Vertical Mammaplasty: Vertical and Transverse Flaps through a Vertical Incision

Abstract

An adjustable vertical incision with a final length ranging from 6 to 7 cm is employed for reduction mammaplasty in moderate hypertrophy or ptosis of the breast. A vertical rectangular flap with an inferior pedicle at the inframammary fold and transverse triangular flaps supporting each one of the vertical columns of the breast were used to improve breast contour and projection. The vertical rectangular flap provides fullness for either the upper or the lower pole of the breast. It is fixed, bilaterally, over the aponeurosis of the pectoralis major from the second to the sixth intercostal spaces. Length, width, and thickness of the vertical rectangular flap changed with regard to the extent of breast ptosis and hypertrophy. Two transverse triangular flaps with apex turned superiorly were dissected from the vertical pillars created by the vertical incision with a pedicle supported on the inferior half of the vertical pillars at the incision margins. The criss-crossing of the triangular flaps creates a transverse support sling avoiding the downward displacement of the breast and vertical flap. The association of the vertical flap with the transverse triangular flaps provided the necessary projection and reduction of the breast diameter with long-term stabilization of the mammary cone. Resection of breast tissue is only carried out to fit the breast volume in the skin envelope.