Dermo-Fascial Suspension in Mastopexy for Improvement of Aesthetic Outcomes

Kamel, Ibrahim H

doi:10.21608/ejprs.2020.68200

Dermo-Fascial Suspension in Mastopexy for Improvement of Aesthetic Outcomes

Document Type : Original Article

Author

Ibrahim H Kamel

The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

10.21608/ejprs.2020.68200

Abstract

Background: Mastopexy is the art of restoring breast
volume and its youthful appearance.
Aim: We present a surgical technique for simultaneous
mastopexy using auto-augmentation by superiorly based
dermoglandular flap. In addition, we use two dermo-facial
flaps to support the breast tissue in high position to restore
and maintain central mound projection and elevate inframammary
fold.
Patients and Methods: Auto-augmentation mastopexy
was performed for 36 patients using vertical superior pedicle
deepithelialized dermoglandular flap that inserted beneath
the breast tissue. Two opposing dermo-facial flaps based on
medial and lateral pillars along the vertical line were used to
support the deepithelialized dermoglandular tissue that sutured
to anterior chest wall and to each other.
Results: During follow-up period there was no bottoming
out of breast tissues or other major adverse effects except for
mild asymmetry in early 3 patients and patients showed high
rate of satisfaction by the results. The results confirmed that
this technique corrects ptosis while increasing the projection
and apparent volume of the breast and keep inframammary
fold (IMF) in high position with minimal degree of descend
which is parallel to that of the nipple.
Conclusion: The combined use of dermo-fascial flap to
support the glandular tissue with auto-augmentation mastopexy
improves the shape; projection and contour of the breast and
it also help to have long lasting results. The advantage of the
technique is that it optimizes the shape and volume of the
breast and creating a narrow breast base with a new high
inframammary fold without the use of an implant. With this
technique recurrent breast ptosis can be minimized after
mastopexy procedures.
Evidence Based Medicine: Level IV, case series.

