Comparative Study between No Vertical Scar Reduction Mammoplasty and Subcutaneous Mastectomy with Free Nipple and Areola Grafting in Management of Post Bariatric Marked Breast Ptosis

Emad, Amed; Basuoni, Ahmed Saeed; Ali, Mahmoud F. S.; Abdel Hady, Marwa Shehta

doi:10.21608/ejprs.2023.319947

Comparative Study between No Vertical Scar Reduction Mammoplasty and Subcutaneous Mastectomy with Free Nipple and Areola Grafting in Management of Post Bariatric Marked Breast Ptosis

Document Type : Original Article

Authors

¹ The Departments of Plastic Surgery, Faculty of Medicine, Beni Suef University

² The Department of Radiodiagnosis, Faculty of Medicine, Beni Suef University

³ The Department of Plastic Surgery, Faculty of Medici Faculty of Medicine, Beni Suef University

10.21608/ejprs.2023.319947

Abstract

Background: Marked breast ptosis in males is considered
one of the most challenging problems for plastic surgeons
and so many techniques have been used in the last few years
trying to give the patients the best esthetic outcomes, our
research will help us to determine the proper management for
such patients.
Objectives: To compare between no vertical scar reduction
mammoplasty and subcutaneous mastectomy with free NAC
grafting in management of post bariatric marked breast ptosis
cases regarding patient satisfaction, objective esthetic outcome.
Methods: This is a prospective, comparative, randomized
and descriptive study of 30 male patients suffering from postbariatric
marked breast ptosis. The patients were divided into
two groups; Group A subjected to no vertical scar reduction
mammoplasty technique (15 patients). Group B subjected to
subcutaneous mastectomy with free NAC grafting technique
(15 patients). Both groups were compared for objective esthetic
outcome, patient satisfaction and rate complications.
Results: Both techniques resulted in a good satisfaction
rate through getting red from excess skin and breast tissue.
Cases that were managed by no vertical scar technique had
little NAC complications but were more liable to contour
irregularities and asymmetries, on the other hand better esthetic
outcomes but more NAC complications occurred with cases
managed by subcutaneous mastectomy with free NAC grafting
technique.
Conclusion: No vertical scar reduction mammoplasty
technique has better results regarding preservation of NAC
sensation and color, while subcutaneous mastectomy with
free NAC grafting technique provides a better breast contour
and little irregularities but carries more risk of NAC complications.

Keywords

Main Subjects

Aesthetics

References

https://www.plasticsurgery.org/documents/News/Statistics/
2016/body contouring-gender-confirmation-surgery-
2016.pdf. Accessed 12 Apr 2018.
2- Cogliandro A., Barone M., Cassotta G., Salzillo R. and
Persichetti P.: Mastopexy on reconstructed breast following
massive weight loss: An innovative technique using
Dermo-Capsular flaps. Aesthetic Plast Surg., 42: 396-
399, 2008.
3- Marco Ettore Attilio Klinger, Valeria Bandi, Valeriano
Vinci, Davide Forcellini and Luca Maione: Innovations
in the Treatment of Male Chest Deformity after Weight
Loss: The Authors' Technique. Aesth. Plast. Surg., 35:
856-858, 2011.
4- Examination of the massive weight loss patient and staging
considerations. Plast Reconstr Surg., 117 (Suppl 1): 22S-
30S, 2006.
5- Finckenstein J.G. and Wolf H.: Chest lifting. Aesthetic
Plast. Surg., 30: 286-293, 2006.
6- Fruhstorfer B.H. and Malata C.M.: A systematic approach
to the surgical treatment of gynaecomastia. Br. J. Plast.
Surg., 56: 237-246, 2003.
7- Aslan G., Tuncali D., Terzioglu A. and Bingul F.: Periareolar-
transareolar-perithelial incision for the surgical
treatment of gynecomastia. Ann. Plast. Surg., 54: 130-
134, 2005.
8- Hage J.J. and Bloem J.J.: Chest wall contouring for femaleto-
male transsexuals: Amsterdam experience. Ann. Plast.
Surg., 34 (1): 59-66, 1995.
9- Bishara S. Atiyeh, Saad A. Dibo and Shady N. Hayek:
Contouring of the Male Anterior Chest Following Bariatric
Surgery and Massive Weight Loss. Aesthetic Surgery
Journal., Volume 28, Number 6 November/December
2008.
10- Ibrahim Hussein Kamel: Free Nipple Grafting as A Simple
Technique in Severe Forms of Post-Bariatric Male Pseudogynecomastia.
Egypt, J. Plast. Reconstr. Surg., Vol. 43,
No. 2: 197-202, July 2019.
11- Webster J-P.: Mastectomy for gynecomastia through
semicircular intra-areolar incisions. Ann. Surg., 124: 557,
1946.
12- Ibrahiem S.M.: Severe gynecomastia. New technique
using superior pedicle NAC flap through a circumareolar
approach. Ann. Plast. Surg., 76: 645-651, 2016.
13- Fruhstorfer B.H. and Malata C.M.: A systematic approach
to the surgical treatment of gynaecomastia. Br. J. Plast.
Surg., 56: 237-246, 2003.
14- Davidson B.A.: Concentric circle operation for massive
gynecomastia. Plast. Reconstr. Surg., 63: 350-375, 1979