Inverted Keel Resection Breast Reduction

  • Ivo Pitanguy
  • Henrique N. Radwanski

Patients presenting with breast hypertrophy invariably complain of physical discomfort, especially of the skeletal system. Psychological evaluation many times reveals a state of unhappiness and self-consciousness, and may result in difficult social adaptation. In warm climates, as in Brazil, where participation in outdoor activities and sports is stimulated year-round, and where the media promote the use of lighter and more revealing attire, aesthetic complaints because of large, cumbersome breasts become more relevant. In our country, breast hypertrophy is among the most common contour deformities that present for surgical correction.

A personal modification of Arié's technique was initially presented in 1959, and published in the following year [1]. With the description of point A, which is the projection of the submammary sulcus along the midclavicular line, the vertical incision was extended above the nipple—areolar complex, with more satisfactory and longer-lasting results. Soon after, with the same principles, the Pitanguy technique [2], with the inverted keel resection, was developed for the treatment of large breast hypertrophy. These two procedures have served the purpose of approaching most aesthetic deformities of the breast, such as hypertrophy with or without ptosis, and represent the technical basis of many subsequent procedures.


Dead Space Breast Augmentation Breast Reduction Excess Skin Midclavicular Line 
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  1. 1.
    Pitanguy I: Breast hypertrophy. In: Wallace AB (ed). Transactions of the International Society of Plastic Surgeons. Second Congress, Edinburgh, Livingstone 1960, p 509Google Scholar
  2. 2.
    Pitanguy I: Une nouvelle technique de plastique mammaire: Estude de 245 cas consecutifs et presentation d'une technique personelle. Ann Chir Plastique 1962;7(3):199–208PubMedGoogle Scholar
  3. 3.
    Biesenberger H: Eine neue methode der mammaplastik. Zentrabl Chir 1928;38:2382–2387Google Scholar
  4. 4.
    Lexer E: Zur operation der mammahypertrophie und der hängebrust. Dtsch Med Wochenschr 1925;51:26CrossRefGoogle Scholar
  5. 5.
    Arié G: Una nueva técnica de mastoplastia. Rev Latinoamericana Cir Plast 1957;3:23Google Scholar
  6. 6.
    Pitanguy I: Contribuição a técnica do enxerto livre para a correção das grandes hipertrofias mamárias. (Personal contribution to the free-grafting technique in very large breasts). Rev Lat Americana Cir Plástica 1963;7(2):75Google Scholar
  7. 7.
    Pitanguy I: Surgical treatment of breast hypertrophy. Br J Plast Surg 1967;20(1):78–85CrossRefPubMedGoogle Scholar
  8. 8.
    Pitanguy I: The breast. In: Pitanguy I (ed). Aesthetic Plastic Surgery of Head and Body. Berlin, Springer 1981Google Scholar
  9. 9.
    Pitanguy I: Reduction mammaplasty by the personal technique. In: Chang WHJ (ed), The Breast: An Atlas of Reconstruction. Baltimore, Williams and Wilkins 1984, pp 75–160Google Scholar
  10. 10.
    Pitanguy I: Personal preferences for reduction mamma-plasty. In: Georgiade ND (ed). Aesthetic Surgery of the Breast. Philadelphia, Saunders 1990, p 167Google Scholar
  11. 11.
    Pitanguy I: Principles of reduction mammaplasty. In: Georgiade ND (ed), Aesthetic Surgery of the Breast. Philadelphia, Saunders 1990, p 191Google Scholar
  12. 12.
    Pitanguy I: Reduction mammaplasty: A personal odyssey. In: Goldwyn RM (ed.). Reduction Mammaplasty, Boston, Little, Brown 1990, p 95Google Scholar
  13. 13.
    Pitanguy I, Radwanski HN: Philosophy and principles in the correction of breast hypertrophy. In: Mang WL, Bull HG (eds). Ästhetische Chirurgie. Germany, EinhornPresse 1996, pp 216–232Google Scholar
  14. 14.
    Pitanguy I: Evaluation of body contouring surgery today: A 30-year perspective. Plast Reconstr Surg 2000;105(4): 1499–1514CrossRefPubMedGoogle Scholar

General References

  1. Goin MK: Psychological aspects of aesthetic surgery of the breast. In: Georgiade, N.D. (ed.). Aesthetic Surgery of the Breast. Philadelphia, Saunders 1990, p 19Google Scholar
  2. Gifford S: Emotional attitudes toward cosmetic breast surgery: Loss and restitution of the “ideal self.” In: Goldwyn RM (ed). Plastic and Reconstructive Surgery of the Breast. Boston, Little, Brown 1976, p 103Google Scholar
  3. Rees TD: Concepts of beauty. In: Rees TD (ed). Aesthetic Plastic Surgery. Philadelphia, Saunders 1980, p 1Google Scholar
  4. Baroudi R: Preoperative evaluation for breast surgery. In: Georgiade ND (ed). Aesthetic Surgery of the Breast. Philadelphia, Saunders 1990, p 19Google Scholar
  5. McCarty KS Jr, Glaubitz L, Thienemann M, Rief ohl R: The breast: Embryology, anatomy and physiology. In: Georgiade ND (ed.), Aesthetic Surgery of the Breast, Philadelphia, Saunders 1990, p 3Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Ivo Pitanguy
    • 1
  • Henrique N. Radwanski
    • 1
  1. 1.Ivo Pitanguy ClinicRio de JaneiroBrazil

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