Double Flap Technique: An Alternative Mastopexy Approach

  • Andreas Foustanos

If we review the history of mammaplasty, we see that several techniques have been described. Although the subsequent reduction mammaplasties were probably performed by Dieffenbach (1848), Morestin (1909), and Villarde (1911), the first publication was made by Lexer (1921) describing a technique with nipple areola complex transposition using an inverted Thscar [1–4]. The superiorly based dermal pedicle, the vertical bipedicle dermal flap, the inferior pyramidal free nipple graf, the concentric mastopexy techniques, and Benelli modifications of the old “donut” mastopexy are some of the techniques described previously [5–11]. Pitanguy [12] described the inverted-Thincision with a superior pedicle carrying the areola. Strombeck [13] used a horizontal bipedicle cutaneous flap; Mckissock [14] described a vertical bipedicle flap. Courtiss and Goldwyn [15] used an inferior pedicle. Lassus [16], Lejour [17], Peixoto [18], Hallfindlay [19], Skoog [20], Qun Qiao et al. [21], and Hinderer [22] described other techniques. Goes [23] used a large sheet of mesh, placed over the entire upper pole. Flowers and Smith [24] described the “flip-flap” mastopexy technique. Hammond described the short scar periareolar inferior pedicle reduction mam-maplasty [25]. Ali Eed [26] described a technique creating a cone; the nipple areola complex is carried on a subcutaneous inferior pedicle. Some surgeons proposed the L-shaped or J-shaped incision [27–29]. Cerqueira [30] described breast fixation with a dermoglandular upper pedicle flap under the pectoralis muscle. Marchac and de Olarle [31] introduced the concept of upper glandular plication and suspension to the pectoralis fascia. Ribeiro [32] mobilized a chest wall-based flap into the upper pole. Daniel [33] suggested the passage of the flap under an elevated loop of pectoral muscle. Regardless of the degree of ptosis, the theme of a mastopexy is to get long-term maintenance of upper pole volume, to contour the gland, to reposition the nipple areola complex preserving its vascular supply, and to resect the redundant skin. A reasonable solution to the upper pole deficiency is to relocate and secure tissue from the caudal breast into the upper chest.


