Long Term Follow Up of Reduction Mammoplasy using Inferior Pyramidal Dermal Technique

The inferior pyramidal dermal technique has many advantages in various reduction mammoplasty procedures. It has been possible to increase the amount of breast tissue removed, which enhances the quality of the final result. However, the main disadvantage of this method is the large and long reverse T scars, particularly in Asian women. Twenty breasts of 10 patients, who underwent an operation by the inferior pyramidal dermal technique with several modification from March 1989 to March 2001 were followed up. The mean age was 35 and the mean follow up period was 5.5 years. The mean resection amount was 692 gm per breast. In order to prevent a boxy breast, the inferior margin of the medial flap had a gentle curve, and the lateral flap had a "lazy S" contour. A small triangle of the skin was leaved with its base on the inframammary fold to relieve the T-junctional tension. In order to ensure nipple projection, the skin was deepithelialized at the recipient site for the relocated nipple-areola complex and 2 cm around areola. Because the vascular supply to the nipple-areola complex of the pyramidal flap was derived from the intercostal perforating vessels, the full-thickness removal of the skin from the pyramidal flap was made to reduce the operation time. A sufficient parenchyma resection beneath the lateral flap was performed to minimize a boxy breast. A postoperative hyperpigmented scar became light after 2 years and was inconspicuous after 3 years. An immediate postoperative boxy breast was noticed. However, it has been observed that there was gradual increase in the distance from the inframammary fold to the areola, because of the descent of the breast parenchyma due to gravity, along with the displacement of the nipple-areola complex superiorly. It is believed that this problem can be overcome by pedicle trimming, medial and superior fixation sutures with the nipple areola complex 1-2cm being situated below the expected position.

Correction of Cryptotia Using Lotus Flower Shaped V-Y Advancement Flap and Auriculocephalic Sulcus Percutaneous Cinch Sutures

In cryptotia the upper part of the auricle is buried beneath the temporal scalp, so the upper auriculocephalic sulcus is absent and auricular cartilage deformity is accompanied. The goals of surgical correction of cryptotia are to release the upper ear from temporal scalp to restore auriculocephalic sulcus, and to correct the cartilage deformity. Authors have experienced 23 auricles in 14 patients with cryptotia to correct cryptotia using lotus flower shaped V-Y advancement flap for the upper auricular skin deficiency and scoring for cartilage deformity. Lotus flower shaped flap is designed above superior pole of auricle. Designed flap has wider lower third than conventional V-Y flap. After complete exposure of upper auricular cartilage, cartilage deformity is corrected by scorings on lateral surface of the scapha and medial surface of the superior crus of antihelix. For construction of auriculocephalic sulcus, the flap is advanced inferiorly about 1 cm and 3 stab incisions on the flap are made at the expected auriculocephalic sulcus. The cinch suture is done between dermal layer of the stab incisions and auriculocephalic sulcus cartilage with 4-0 Prolene . Packing gauze is tied at corrected scapha for contour maintenance. A satisfactory contour of scapha and antihelical crus and deep auriculocephalic sulcus were maintained postoperatively. However, hypertrophic scar formation was found due to tension. Our method is similar to Ono's method in triangular flap shape. But the lotus flower shaped flap has wider lower 1/3 than Ono's triangular flap and provides sufficient skin for formation of auriculocephalic sulcus without additional rhomboid flap elevation in front of the ear.