The Triple-Flap Interposition Mammaplasty

The history of reduction mammaplasty from 1980 until now can be seen as a period of refinements of existing techniques which mostly focused on the reduction of the final scar. These existing techniques were established in the late fif ies to the late seventies, a period defined by Cardoso de Oliveira in Goldwyn's “Reduction mamma-plasty” as the “period of safety” [1]. Many of these techniques share the principle of Lexer-Kraske [2, 3], that is, central wedge dissection in the lower half and approximation of the lateral poles to form the breast. Almost all techniques reinforced an element that was felt to be neglected before and is nowadays associated with Schwarzmann [4], that is, deepithelialization of the skin around the areola and avoidance of skin separation from the gland to respect the cutaneous—glandular unity.

However, less consideration has been given to what we believe to be the fundamental principle in reduction mammaplasty. To produce a long lasting aesthetically pleasing breast shape, the gland itself has to be altered into the desired form. Some breasts need to have reduction in their base to control the height and form of the conical projection. Thus, there may be need for dissection of the gland from the pectoralis fascia. Other breasts need a reduction in their axillary pole and have to be put into a more medial position, with the areola on the apex of the newly created cone. Consequently, it may be necessary to manipulate the lateral and medial poles.