Abstract
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.
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References
Wise RJ (1956) A preliminary report on a method of planning the mammaplasty. Plast Reconstr Surg 17:367
Lassus C (1996) A 30-year experience with vertical mammaplasty. Plast Reconstr Surg 97:373e80
Lejour M (1994) Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg 094:100e14
Orlando JC, Gutherie RH Jr (1975) The superomedial dermal pedicle for nipple transposition. Br J Plast Surg 28:42–45
Nahai F (2005) Clinical decision-making in breast surgery. The art of aesthetic surgery. Quality Medical publishing Inc, St. Louis, pp 1817–58
Lejour M (1999) Vertical mammaplasty: early complications after 250 personal consecutive cases. Plast Reconstr Surg 104:764–770
Hall-Findlay EJ (2002) Pedicles in vertical reduction and mastopexy. Clin Plastic Surg 29:379
Courtiss EH, Goldwyn RM (1977) Reduction mammaplasty by the inferior pedicle technique. An alternative to free nipple and areola grafting for severe macromastia or extreme ptosis. Plast Reconstr Surg 59:500–7
Dancey A, Khan M, Dawson J, Gigantomastia PF (2008) A classification and review of the literature. J Plast Reconstr Aesthet Surg 61(5):493–502
Hall-Findlay EJ (2010) The three breast dimensions: analysis and effecting change. Plast Reconstr Surg 125(6):1632–1642. https://doi.org/10.1097/PRS.0b013e3181ccdb97
Hall-Findlay E (2012) Comentary on: vertical reduction mammaplasty utilizing the superomedial pedicle: is it really for everyone? [Peer comentary on (k)vertical reduction mammaplasty utilizing the superomedial pedicle: is it really for everyone?(k) by Neaman KC]. Aesthet Surg J 32(6):726–728. https://doi.org/10.1177/109O82OX12452757
Graf R, Biggs TM, Steely RL (2000) Breast shape: a technique for better upper pole fullness. Aesthet Plast Surg 24(5):348–52
Graf R (2002) In search of better shape in mastopexy and reduction mammoplasty. Plast Reconstr Surg 110(1):309–17
Hidalgo DA, Elliot LF, Palumbo S, Casas S, Hammond D (1999) Current trends in breast reduction. Plast Recosntr Surg 104:806–815
Pennington DG (2006) Improving the results of inferior pedicle breast reduction using pedicle suspension and plication. Aesthet Plast Surg 30(4):309–394
Davison SP, Mesbahi AN, Ducic I et al (2007) The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg 120(6):1466–1476
Hammond DC, Loffredo M (2012) Breast reduction. Plast Reconstr Surg 129(5):829e-e839. https://doi.org/10.1097/PRS.0b013e31824a2efc
Graf R, Ricardo Dall Oglio Tolazzi A, Balbinot P et al (2016) Influence of the pectoralis major muscle sling in chest wall-based flap suspension after vertical mammaplasty: ten-year follow-up. Aesthet Surg J 36(10):1113–1121 (Epub 2016 Jul 8)
Graf R, Reis de Araujo LR, Rippel R, Neto LG et al (2003) Reduction mammaplasty and mastopexy using the vertical scar and thoracic wall flap technique. Aesthetic Plast Surg 27(1):6–12 (Epub 2003 Apr 14)
Reus WF, Mathes SJ (1987) Preservation of projection after reduction mammaplasty: long-term follow-up of the inferior pedicle technique. Plast Reconstr Surg 82:644
Makboul M, Abdelhamid M, Al-Attar G (2017) Long term follow up and patient satisfaction after reduction mammoplasty: superomedial versus inferior pedicle. World J Plast Surg 6(1):82–87
Atluntas ZK, Kamburoglu HO, Yavuz N et al (2015) Long-term changes in nipple-areolar complex position and inferior pole length in superomedial pedicle inverted “T” scar reduction mammaplasty. Aesthet Plast Surg 39(3):325–330. https://doi.org/10.1007/s00266-015-0470-3 (Epub 2015 Mar 18)
Quan M, Fadl A, Small K et al (2011) Defining pseudoptosis (bottoming out) 3 years after short-scar medial pedicle breast reduction. Aesthetic Plast Surg 35(3):357–364. https://doi.org/10.1007/s00266-010-9615-6 (Epub 2010 Nov 17)
Kankaya Y, Melike O, Sungur N (2016) Four flap suspension technique for prevention of bottoming out after breast reduction. Ann Surg Treat Res 90(1):10–15
Brown HR, Izaddoost S, Bullocks JM (2010) Preventing the “bottoming out” and “star-gazing” phenomena in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere. Aesthet Plast Surg 34:760–767
Zehm S, Puelzl P, Wechselberger G et al (2012) Inferior pole length and long-term aesthetic outcome after superior and inferior pedicled reduction mammaplasty. Aesthet Plast Surg 36(5):1128–33. https://doi.org/10.1007/s00266-012-9938-6 (Epib 2012 Jul 19)
Hamdi M, Greuse M, De Mey A, Webster MH (2001) A prospective quantitative comparison of breast sensation after superior and inferior pedicle mammaplasty. Br J Plast Surg 54:39–42
Hamdi M, Blondeel P, Van de Sijpe K, Van Landuyt K, Monstrey S (2003) Evaluation of nipple-areola complex sensitivity after the latero-central glandular pedicle technique in breast reduction. Br J Plast Surg 56(4):360–364
Cruz-Korchin N, Korchin L (2003) Vertical versus Wise pattern breast reduction: patient satisfaction, revision rates, and complications. Plast Reconstr Surg 112:1573
Garcia ES, Veiga DF, Sabino-Neto M, Beraldo Cardoso FN et al (2015) Sensitivity of the nipple-areola complex and sexual function following reduction mammaplasty. Aesthet Surg J 35(7):NP193-202. https://doi.org/10.1093/asj/sjsv034
Echo A, Guerra G, Yuksel E (2011) The dermal suspension sling: shaping the inferior pedicle during breast reduction. Aesthet Plast Surg 35(4):608–616. https://doi.org/10.1007/s00266-010-9632-5 (Epub 2010 Dec 7)
Hammond DC (2004) The short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty. Semin Plast Surg 18(3):231–243. https://doi.org/10.1055/s2004-831910
Hall-Findlay EJ (2013) Discussion: a matched cohort study of superomedial pedicle vertical scar breast reduction (100 breasts) and traditional inferior pedicle Wise-pattern reduction (100) breasts: an outcomes study over 3 years. Plast Reconstr Surg 132(5):1077–1079. https://doi.org/10.1097/PRS-0b013e3182a48bb4
Kirwan L, Wazir U, Mokbel K (2015) Breast auto-augmentation: a versatile method of breast rehabilitation-a retrospective series of 107 procedures. Arch Plast Surg 42:438–445
Würinger E, Mader N, Posch E, Holle J (1998) Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg 101(6):1486–1493
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Sozer, S.O., Phillips, P.M. Myo-Glandular Flap Breast Reduction: Preventing the Bottoming out Deformity—A Novel Technique. Aesth Plast Surg 45, 1419–1428 (2021). https://doi.org/10.1007/s00266-021-02189-4
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DOI: https://doi.org/10.1007/s00266-021-02189-4