RESUMO
Background: The demand for augmentation-mastopexy surgery without using implants has significantly increased over the years. Fat transfer offers an alternative method, but some patients do not favor this procedure either. The purpose of this study was to evaluate the versatility of using a lateral-based mammary flap as an "auto-implant" for enhancing the breast mound for patients undergoing primary mastopexy. Method: This retrospective study was performed between February 2016 and April 2019, including 36 female patients (72 breasts). Our technique involves using the inferior breast tissue by elevating the lateral-based dermoglandular flap that was moved cranially with a 90 degree rotation in a conical shape within the created pocket to refill the superior and central mound. Result: The mean nipple projection was 11.2 after 36 months postoperative compared with 5.2 before surgery. The mean ± SD of pre- and postoperative measurements for the lower pole zone were 80.2 ± 10.5 and 50.1 ± 6.4, and those for the upper pole zone were 40.3 ± 9.5 and 63.9 ± 6.5, respectively. The distance of breast mound elevation after the surgical procedure ranged from 5.30 to 9.55 cm, with a mean of 7.90 cm. Conclusions: The lateral-based mammary flap acts like an implant that helps shape and augment the breast, enhances the mammary projection, and restores the breast contour without requiring a synthetic implant or fat grafting. It is a reliable technique with high patient satisfaction but is unsuitable for patients with insufficient breast volume.
RESUMO
BACKGROUND: Revision augmentation-mastopexy is a complex procedure that aims to correct the complications of a previous surgery. The purpose of this study was to evaluate the reliability of the inferior-based dermoglandular flap with partial subpectoral implant coverage to correct implant- and tissue-related complications associated with primary subglandular breast augmentation and its influence on improving outcomes. METHODS: This was a retrospective study in which a total of 53 patients (106 breasts) underwent revision augmentation-mastopexy using the double coverage technique for an implant with an inferior-based dermoglandular flap and superior-based pectoralis major muscle (biplane) as the first layer and a nipple-areolar flap with breast pillars as the second layer. This technique provides a suspensory reconstruction that acts as hammock to minimize the pressure on the inframammary fold and maintain position integrity. RESULTS: The follow-up period ranged from 2.3 to 4 years (mean 3.6 years), and the recorded complications were minor wound dehiscence less than 1 cm2 at the "T" junction in three breasts (2.83 %) and mild hypertrophic scarring in five breasts (4.72%). CONCLUSION: The use of an inferior-based dermoglandular flap with partial subpectoral biplane implant reinforcement allows autologous support and double coverage to decrease the incidence of implant- and tissue-related complications, especially pseudoptosis, lower pole widening, capsular contracture, rippling, and implant visibility. It achieves enhanced upper pole fullness, medial cleavage, projection, and breast volume. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
