Lateral Wings Suspension Technique for Improving the Results of Inferior-Pedicle Breast Reduction in Patients Attending Main University Hospital of Alexandria, Egypt

Document Type : Original Article

Authors

The Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, Egypt

Abstract

Background: The inferior pedicle wise pattern breast
reduction is one of the most popular techniques used. However,
a major criticism of inferior pedicle technique is bottoming
out of the breast and lack of upper pole fullness. This is caused
by gravitational pressure of the breast parenchyma/pedicle
on the inferior pole with subsequent scaphoid appearance in
the upper pole and lengthening of the vertical scar. In this
study, a modification of the inferior pedicle technique will be
done by creation of two lateral dermal flaps alongside with
the inferior pedicle, and using these flaps to suspend the
pedicle to the chest wall and prevent its descent to evaluate
its effect on prevention of bottoming out of the breast.
Patients and Methods: This is a prospective randomized
study that included 20 healthy female patients suffering from
breast hypertrophy and they are candidate for reduction
mammoplasty by the proposed technique. Design of skin
marking for inferior pedicle breast reduction technique was
carried out with the standard wise pattern with the creation
of two wings (medial and lateral) at the middle of the inferior
pedicle; composed of de-epithelialized dermal flaps. Buttressing
these two wings to the pectoral fascia at the suitable
distances would create a sort of an internal bra effect; which
supports the inferior pedicle. During the follow up, the length
of the vertical scar (as an indicator of bottoming out) was
measured immediately postoperative and every 3 months in
the follow-up period.
Results: This study includes 20 female patients of an age
ranged between 22-51 years old and a breast size (suprasternal
notch to nipple distance) ranging from 31 to 44cm. The followup
for 1-year post-operative shows change in the areola to
fold distance by a ratio satisfaction reaching 60%.
Conclusion: From this study we concluded that the inferior
pedicle suspension to pectoral fascia improve the result shape
of the breast and decrease the bottoming out of the breast.

Keywords

Main Subjects


1- Erdogan B., Ayhan M., Deren O. and Tuncel A.: Importance
of Pedicle Length in Inferior Pedicle Technique and Long-
Term Outcome of Areola-to-Fold Distance. Aesth. Plast.
Surg., 26: 436-43, 2002.
2- Lickstein L.H. and Shestak K.C.: The conceptual evolution
of modern reduction mammaplasty. Oper. Tech. Plast.
Reconstr. Surg., 6 (2): 88-96, 1999.
3- Magdy A.: Three Slips Dermo-Fascial Brassiere Breast
Reduction Technique. J. Plast. Reconstr. Surg., 32 (1):
23-30, 2008.
4- Small K.H., Tepper O.M., Unger J.G., Kumar N., Feldman
D.L., Choi M., et al.: Re-defining pseudoptosis from a
3D perspective after short scar-medial pedicle reduction
mammaplasty. J. Plast. Reconstr. Aesth. Surg., 63: 346-
53, 2010.
5- Awad M., AL-Leithy I.M., Abd-Aal M.M. and Mahmoud
N.: Dermofascial Suspension of the Breast in Cases of
Gigantomastia. Egypt J. Plast. Reconstr. Surg., 30 (2):
171-6, 2006.
6- Abdelaal M.M. and Aboelatta Y.A.: Dermo-Fascial Suspension
for Better Contouring and Long Lasting Results
in Reduction Mammoplasty. Aesth. Plast. Surg., 39: 78-
83, 2014.
7- Brown R.H., Izaddoost S. and Bullocks J.M.: Preventing
the "bottoming out" and "star-gazing" phenomena in
inferior pedicle breast reduction with an acellular dermal
matrix internal brassiere. Aesth. Plast. Surg., 34 (6): 760-
7, 2010.
8- Nahabedian M.Y. and Mofid M.M.: Viability and sensation
of the nipple-areolar complex after reduction mammaplasty.
Ann. Plast. Surg., 49: 24-31, 2002.
9- Widgerow A.D.: Breast reduction with inferior pedicle
fascial suspension. Aesth. Plast. Surg., 29 (6): 532-7,
2005.
10- De Araujo Cerqueira A. Mammaplasty: Breast fixation
with dermo-glandular mono upper pedicle under the
pectorals muscle. Aesth. Plast. Surg., 22: 276-82, 1998.
11- Graf R., Biggs T. and Steely R.: Breast shape: A technique
for better upper pole fullness. Aesth. Plast. Surg., 24:
348-54, 2000.
12- Pennington D.G.: Improving the results of inferior pedicle
breast reduction using pedicle suspension and plication.
Aesth. Plast. Surg., 30 (4): 390-4, 2006.
13- Pérez-Macías J.M.: Long-lasting evolution of ptosis control
after reduction mammaplasty using the hammock technique.
Aesthetic Plast. Surg., 31: 266-74, 2007.
14- Kankaya Y., Oruç M., Sungur N., Aslan C., Gürsoy K.,
Özer K., et al.: Four flap suspension technique for pre-
462 Vol. 43, No. 3 / Lateral Wings Suspension Technique for Improving the Results
vention of bottoming out after breast reduction. Ann.
Surg. Treat. Res., 90 (1): 10-5, 2016.
15- Gabka C. and Bohmert H.: Introduction in Aesthetic and
Plastic Surgery of the Breast. In: Plastic and reconstructive
surgery of the breast, 2nd edition, Thieme. Stuttgart &
New York, (1) 14, 2009.
16- O'Grady K.F., Thoma A. and Dal Cin A.: A comparison
of complication rates in large and small inferior pedicle
reduction mammaplasty. Plast. Reconstr. Surg., 115 (3):
736-42, 2005.
17- Brown R.H., Izaddoost S. and Bullocks J.M.: Preventing
the "bottoming out" and "stargazing" phenomena in inferior
pedicle breast reduction with an acellular dermal matrix
internal brassiere. Aesthetic Plast. Surg., 34: 760-7, 2010.
18- Graf R. and Biggs T.M.: In search of a better shape in
mastopexy and reduction mammaplasty. Plast. Reconstr.
Surg., 110 (1): 309-17, 2002.
19- Echo A., Guerra G. and Yuksel E.: The dermal suspension
sling: Shaping the inferiorpedicle during breast reduction.
Aesthetic Plast. Surg., 35: 608-16, 2011.
20- Aydin H., Tumerdem B., Onel D. and Cerci Ozkan A.:
Reduction mammaplasty using inferior pedicle technique
combined with dermal suspension. Plast. Reconstr. Surg.,
111: 1362-3, 2003.
21- Goes J.C.: Periareolar mammaplasty:double skin technique
with application of polyglactine or mixed mesh. Plast.
Reconstr. Surg., 97: 959-68, 1996