Ann Surg Treat Res.  2016 Jan;90(1):10-15. 10.4174/astr.2016.90.1.10.

Four flap suspension technique for prevention of bottoming out after breast reduction

• Kankaya Y
• Oruc M
• Sungur N
• Aslan OC
• Gursoy K
• Ozer K
• Kocer U

• KMID: 2149926
• DOI: http://doi.org/10.4174/astr.2016.90.1.10

Abstract

PURPOSE
Bottoming-out deformity is accepted as the most important disadvantage of inferior pedicle breast reduction. For prevention of this deformity, different techniques are used in combination with inferior pedicle. In this study, we aimed to prevent bottoming-out deformity by producing an internal bra effect through combination of inferior pedicle technique with 2 superior and 2 inferior dermal flaps that were raised from each side of the pedicle.
METHODS
Thirteen patients whose medical records became available during the follow-up period at Ankara Training and Research Hospital from January 2010 to January 2015 were included in this study. We retrospectively obtained patient medical records including demographic characteristics and clinical data. Superior dermal flaps were planned on both sides of the pedicle 2 cm inferior to the lower border of areola and inferior dermal flaps were planned 6 cm inferior to the superior dermal flaps. The superior and inferior dermal flaps were secured to the periosteum of the 2nd and 4th ribs respectively with permanent sutures.
RESULTS
Preoperatively, the average distance between the inframammary fold and areola was 13.9 cm (range, 11-18 cm). The average amount of breast parenchymal resection was 745 g (range, 612-1,496 g). The average distance between the inframammary fold and the lower border of the areola was 7.9 cm (range, 7.5-9 cm) on the postoperative first-year measurements.
CONCLUSION
In conclusion, according to our study, suspension technique to prevent bottoming-out deformity is associated with an easier technique without the need for alloplastic or allogenic materials. Since fixation is performed to the ribs instead of soft tissues like the pectoral fascia or muscle, we believe that this fixation is more long lasting and can be an effective alternative to other suspension techniques.

Keyword

Mammaplasty; Breast reduction; Flap; Suspension

MeSH Terms

Breast*
Congenital Abnormalities
Fascia
Female
Follow-Up Studies
Humans
Mammaplasty
Medical Records
Periosteum
Retrospective Studies
Ribs
Sutures

Figure

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  Fig. 1 (A, B) Preoperative schematic drawings of inverted T scar inferior pedicle technique combined with dermal suspension flaps. (C) Measurement and planning of dermal flaps on pedicle. (D) Elevation of inferior pedicle and dermal suspension flaps.

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  Fig. 2 (A) Intraoperative deepithelization of inferior pedicle and dermal suspension flap. (B) Elevation of dermal suspension flaps and inferior pedicle. (C) Fixation of dermal flaps to periosteum of 2nd and 4th costa.

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  Fig. 3 Case 1: (A) preoperative anteroposterior view; (B) preoperative left oblique view; (C) preoperative left lateral view; (D) anteroposterior view at postoperative year 1; (E) left oblique view at postoperative year 1; (F) left lateral view at postoperative year 1.

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  Fig. 4 Case 2: (A) preoperative anteroposterior view; (B) preoperative left oblique view; (C) preoperative left lateral view; (D) anteroposterior view at postoperative year 1; (E) left oblique view at postoperative year 1; (F) left lateral view at postoperative year 1.

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