Benelli Mastopeksy Scar Revision Using Vertical Mastopexy Insicion: A Case Report

Minimal or moderate breast ptosis can be treated with Benelli mastopexy technique in experienced hands. Tightening of the periareolar tissue, inappropraite suture usage, excessive tissue removal lead to severe complications in some patients. Patients with these complications is more than difficult to treat breast ptosis. It needs extra tissue to reduce the tensions in patients with wide circumareolar scar tissue and wide areolary complex. Vertical scar mastopexy technique can be used to treat these type of complications as a scar reduction methods.

A New Technique for Mastopexy and Reduction Mammaplasty: The Rolling Bilateral Flap Technique

Background: Numerous techniques have been proposed as “gold standard” for mastopexy, as for reduction mammaplasty. The quality of the breast parenchyma should be a primary factor in selecting the most appropriate technique for an individual case. Objective: The article describes a simple technique that can be used either for mastopexy or for reduction mammaplasty, giving optimal breast shape and position. It is appropriate for patients having some degree of ptosis, and especially for those in whom the glandular component of the breast predominates. Methods: The technique entails elevating the entire dome of the breast, rolling it under, and then stitching the two halves of the breast parenchyma together (lateral and medial dermoglandular flaps), while the upper pedicle (a third dermoglandular flap) bearing the nipple areolar complex (NAC) severed from the two inferior flaps is attached as a cap. The result is a new and attractive shape of the underlying supporting “barrel”. The technique can be performed with the T scar or the vertical scar approach. Results: The procedure was applied for various indications on 45 patients aged 20 - 62 years. Good results were only achieved in 36 women with predominant glandular component. Nine patients with fatty breasts achieved unsatisfactory results (6 with T scar, 3 with vertical scar) and very poor breast projection. Conclusions: The best-suited candidates for the proposed technique for mastopexy or reduction mammaplasty are women in whom the glandular component of the breast predominates. This simple technique, applicable with either inverted T scar or vertical scar approaches, carries very low morbidity, affording an attractive profile, long-lasting results, and conserving the patient’s ability to breast feed.

Breast Surgery with Application of Doughnut Mastopexy Lumpectomy Technique

Purpose: Doughnut mastopexy lumpectomy (DML) is a breast resection technique in which a tissue segment is removed and the breast reshaped through a doughnut-shaped de-epithelialized periareolar area. In this study, we attempted to determine whether the DML technique could be useful for other types of breast surgery, in addition to breast cancer lumpectomy. Methods: This study examined a total of 4 patients who underwent the DML technique and were followed up for at least 1 year postoperatively. One patient underwent phyllodes tumor resection, 1 patient underwent removal of a siliconoma, and 2 patients underwent breast reduction mammaplasty. Results: This method enabled en-bloc removal of a large tissue mass or large foreign body that could not be removed through a short periareolar incision. The surgical method of this study enabled the extent of de-epithelialization to be changed according to the size and location of the mass to be excised;good cosmetic results were also obtained. In addition, the surgical method enabled the facile excision of tumors and foreign materials. Conclusions: The DML technique is a useful surgical method that is applicable to other breast surgeries, in addition to breast cancer surgery.

Augmentation mastopexy and augmentation mammoplasty:an analysis of 1,406 consecutive cases

