fold. Plast Reconstr Surg 102(4):1030–1033

  3. 3.

    Hammond D (2009) Atlas of aesthetic breast surgery. Elsevier, China

  4. 4.

    Massiha H (2000) Augmentation in ptotic and densely glandular breasts: prevention, treatment and classification of double-bubble deformity. Ann Plast Surg 44:143–146

  5. 5.

    Spear S, Bulan E, Venturi M (2004) Breast augmentation. Plast Reconstr Surg 114:73e–81e

  6. 6.

    Hidalgo DA (2000) Breast augmentation: choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg 105:2202–2216

  7. 7.

    Fisher J, Handel N (2014) Problems in breast surgery: a repair manual. CRC Press, FL 1:227--252

  8. 8.

    Medard de Chardon V, Balaguer T, Chignon-Sicard B et al (2010) Double breast contour in primary aesthetic breast augmentation, incidence, prevention and treatment. Ann Plast Surg 64:390–396

  9. 9.

    de la Fuente A, del Yerro M (1992) Periareolar mastopexy with mammary implants. Aesthet Plast Surg 16:337–341

  10. 10.

    Rees TD, Aston SJ (1976) The tuberous breast. Clin Plast Surg 3:339–347

  11. 11.

    Grolleau J-L, Lanfrey E, Lavigne B, Chavoin J-P, Costagliola M (1999) Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry. Plast Reconstr Surg 104:2040–2048

  12. 12.

    Scheepers JH, Quaba AA (1992) Tissue expansion in the treatment of tubular breast deformity. Br J Plast Surg 45:529–532

  13. 13.

    Tebbetts JB (2001) Dual plane breast augmentation: optimizing implant–soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 107:1255–1272

  14. 14.

    Meara JG, Kolker A, Bartlett G, Theile R, Mutimer K, Holmes AD (2000) Tuberous breast deformity: principles and practice. Ann Plast Surg 45:607–611

  15. 15.

    Mailard GF (1986) A Z mammaplasty with minimal scaring. Plast Reconstr Surg 77:66–76

  16. 16.

    Dinner MI, Dowden RV (1987) The tubular/tuberous breast syndrome. Ann Plast Surg 19:414–420

  17. 17.

    Muti E (2010) Tuberous breast. Acta Medica Edizioni — Adottati, Fidenza, Parma

  18. 18.

    Puckett CL, Concannon MJ (1990) Augmenting the narrow-based breast: the unfurling technique to prevent the double-bubble deformity. Aesthetic Plast Surg 14:15–19

  19. 19.

    Mandrekas AD, Zambacos GJ, Anastasopoulos A et al (2003) Aesthetic reconstruction of the tuberous breast deformity. Plast Reconstr Surg 112:1099–1108

  20. 20.

    Ribeiro L, Canzi W, Buss A, Accorsi A Jr (1998) Tuberous breast: a new approach. Plast Reconstr Surg 101:42–50

  21. 21.

    Kolker AR, Collins MS (2015) Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction. Plast Reconstr Surg 135:73–86

  22. 22.

    Coleman SR, Saboeiro AP (2007) Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg 119:775–785, 786-7

  23. 23.

    Bresnick SD (2016) Management of a common breast augmentation complication: treatment of the double-bubble deformity with fat grafting. Ann Plast Surg 76(1):18–22

  24. 24.

    Handel N (2013) The double-bubble deformity: cause, prevention, and treatment. Plast Reconstr Surg 132(6):1434–1443

  25. 25.

    Muntan CD, Sundine MJ, Rink RD, Acland RD (2000) Inframammary fold: a histologic reappraisal. Plast Reconstr Surg 105:549–556, 557

  26. 26.

    Barnett A (1990) Transaxillary subpectoral augmentation in the ptotic breast: augmentation by disruption of the extended pectoral fascia and parenchymal sweep. Plast Reconstr Surg 86:76–83

  27. 27.

    Shiffman MA (2005) Mammograms in cosmetic breast surgery. Indian J Plast Surg 38:100–104

  28. 28.

    Miglioretti DL, Rutter CM, Geller BM et al (2004) Effects of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA 291(4):442–450

  29. 29.

    Lavigne E, Holowaty EJ, Pan SY et al (2013) Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ 346:f2399

  30. 30.

    Brown L, Ferlo Todd J, Do Lou HM (2004) Breast implant adverse events during mammography: reports to the Food and Drug Administration. J Women's Health 13(4):371–378

  31. 31.

    Kim H, Kang BJ, Kim SH, Kim HS, Cha ES (2015) What we should know in mammography after reduction mammoplasty and mastopexy? Breast Cancer 22(4):391–398

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Correspondence to Dmitry Batiukov.

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Dmitry Batiukov and Vladimir Podgaiski declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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For this type of study, formal consent is not required.



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Batiukov, D., Podgaiski, V. Breast augmentation combined with a transposed glandular flap for prevention and correction of lower pole deformities. Eur J Plast Surg 41, 21–26 (2018) doi:10.1007/s00238-017-1312-0

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  • Breast augmentation
  • Double bubble
  • Inframammary crease
  • Lower pole deformity
  • Tuberous breast
  • Glandular flap
  • Revisional augmentation