Keywords

Main Subjects

Aesthetics

References

1- Romrell L. and Bland K.I.: Anatomy of the breast, axiilla,
chest wall, and related metastatic sites. In Bland K.I. and
Copeland E.M. (eds.): The breast; comprehensive management
of benign and malignant diseases. Philadelphia;
Saunders Company, 1991.
2- Bostwick J.: Plastic and reconstructive breast surgery. St.
Louis: Quality Medical Publishing, p. 67, 1990.
3- Lockwood T.E.: Superficial fascial system (SFS) of the
trunk and extremities: A new concept. Plast. Reconstr.
Surg., 87: 1009, 1991.
4- Van Deventer P.V., Graewe F. and Würinger E.: Improving
the Longevity and results of mastopexy and breast reduction
procedures: Reconstructing an internal breast support
system with biocomppatible mesh to replace the supporting
function of the ligamentous suspension. Aesth. Plast.
Surg., 36: 578-589, DOI 10.1007/s00266-011-9845-2,
2012.
5- Singh D., Forte A.J., Apostolides J., Zahiri H.R., Stromberg
J. and Alonso N.: Z-Mammoplasty: A novel concept in
mastopexy. E Plasty, 11: e29, 2011.
Egypt, J. Plast. Reconstr. Surg., October 2019 481
6- Strombeck J.: Loockwood. Mammoplasty: Report on new
technique based on the two-pedicle technique. Br. J. Plast.
Surg., 13: 79, 1960.
7- McKissock P.: Reduction mammoplasty with a vertical
dermal flap. Plast. Reconstr. Surg., 49: 245, 1972.
8- Hindrer U.: The dermal breastiere mammoplasty. Clin.
Plast. Surg., 3: 349, 1976.
9- Goulian D.Jr.: Dermal mastopexy. Plast. Reconstr. Surg.,
47: 105, 1971.
10- Bustos R.A.: Periareolar mammoplasty with silicone
supporting lamina. Plast. Reconstr. Surg., 89: 646-657,
1992.
11- Johnson G.W.: Central core reduction mammoplasties and
Marlex suspension of breast tissue. Aesthet. Plast. Surg.,
5: 77-84, 1981.
12- Grotting J.C., Marx A.P. and Chen S.M.: Masatopexy. In
Mathes S.J. (ed.): Plastic Surg. 2nd edition, Philadelphia;
Elsevier Inc., p. 47, 2006.
13- Awad M., Al-Leithy I.M., Abd-Aal M. and Mahmoud N.:
Dermofascial suspension of the breast in cases of gigantomastia.
Egypt. J. Plast. Reconstr. Surg., 30: 171, 2006.
14- Regnault P.: Breast ptosis: Definition and treatment. Clin.
Plast. Surg., 34 (2): 193-203, 1976.
15- Rohrich R.J., Thornton J.F., Jakubietz R.G., Jakubietz
M.G. and Grünert J.G.: The limited scar mastopexy:
Current concepts and approaches to correct breast ptosis.
Plast. Reconstr. Surg., 114: 1622-1630, 2004.
16- Pusic A.L., Klassen A.F., Scott A.M., Klok J.A., Cordeiro
P.G. and Cano S.J.: Development of a new patient-reported
outcome measure for breast surgery: The breast-Q. Plastic
& Reconst. Surgery, 124 - Issue 2: 345-353, 2009.
17- The American Society for Aesthetic Plastic Surgery,
cosmetic surgery national data bank statistics, 2015.
18- Nahabedian M.: Breast deformities and mastopexy. Plast.
Reconstr. Surg., 127: 91e, 2011.
19- Hönig J.F., Frey H.P., Hasse F.M. and Hasselberg J.:
Autoaugmentation mastopexy with an inferior-based
pedicle. Aesth. Plast. Surg., 33: 302-307, DOI
10.1007/s00266-009-9310-7, 2009.
20- Goes J.C.S.: Periareolar mammoplasty with mixed mesh
support: The double skin technique. Plast. Reconstr. Surg.,
89: 459-467, 1992.
21- Goes J.C.S.: Periareolar mammoplasty: Double skin technique
with application of polyglactin or mixed mesh. Plast. Reconstr.
Surg., 97: 959-968, 1996.
22- Ryan J.J. and Alowen: Thoracic advancement flap in breast
reconstruction aafter mastectomy. Plast. Reconstr. Surg., 70:
153, 1982.
23- Joa G. and Sampio Goes: Periareolar mammoplasty: Double
skin technique with application of polygalactine or mixed
mesh. Plast. Reconstr. Surg., 97: 5, 1996.
24- Kejour M. and Abbound M.: Vertical mammoplasty without
inframammary scar and with breast liposuction. Perspect.
Plast. Surg., 4: 67, 1996.
25- Foustanos A. and Zavrides H.: A double-flap technique: An
alternataive mastopexy approach. Plast. Reconstr. Surg.,
120: 55-60, 2007.
26- Boehm K.A. and Nahai F.: Mastopexy. In: Nahabedian M.Y.,
ed. Cosmetic and Reconstructive Breast Surgery. London:
Saunders (Elsevier), 109-118, 2008.
27- Ritz M., Silfen R. and Southwick G.: Fascial suspension
matoppexy. Plast. Reconstr. Surg., 117: 86-94, 2006.
28- Graf R. and Biggs T.M.: In search of better shape in mastopexy
and reduction mammoplasty. Plast. Reconstr. Surg., 110:
309-317, 2002.
29- Adams W.Jr.: Discussion of the article: In search of better
shape in mastopexy and reduction mammoplasty by Ruth
Graf M.D. and Thomas M. Biggs M.D. Plast. Reconstr.
Surg., 110: 321, 2002.
30- Marche D. and de Olarte G.: Reduction mammoplasty and
correction of ptoosis with a short inframammary scar. Plast.
Reconstr. Surg., 69: 45, 1982.
31- Lejour M.: Vertical mammoplasty and liposuction of the
breast. Plast. Reconstr. Surg., 94: 100, 1994.
32- Kejour M.: Vertical mammoplasty: Early complications after
250 personal consecutive cases. Plast. Reconstr. Surg., 104:
764, 1999.
33- Loockwood T.: Reduction mammoplasty and mastopexy
with superficial fascial system suspention. Plast. Reconstr.
Surg., 103: 1411, 1999.
34- Al-Liethy I. and Emara M.: Superficial fascial system of the
breast: A histologic study. Sc. J. Al-Azhar, 26: 2, 2005.
35- Abdelaal M. and Aboelatta Y.A.: Dermo-fascial suuspension;
better contouring and long lasting results with reduction
mammoplasty. Aesth. Plast. Surg., 39: 78-83 DOI
10.1007/s00266-014-0433-0, 2015.
36- Stevens W.G.1, Stoker D.A., Freeman M.E., Quardt S.M.
and Hirsch E.M.: Mastopexy revisited: A review of 150
consecutive cases for complication and revision rates. Aesthet.
Surg. J., 27 (2): 150-4. doi: 10.1016/j.asj.2006.12.014, 2007.
37- Migliori F.: Upside-Down augmentation mastopexy. Aesth.
Plast. Surg., 35: 593, 2011.
38- Rohrich R.J., Gosman A.A., Brown S.A. and Reisch J.:
Mastopexy preferences: A survey of board-certified plastic
surgeons. Plast. Reconstr. Surg., 118: 1631-1638, 2006