Aim:Simultaneous augmentation mastopexy is a challenging operation for esthetic plastic surgeons.Complication and revision rates following augmentation mammoplasty or mastopexy are less commonly seen when these two procedures are performed separately.However,when the two procedures are combined,the complication rate is reported exponentially higher when compared with its individual component carried out separately.The current retrospective chart review is a comparative analysis of the two procedures performed by a single surgeon.Methods:Retrospective data were collected using patient’s charts.All patients who had augmentation mammoplasty(Group A)or simultaneous augmentation with mastopexy(Group B)in muscle splitting biplane using round cohesive gel textured silicone implants by a single surgeon were included.Results:A total of 1,406 patients had consecutive augmentation mammoplasty or simultaneous augmentation mastopexy.Augmentation mammoplasty(Group A)included 1,298 and simultaneous augmentation with mastopexy(Group B)had 108 patients,respectively.The mean age of the patients in Group A and B was 29.6 years and 32.2 years,respectively(P=0.006).The mean size of the implants in Group A and B was 340 mL and 308 mL(P=0.001),respectively.Wound infection in Group A and B was seen in 0.6%and 3.7%,respectively.Wound breakdown was seen in 1.1%in Group A as compared to 6.5%in Group B(P=0.001).Revision surgeries were performed in 1.4%and 11.1%of Group A and B,respectively(P=0.001).Conclusion:There was a statistically and clinically significant higher rate of complications and revision rate noted in simultaneous augmentation with mastopexy(Group B)as compared to augmentation mammoplasty alone(Group A).However,the rise in complications rate is sum of the complications of the two individual components performed and not exponential.

Use of the multiplane internal mastopexy for ptosis correction revision-augmentation mammoplasty

Aim:Augmentation mammoplasty is a commonly performed procedure with a high satisfaction rate.Multiplane pocket was described for simultaneous internal mastopexy and augmentation using inframammary crease incision for selected primary and secondary mammoplasties.The use of the technique is presented with a larger experience for correction of ptosis in a patient presenting for revision surgery following subglandular augmentation mammoplasty.Methods:A retrospectively collected data were analyzed using the Excel Spread Sheet.A total of 25 patients had multiplane augmentation with the internal mastopexy following augmentation mammoplasty in subglandular pocket.Data of 25 patients who had their revision surgery in multiplane were analyzed.Results:The group included 25 patients with a mean age of 36.6 years(range:25-54 years)with mean implant duration of 6.4 years(range:1.5-13 years).Twenty-three of the patients were nonsmokers,1 smoker and 1 patient’s smoking status was not mentioned.Eighteen patients presented with grade I capsular contracture,3 patients with grade II contracture and 4 patients had a combination of grade I and II capsular contracture.Pseudoptosis was present in 6,class B ptosis in 6,A/B ptosis in 3,water-down deformity in 5 and rippling in 5 patients.Average preoperative size of implant used initially was 334.4 mL(range:250-340 mL)and the mean implant size selected for revision surgery was 416 mL(range:260-525 mL).Mean follow-up time was 18 months(range:6-48 months).Of 25 patients,21 had a bilateral procedure whereas the technique was used unilaterally in 4 patients for the correction of asymmetry.All patients had a single dose of intravenous antibiotics and followed by an oral course for 5 days,there was no infection noted in the series.In the current series,no patient required revision surgery following the multiplane internal mastopexy.Conclusion:Multiplane internal mastopexy can be useful in selected cases of revisionary augmentation mammoplasty.

A long term review of augmentation mastopexy in muscle splitting biplane

Aim:Simultaneous or single stage mastopexy with augmentation is challenging,unique and commonly performed by a plastic surgeon.In this procedure pocket for implant placement,marking for envelope reduction and type of implants used can affect the outcome of the procedure.Muscle splitting pocket for mastopexy is a plane described by the author for implant placement with a short term follow up.The use and outcome of the technique is presented with a larger series and a long term follows up to evaluate the efficacy of the procedure.Methods:Retrospective data was collected.Augmentation was performed using muscle splitting technique and periareolar,vertical scar and wise pattern were used for skin reduction and mastopexy.A single surgeon performed all procedures.Results:In total 108 patients mastopexy with augmentation in muscle splitting technique.The mean age of the patient was 32.2 years(range:18-67 years)with an average follow up of 4.5 years(range:3 months to 10 years).All patients had round textured cohesive gel silicone implants with a mean size of 308 cc(range:200-555 cc).Wound infection was seen in 4(3.7%),wound breakdown in 7(6.5%)patients.Drains were used in 25(23.1%).All patients were treated as day cases and revision surgery was performed in 12(11.1%).There was no hematoma,deep venous thrombosis(DVT)or nipple areolar complex in the series.Conclusion:Simultaneous augmentation mastopexy in muscle splitting pocket can be performed with good aesthetic results along with an acceptable revision rate.