Skin Flap Nipple Areola Complex Vertical Scar Inferior Pedicle Superior Pedicle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Dieffenbach JF: Die extirpation der bruestdruese. In: Dieffenbach JF (ed), Die Operative Chirurgie. Brockhaus, Leipzig 1848, pp 359–373Google Scholar
  2. 2.
    Morestin H: Hypertophie mammaire unilaterale corrige par la resection discoide. Bull Mem Soc Chir Paris 1909;35:996Google Scholar
  3. 3.
    Villarde I: 1911-as mentioned in Dartigues L: Traitement chirurgical du prolapsus mammaire. Arch Franco-Belg Chir 1925;28:313Google Scholar
  4. 4.
    Lexer E: Correccion de los pechos pendulos (Mastoptose) por medio de la implantacion de grasa. Guipuzcoa Medica 1921;63:213Google Scholar
  5. 5.
    Strombeck JO: Mammaplasty: report of a new technique based on the two pedicle procedure. Br J Plast Surg 1961;13:79–90CrossRefGoogle Scholar
  6. 6.
    Skoog T: A technique of breast reduction: transposition of the nipple on a cutaneous vascular pedicle. Acta Chir Scand 1963;126:453–465PubMedGoogle Scholar
  7. 7.
    Pitanguy I: Surgical treatment of breast hypertrophy. Br J Plast Surg 1967;20(1):78–85CrossRefPubMedGoogle Scholar
  8. 8.
    McKissock PK: Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg 1972;49(3):245–252CrossRefPubMedGoogle Scholar
  9. 9.
    Skoog T: Plastic Surgery: New Methods and Refinements. Stockholm, Almqvist & Wiksell 1974Google Scholar
  10. 10.
    Ribeiro L: A new technique for reduction mammaplasty. Plast Reconstr Surg 1975;55(3):330–334CrossRefPubMedGoogle Scholar
  11. 11.
    Courtiss EH, Goldwyn RM: Reduction mammaplasty by the inferior pedicle technique: an alternative to free nipple and areola grafing for severe macromastia or extreme ptosis. Plast Reconstr Surg 1977;59(1):500–507CrossRefPubMedGoogle Scholar
  12. 12.
    Peixoto G: Reduction mammaplasty: a personal technique. Plast Reconstr Surg 1980;65(2):217–226CrossRefPubMedGoogle Scholar
  13. 13.
    Marconi F: The dermal pursestring suture: a new technique for a short inframammary scar in reduction mam-maplasty and dermal mastopexy. Ann Plast Surg 1989; 22(6):484–493CrossRefPubMedGoogle Scholar
  14. 14.
    Parenteau JM, Regnault P: The Regnault B technique in mastopexy and breast reduction: a 12 year review. Aesthetic Plast Surg 1989;13(2):75–79CrossRefPubMedGoogle Scholar
  15. 15.
    Marchac D, Olarte G: Reduction mammaplasty and correction of ptosis with a short inframammary scar. Plast Reconstr Surg 1982;69(1):45–55CrossRefPubMedGoogle Scholar
  16. 16.
    Regnault P: Breast reduction and mastopexy, an old love story: B technique update. Aesthetic Plast Surg 1990;14(2):101–106CrossRefPubMedGoogle Scholar
  17. 17.
    Krupp S: Mastopexy: modification of periwinkle shell operation. Ten years of experience. Aesthetic Plast Surg 1990;14(1):9–14CrossRefPubMedGoogle Scholar
  18. 18.
    Benelli L: A new periareolar mammaplasty: the “round block” technique. Aesthetic Plast Surg 1990;14(2):93–100CrossRefPubMedGoogle Scholar
  19. 19.
    Sampaio Goes JC: Periareolar mammaplasty with mixed mesh support: the double skin technique. Plast Surg 1992;2:575Google Scholar
  20. 20.
    Chiari A Jr: The L short-scar mammaplasty: a new approach. Plast Reconstr Surg 1992;90(2):233–246Google Scholar
  21. 21.
    Marconi F, Cavina C: Reduction mammaplasty and correction of ptosis: a personal technique. Plast Reconstr Surg 1993;91(6):1046–1056CrossRefPubMedGoogle Scholar
  22. 22.
    Daniel MJB: Mammaplasty with pectoral muscle flap. Presented at the 64th American Annual Scientific Meeting of the American Society of Plastic and Reconstructive Surgery, Montreal 1995Google Scholar
  23. 23.
    Goes JC: Periareolar mammaplasty: double skin technique with application of polyglactin or mixed mesh. Plast Reconstr Surg 1996;97(5):959–968PubMedGoogle Scholar
  24. 24.
    Flowers RS, Smith EM Jr: “Flip-Flap” Mastopexy. Aesthetic Plast Surg 1998;22(6):425–429CrossRefPubMedGoogle Scholar
  25. 25.
    Fayman MS: Short scar mastopexy with flap transposition. Aesthetic Plast Surg 1998;22(2):135–141CrossRefPubMedGoogle Scholar
  26. 26.
    De Araujo Cerqeira A: Mammoplasty: Breast fixation with dermoglandular mono upper pedicle under the pectoralis muscle. Aesthetic Plast Surg 1998;22(4):276–283CrossRefGoogle Scholar
  27. 27.
    Lejour M: Vertical mammaplasty: Early complications after 250 personal consecutive cases. Plast Reconstr Surg 1999;104(3):764–770CrossRefPubMedGoogle Scholar
  28. 28.
    Lassus C: Update on vertical mammaplasty. Plast Reconstr Surg 1999;104(7):2289–2298CrossRefPubMedGoogle Scholar
  29. 29.
    Hall-Findlay EJ: A simplified vertical reduction mamma-plasty shortening the learning curve. Plast Reconstr Surg 1999;104(3):748–759CrossRefPubMedGoogle Scholar
  30. 30.
    Eed MD: A new personal surgical procedure for breast reduction and lif ing. Aesthetic Plast Surg 2000;24(3):206–211CrossRefPubMedGoogle Scholar
  31. 31.
    Spear SL, Giese SY, Ducic I: Concentric mastopexy revised. Plast Reconstr Surg 2001;107(5):1294–1299CrossRefPubMedGoogle Scholar
  32. 32.
    Hinderer U: Circumareolar dermo-glandular plication: a new concept for correction of breast ptosis. Aesthetic Plast Surg 2001;25(6):404–420CrossRefPubMedGoogle Scholar
  33. 33.
    Hall-Findlay EJ: Pedicles in vertical breast reduction and mastopexy. Clin Plast Surg 2002;29(3):379–391CrossRefPubMedGoogle Scholar
  34. 34.
    Hammond DC: The SPAIR mammaplasty. Clin Plast Surg 2002;29(3):411–421CrossRefPubMedGoogle Scholar
  35. 35.
    GrafR, Reis de Araujo LR, Rippel R, Neto LG, Pace DT, Biggs T: Reduction mammaplasty and mastopexy using the vertical scar and thoracic wall flap technique. Aesthetic Plast Surg 2003;27(1):6–12CrossRefPubMedGoogle Scholar
  36. 36.
    Qiao Q, Sun J, Liy C, Liu Z, Zhao R: Reduction mamma-plasty and correction of ptosis: dermal bra technique. Plast Reconstr Surg 2003;111(3):1122–1130CrossRefPubMedGoogle Scholar
  37. 37.
    Perez-Macias JM: Personal mastopexy technique for breast stabilisation: update. Br J Plast Surg 2004;57(2):178CrossRefPubMedGoogle Scholar
  38. 38.
    GrafR, Biggs TM: In search of better shape in mastopexy and reduction mammoplasty. Plast Reconstr Surg 2002;110(1):309–317CrossRefPubMedGoogle Scholar
  39. 39.
    Gasperoni C, Salgarello M, Gasperoni P: A personal technique: mammaplasty with J scar. Ann Plast Surg 2002;48(2):124–130CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Andreas Foustanos
    • 1
    • 2
  1. 1.Dimokrition UniversityGreece
  2. 2.Carol Davila UniversityBucharestRomania

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