Dermoglandular Flap Research Articles

Therapeutic mammoplasty with rotation advancement dermoglandular flap – A simple and effective technique

Introduction: Breast conserving surgery is used for local control of breast cancer in preference to mastectomy wherever applicable. Various techniques of Therapeutic Mammoplasty (TM) are used to allow breast conserving surgery to be performed with better aesthetic and possibly better oncological outcomes.

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Background:Revision breast surgery following breast augmentation secondary to capsular contracture and implant rupture is not uncommon. Breast autoaugmentation using an inferior pedicle dermoglandular flap following implant removal was used in patients who did not want new implants, and outcomes wer

Huge myoid hamartoma of the breast treated with reduction mammaplasty: report of a case

Breast hamartoma is an uncommon benign tumor characterized by the variety of component tissues. Adipose tissue, mammary glands, and fibrous tissue in various proportions are the main components and form a well-circumscribed mass. Myoid (muscular) hamartoma is an extremely rare subtype of breast hamartoma, which contains an additional smooth muscle component. Inadequate breast contour and nipple-areola complex malposition and expansion can occur after resection of a large myoid hamartoma. Immediate mammaplasty for the affected breast, using the dermoglandular flap technique, is required to provide symmetry of the bilateral breasts. We report a case of myoid hamartoma that was larger than ever documented before. An acceptable aesthetic result was achieved by resection and application of reduction mammaplasty in a single-stage operation.

Outcomes Analysis of Patients Undergoing Autoaugmentation after Breast Implant Removal

Revision breast surgery following breast augmentation secondary to capsular contracture and implant rupture is not uncommon. Breast autoaugmentation using an inferior pedicle dermoglandular flap following implant removal was used in patients who did not want new implants, and outcomes were analyzed. Thirty-nine breasts (38 breasts bilateral, one breast unilateral) in 20 consecutive patients (aged 38 to 66 years) were operated on. Breast implant-related problems in 39 breasts included capsular contracture (grade III to IV) in 30 breasts, asymmetry in 20, implant rupture/bleed in 15, and hematoma in nine. The size of implants removed was between 250 and 525 cc. Forty-five percent of implants were saline filled and 55 percent were silicone filled. Forty percent were removed from the subglandular plane and 60 percent from the submuscular plane. A deepithelialized inferior dermoglandular flap was used to reorient breast volume along with superior or superior medial pedicle mastopexy. Reorientation of volume of the inferior flap ranged between 125 and 300 cm(3). Mean follow-up was 13.5 months. BREAST-Q data showed improvement of satisfaction with breasts, psychosocial well-being, and sexual well-being after capsulectomy, implant removal, and autoaugmentation. There was a one-cup reduction in brassiere size in 17 patients, and the cup size remained the same in three patients. There was no evidence of fat necrosis. The inferior dermoglandular flap along with mastopexy was a safe, reasonable, and reliable method of reorienting breast volume and configuring breast shape in this series of patients for whom implant explantation was indicated and replacement was not an option secondary to concern with reimplantation. Therapeutic, IV.

A versatile modification of dermoglandular hammock flap for mastopexy: Extended hammock

Breast ptosis commonly develops in response to ageing and breastfeeding. Clinical studies now focus on both filling the upper pole of the breast with parenchymal flaps and long-term maintenance of the breast projection without recurrence of upper pole concavity and a significant change in breast shape over time. This study presents a modification for a well-known mastopexy technique, the dermoglandular hammock flap, which provides not only autoaugmentation for the breast but also suspension for the breast parenchyma. This technical modification involving a hammock flap extended in both width and length dimensions, was performed in 17 patients aged 28–43 years with an average age of 31 years. They had minimal, moderate, and severe ptosis. Of these, eight patients had mastopexy only without needing any resection of the breast tissue. In four patients, there was significant asymmetry, needing excision of the breast tissue. In five patients, it was necessary to resect less than 290 g of glandular tissue from both breasts to provide enough reduction of the breast volume. There were no severe complications either in the early or late postoperative period, such as nipple-areolar necrosis, haematoma, infection, or dehiscence of the suture line. However, in one patient, skin depression developed at the end of the vertical scar line in one breast. In the follow-up, medial and upper pole fullness of the breast maintained without recurrence of the ptosis, providing satisfactory shape and projection. With this modification, dermoglandular suspension flap turns to be a more effective procedure and suitable for all types of ptosis. As the sagged lower pole of the breast is used as a flap behind the nipple-areola complex and upper pole, it makes not only parenchymal reposition, but also autoaugmentation in the breast, leading to successful breast fullness.