One-stage mastopexy and augmentation mammoplasty in layers: outcome analysis of first 50 consecutive cases

Aim: The single-stage procedure is a challenging procedure for Plastic Surgeons. The single-stage layered mastopexy with augmentation is a new technique that is aiming to add safety, preserving breast function and to restore normal parameters of breast. Methods: A retrospective chart review of 50 consecutive cases of layered mastopexy with augmentation mammoplasties was performed. All patients had their implants placed in muscle splitting pocket. Incisions for mastopexy were selected on the basis of nipple areolar complex to inframammary crease. Mastopexy is performed using a medially based pedicle, leaving a sufficient tissue covering the implant. Patients were divided into three groups. Group 'A' who had periareolar mastopexy, Group 'B' had vertical scar mastopexy and Group 'C' patients had mastopexy with Wise pattern markings. Results: Group A comprised 11 patients. The mean age was 28.82± 7.01 years, mean preoperative and postoperative nipple areolar complex (NAC) to IMC measurement was recorded in 10 patients with the mean of 7.15± 1.98 cm and 8.35± 1.18 cm respectively. Mean size of the implant used was 379.55± 77.18 cm3. Group B comprised 29 patients. Mean age was 35.17± 12.37 years and the mean preoperative and postoperative NAC to IMC crease was 8.53± 1.48 cm and 9.72± 1.51 cm respectively. The mean implant size used was 289.48± 109 cm3. Group C had 10 patients. Mean age was 39.60± 12.15 years and the mean preoperative and postoperative NAC to IMC crease of 10.11± 1.24 cm and 8.75± 0.98 cm respectively. The mean implant size used was 287.00± 55.08 cm3. Conclusion: The procedure allows better arterial supply, wider area for venous and lymphatic drainage, better sensory innervation to NAC and maximises lactation potential of the breast.

Photometric analysis of absorbable barbed suture for periareolar closure in mastopexy

Aim:The primary author previously described his technique for periareolar closure in mastopexy using a pinwheel interlocking purse string with absorbable barbed suture and now reports the results of a retrospective photometric analysis comparing this technique with the same closure using Gortex®suture.This study is designed to compare the degree of areolar widening and safety profile of using absorbable barbed sutures for periareolar closure versus permanent smooth suture.Methods:A retrospective chart review was conducted of all patients whose periareolar closures were performed using an interlocking purse-string technique over a 10-year period.Only patients undergoing circumvertical mastopexy were included.All had photometric evaluation and follow-up performed within 6-24 months.Results:In total,20 patients(40 areolas),which were closed with absorbable barbed suture,were analyzed photometrically.In this suture group,areola size increased a mean of 4.9%from baseline,and no complications(0%)were observed.This compared favorably with previously reported complication rates using permanent sutures and with a series of cases presented herein in which permanent smooth suture was used for purse string closure.The degree to which absorbable barbed suture controls areolar spread was shown to be significantly better than those where permanent smooth purse string techniques were employed.Conclusion:Circumvertical mastopexy closures using absorbable barbed suture was shown to be safe and effective and compared favorably to older techniques using permanent smooth suture for similar closures.This paper lends support to the safety of using absorbable barbed suture in circumareolar closures to limit areolar spread.

The Extended Superomedial Pedicle: Advancing Mammaplasty Techniques

Many variations can be applied to traditional mammoplasty techniques to improve outcomes in certain situations. The purpose of this report was to demonstrate the indications and benefits of mammoplasty autoaugmentation using an extended superomedial pedicle. All patients who underwent transfer of an extended superopedicleto other parts of the breast for autoaugmentation were included. Indications were determined and outcomes were assessed. Forty-eight patients were included in the series. The average follow-up was 2.1 years. Indications were categorized into reconstruction of a partial mastectomy defect (oncoplastic group, n = 18), upper pole volume in the contralateral mastopexy (implant reconstruction group, n = 9), and volume improvement and suspension (massive weight loss group, n = 21). The overall complication rate was 15% (n = 7/48), with a revision rate of 10% (5/48). The extended superomedial pedicle is a reliable and versatile adjunct to regular mastopexy techniques for various indications. It gives us the ability to transfer vascularized tissue from the lower pole to areas that require autoaugmentation.

