Abo Zeid, M., Badawi, D. (2019). Augmentation Mastopexy: Implementing Autologous Breast Tissue for Optimum Results; Case Series Study with a Nine-Month Follow-up. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(1), 31-39. doi: 10.21608/ejprs.2019.65153
Mohamed Fathi Abo Zeid; Dina Badawi. "Augmentation Mastopexy: Implementing Autologous Breast Tissue for Optimum Results; Case Series Study with a Nine-Month Follow-up". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 1, 2019, 31-39. doi: 10.21608/ejprs.2019.65153
Abo Zeid, M., Badawi, D. (2019). 'Augmentation Mastopexy: Implementing Autologous Breast Tissue for Optimum Results; Case Series Study with a Nine-Month Follow-up', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(1), pp. 31-39. doi: 10.21608/ejprs.2019.65153
Abo Zeid, M., Badawi, D. Augmentation Mastopexy: Implementing Autologous Breast Tissue for Optimum Results; Case Series Study with a Nine-Month Follow-up. The Egyptian Journal of Plastic and Reconstructive Surgery, 2019; 43(1): 31-39. doi: 10.21608/ejprs.2019.65153
Augmentation Mastopexy: Implementing Autologous Breast Tissue for Optimum Results; Case Series Study with a Nine-Month Follow-up
The Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
Abstract
Background: Augmentation mastopexy of small and medium sized ptotic breasts presents one of the greatest challenges to plastic surgeons. That because both these procedures have opposing effects on the breast parenchyma and skin. The primary objective of our study is to explore the reliability of the lower pole triangular dermoglandular flap sutured to the pectoral fascia in the improvement of the results regarding both the aesthetic appearance and the long term maintenance. Methods: The study was conducted in Royal Hospital, Cairo, Egypt during the period from June 2013 to December 2015. The study included female patients undergoing augmentation mastopexy; some were implant-based while others were based on the autologous breast tissue, depending on the patient's desire whether to increase the cup size or to retain the same size. All patients were evaluated by detailed history, careful physical examination and photographed pre and postoperative. At the lower pole of the breast, we created a dermoglandular flap which is triangular in shape. We did not dissect it deeply from the pectoralis fascia. The flap was kept at the lower pole in cases of implant-based augmentation. However, in autologous augmentation, it was freed along the margins and mobilized to provide upper and medial fullness. After surgery, all cases were followed up for nine months to assess the outcomes of the procedure. Results: Sixty subjects were included in the analysis of this study. The age of the patients ranged from 22 to 48 years with a mean age at presentation of 34.1 (6.5) years. All patients requested to improve the projection of the breast together with the lifting of the NAC. Thirty-six patients (60%) desired to increase the cup size and accordingly underwent implantbased augmentation with mastopexy. Twenty-four patients (40%) wanted to retain the same size and therefore underwent auto-augmentation mastopexy. The patients were very satisfied with the outcome of the operation in most of the cases (54 cases), satisfied in 6 cases, and we had no unsatisfied patients. Statistically, there was a significant (p < 0.001) reduction in the cup size during the postoperative follow-up period than in the preoperative cup sizes. Preoperatively, thirty percent of patients were cup size A, 45% B and 25% C. Postoperatively, eighty percent of patients were cup size C and 15% B at all follow-up visits. 31 The maintenance of improvement of ptosis was measured by the distance between the suprasternal notch (SSN) and 12 O'clock point of the NAC (12'NAC), as well as by the distance between the 6 O'clock point of the NAC (6'NAC) and the IMF. The distance between the SSN to the 12'NAC varied between 31 and 24cm preoperatively (mean±SD: 26.7±2.1cm), and between 22 and 20cm postoperatively at nine months (mean ± SD: 21.0±0.8cm), (p-value <0.001). Besides, the distance between the 6'NAC and the IMF pre-operatively varied between 8 and 12cm, and at the postoperative followup < br />visits, it ranged from 6.5 to 8cm, (p-value<0.001). No complications detected in 44 cases (73%), Wound problems (puckering, infection, dehiscence) in 7 (12%) and Asymmetry in 9 (15%). All complications resolved by time. Conclusion: Finally, we can conclude that the triangular dermoglandular flap proved to (i) provide long-term support for the nipple- areola complex in its new position, (ii) support the breast implant inferiorly, and (iii) increase the mass and the fullness of the upper breast for autologous tissue-based augmentation. The method presented is simple, efficient and competent for both implant-based as well as autologous tissuebased augmentation mastopexy operations.
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