Abstract: Bipedicled Pectoralis Major Muscle Flap Suspension Mastopexy

Abstract

INTRODUCTION: A great challenge in aesthetic breast surgery is the long-standing result of breast contour and upper pole fullness. 1, 2 Various techniques have been proposed in order to deal with the long-term post-operative ptotic breast shape.1–5 This study aims to assess the long-term cosmetic results achieved through author’s technique of mastopexy. METHODS: Between January of 2012 and December of 2015, 31 women (62 breasts) underwent consecutive bilateral primary mammaplasty performed by a single surgeon for the treatment of breast ptosis (grade 2 or 3) or breast hypertrophy. The assessments considered the degree of satisfaction of patients and the evaluation of the 62 breasts by two referees in a scale from 1 (poor) to 3 (good) with preoperative and postoperative photographs. Each patient could be scored from 2 (poor) to 6 (excellent). The agreement between the referees was measured by Cohen’s Kappa statistics. Patient’s age, Body Mass Index (BMI), number of pregnancies, resected breast volume, and complications were also analyzed. The technique used was performed under general anesthesia. The aesthetic breast reduction/mastopexy, with skin markings designed in a Pitanguy/Wise inverted “T” pattern, proposes a parenchymocutaneous flap tethered to the thoracic wall (simulating a breast implant) supported by a bipedicled pectoralis major muscle flap. RESULTS: The mean patients’ age was 34 year-old (17–65), the BMI at the time of surgery ranged between 20.76 and 31.38 kg/m2 (mean=25.71) and the number of pregnancies ranged between 0 and 3 (mean 0.92). The resected volume of each breast ranged between 0 and 742g (mean 338.92). Three women complained of pain (5 of 62 breasts, 8.1%), 2 women had bilateral dehiscence of vertical scar at the 3rd post-operative week (4 of 62 breasts, 6.5%), one of them being subjected to further surgery, she was a heavy smoker and had bilateral dehiscence after the second procedure as well. 97% of the patients felt satisfied and 82% felt very satisfied with breast shape at about one year after the surgery. The observers mean score was 4.57 (SD 1.72, k=0.83). CONCLUSION: The mammoplasty performed through an autologous implant supported by a bipedicled pectoralis major muscle flap is safe and was effective for filling the upper pole of the breast and for the maintenance of its shape at about 1 year after mammaplasty. Reference Citations: 1. McKissock, P. K. Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg 1972;49:245–252. 2. Graf, R., Biggs, T. M. In search of better shape in mastopexy and reduction mammoplasty. Plast Reconstr Surg 2002;110:309–317; discussion 318–322. 3. Ribeiro, L., Accorsi, A., Jr., Buss, A., Marcal-Pessoa, M. Creation and evolution of 30 years of the inferior pedicle in reduction mammaplasties. Plast Reconstr Surg 2002;110:960–970. 4. Claro Jr, F. Pectoralis major muscle strap in mammoplasty: personal experience. Revista Brasileira de Cirurgia Plástica 2015;30:533–543. 5. Lockwood, T. Reduction mammaplasty and mastopexy with superficial fascial system suspension. Plast Reconstr Surg 1999;103:1411–1420.