Preoperative planning and breast implant selection for volume difference management in asymmetrical breasts

Aim: To assess volume management in patients presenting with breast asymmetry and ptosis. Methods: Retrospectively collected data was analysed. The patients were divided into 3 groups. Group A included patients who had volumetric difference alone and had different size implants alone. Group B included patients who had volumetric difference with breast ptosis requiring mastopexy with different size implants. Group C included patients who presented with breast asymmetry with ptosis and had same size implants on both sides with different volume breast reduction. Results: Subgroup A1 included 145 patients who had larger implants placed on right side. Subgroup A2 included 95 patients who had larger implants on the left side. Subgroup B1 included 7 patients who had larger implants on the right. Subgroup B2 included 13 patients who had larger implant on the left side. Subgroup C1 included 7 patients who had larger reduction on right side. Subgroup C2 included 11 patients who had larger reduction on left. Conclusion: When different volume implants are used, the vast majority of the patients do not require a volume difference of more than 60 mL. When the breast is larger on the right then larger mean volumes are used on left side to offset the larger right breast.

Technical refinements of the modified central mound breast reduction

Aim: Common pitfalls with existing breast reduction techniques include poor aesthetic outcome, such as development of a 'boxy' breast shape, and pseudoptosis. Presented here are a series of modifications to the technique of central mound breast reduction, based on previous work, aimed at ensuring consistent aesthetic results which are maintained in the long-term. Methods: All patients undergoing bilateral breast reduction by the senior author over a 7-year period were included, with outcome data collected prospectively. A detailed description of the technique is offered. Results: One hundred and sixteen patients underwent bilateral breast reduction over the study period. Mean follow-up was 20.6 months. There were no cases of nipple necrosis or infection requiring antibiotics. There was one post-operative haematoma which required surgical evacuation. Three patients developed a degree of fat necrosis which was managed conservatively in two, but required surgical debridement for liquefactive necrosis in one. Results of these breast reductions at the second post-operative year and beyond are presented. Conclusion: The technique described offers benefits of improved predictability, consistency and longevity of aesthetic results over existing techniques. Development of pseudoptosis in particular is effectively delayed. The modifications described have not been shown to increase the rates of surgical complications.

A simple classification and a simplified treatment's algorithm for ptotic breasts

Aim: Many classifications have been described in the literature for ptotic breasts, focusing on the nipple areola complex position compared to the inframammary fold. These use centimeters and lateral views to illustrate their various grades in a manner always insufficient to propose a clear treatment plan aimed at achieving natural results. We discuss a new dynamic approach to breast ptosis with a complete treatment algorithm. Methods: Patients were examined in a standing position first with hands down then with hands up. We observed the elevation of the inter-nipple line called the 'BK-line' and its relationship to a sternal benchmark that we call the 'BK-Point'. The 'hands-up test' was positive when the line crossed the landmark. The algorithm defines the indication according to this clinical examination and to the patient's wishes. An angle between the nipple, the 'BK-point' and the body meridian (called the 'BK angle') was appreciated before and after surgery. This angle should become 90° or more after ptosis treatment. Results: Three hundred patients were treated for ptotic breasts, including breast reductions, from January 2010 to September 2017. The definitions of 'normal' non-ptotic and ptotic breast and the 'ideal' breast were reconsidered. The surgical indications were adjusted to the clinical situation and to the patient's wishes, refining the final version of the algorithm. Conclusion: This new classification is easy, reproducible and efficient. We propose an appropriate algorithm to treat every situation that takes care to consider patient's wishes and expectations.

Internal bra:a unifying solution for reconstructive and aesthetic breast surgery issues

The utility of the internal bra for breast support,reconstruction,and in revision breast surgery has been recognized and various materials have been introduced for this application.As clinical experience has grown and new products have been developed,the roles of these materials are becoming better defined.This paper reviews the use of the internal bra concept to date.