The three dermoglandular flap support in reduction mammaplasty.

BACKGROUND: Bilateral breast reduction is an established procedure performed to relieve the physical pain and psychological discomfort associated with heavy, pendulous breasts. Numerous techniques have been developed over the years with several refinements to obtain safe nipple-areola complex transposition and harmonious breast shape. Based on the experience of the senior author (M.P.), the three dermoglandular flap technique is proposed to achieve a safe and aesthetically pleasing breast reduction through the surgical concept of dermal support. METHODS: The authors analyzed the benefits of the three dermoglandular flap technique performed in a selected group of smoking patients with a potentially high risk of postoperative complications and high probability of breast ptosis recurrence (each patient had breast volume >1000 cc, breast nipple ptosis grade 3 on Regnault's scale, and body mass index >27). Blood supply to the nipple-areola complex was based on an inferior-central pedicle. RESULTS: Between 1995 and 2007, 47 smokers underwent bilateral breast reduction using the three dermoglandular flap technique. Their ages ranged from 37 to 63 years (mean, 49 years), and their average body mass index was 31.2 kg/m (range, 27 to 38). The overall complications rate was 14.9 percent. No wound breakdowns and no complete or partial necrosis of the nipple-areola complex was observed. Follow-up ranged from 18 to 48 months (mean, 32 months). CONCLUSIONS: : Three dermoglandular flap reduction mammaplasty produced good cone shape, soft texture, and fullness in the central and inferior pole with satisfactory breast projection and was stable over time. It offers a safe and practical approach in the treatment of challenging breast hypertrophy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Maximizing the use of precapsular space and the choice of implant type in breast augmentation mammaplasty revisions: review of 49 consecutive procedures and patient satisfaction assessment.

BACKGROUND: Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction. METHODS: Precapsular reaugmentation was performed in 49 patients who underwent cosmetic breast surgery revisions from 2004 to 2009. All patients had previously received breast implants but complained of implant malposition and dislocation, implant size change, capsular contracture, and symmastia. A precise neoprecapsular pocket was developed above the old anterior implant capsule wall, with dissection limited to create only the space necessary for proper placement of the implant. Patients were evaluated for resolution of symptoms, satisfaction, and complications. RESULTS: Implant malposition and rippling, capsular contracture, breast asymmetry, and symmastia were the most common complaints from the first augmentation. Nineteen women had subpectoral implant placement, 12 had subglandular, and the rest (n = 18) had "dual-plane" location of their implants. We used textured silicone implants in 17 cases and polyurethane-coated prostheses in the remaining 32 cases. The average follow-up time was 24.1 months. Breast augmentation-related complications had resolved in all patients without any recurrence to date. The overall complication rate was very low and patient satisfaction with this procedure was extremely high. CONCLUSION: The creation of a neoprecapsular pocket combined in peculiar cases with the placement of polyurethane-coated implants is a versatile option that offers an effective one-stage solution for the correction of cosmetic mammaplasty-induced deformities.