Three Dermoglandular Flap Support in Reduction Mammaplasty

Three Dermoglandular Flap Support in Reduction Mammaplasty

An Autoprosthesis Technique for Better Breast Projection in Free Nipple Graft Reduction Mammaplasty

Reduction mammaplasty for macromastia provides relief from uncomfortable symptoms and improves self-confidence and the ability to participate in sports activities. Reduction mammaplasty using the free nipple graft technique may result in bottoming-out deformity and a lack of upper-pole projection. We describe a modified breast reduction technique that combines the Graf and Thorek methods. We operated on 26 patients with gigantomastia using this novel technique. Preoperative markings were planned according to the classic Thorek amputation technique using a Wise pattern. A 10-cm×14-cm pyramidal inferior-based dermoglandular flap was prepared, passed under a transverse pectoral muscle loop, and then back-folded over the pectoral loop, thereby establishing an autoprosthesis to increase upper-pole fullness and prevent bottoming-out deformity. The average weight of the removed breast tissue was 1,634g (range=1,120-2,140g) for the right breast and 1,630g (range=1,110-2,120g) for the left breast. The average follow-up period was 22months (range=11-37months). All samples were pathologically assessed. Minor complications included wound breakdown at the T-junction, fat necrosis, hypertrophic scarring, and partial necrosis of the nipple-areola complex (NAC). Loss of nipple projection and partial hypopigmentation of the NAC occurred in most patients. Mild glandular ptosis was observed in two patients, with no flattening or deflation, but no severe bottoming-out deformity was observed during long-term follow-up. All patients were happy with their new bra size, breast projection, and breast weight. Our combined autoprosthesis technique resulted in satisfactory long-term breast projection and upper-pole fullness. 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 .

The Three Dermoglandular Flap Support in Reduction Mammaplasty

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. 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. 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). : 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. Therapeutic, IV.

Pedicled dermoglandular flap reconstruction following breast conserving surgery

Breast conserving therapy is the gold standard treatment of early breast cancer. However, a balance between good cosmetic outcome and limiting the risk of locoregional recurrence remains the key of success.The aim of this work was to evaluate the outcome of partial breast reconstruction using pedicled dermo-glandular flap from the upper outer quadrant, for central quadrantectomy BCS. Patients & methodsThirty patients underwent wide excision of carcinoma of retroareolar or periareolar regions of the breast, from July 2008 to August 2011. Excisions included the nipple/areola complex down to the pectoralis fascia with a wide safety margin, and complete axillary dissection. Breast reconstruction was done by means of pedicled dermoglandular flap. ResultsMean age of patients was 51.86years (range from 30 to 70years). Tumor size ranged from 1 to 4.2cm. Postoperative pathological results came out with 21 (70.0%) patients mean (range) of the tumor safety margin 2.01 (0.5–2.8). Seventeen (56.7%) patients had positive axillary lymph nodes. All patients received postoperative radiation therapy to the breast, while 17/30 (56.67%) and 6/30 (20%) received endocrine therapy or adjuvant chemotherapy, respectively, and only 7/30 (23.34%) patients received both therapies. During a median follow-up period of 24months, neither local nor distant metastasis, were detected. The postoperative cosmetic result was excellent in 80% patients, good in 13.3% patients, acceptable in 6.7% with no poor result. ConclusionFollowing central quadrantectomy BCS for small centrally located breast cancer, a pedicled dermoglandular flap from the upper outer quadrant is a good reconstructive option.

The external dermo glandular mammary flap: an alternative technique for chest wall reconstruction

Chest wall reconstructions can be challenging procedures especially after large thoracic defects generated by cancer resections. We report a case of an anterior chest wall defect after a recurrent metaplastic carcinoma of the breast 7 years after the mastectomy. A partial sternectomy was carried out in conjunction with resection of the first four right ribs. Chest wall skeletal defects were reconstructed with polypropylene mesh folded in four under tension. Soft tissue reconstruction was performed with an external controlateral dermoglandular flap after a mammoplasty. The 12 × 38 cm flap remained on the external mammary vascularization and was tunneled to cover the defect. After follow-up, the patient remains disease-free with satisfactory quality of life. This new breast flap can expand the therapeutic arsenal to cover such chest wall defects offering, at the same time, a mammoplasty.

Breast Reduction With Dermoglandular Flaps

The use of dermoglandular flaps in reduction mastopexy was advocated by Paul Tessier, who never published his method, but had actually almost finished the following article before his death in June 2008. Dr. Tessier is acknowledged as the "father" of craniofacial surgery, but he had interest in aesthetic surgery, and was quite proud of the technique he had developed using dermoglandular flaps in reduction mammoplasty. He had literally hundreds of techniques and methods that he had developed but which never found their way into print, both because of his enormous surgical schedule, and perhaps his self-imposed standards for anything that he published, which were almost impossibly high. The technique proposed by Dr. Gargano is similar in some ways to Dr. Tessier, it seemed good that they will be published together.

A New Simple Technique to Correct Nipple Inversion Using 2 V-Y Advancement Flaps

Nipple inversion is a particular condition characterized by shorter galactophorous ducts, periductal fibrosis, and lack of soft tissue under the nipple base. It can be congenital or acquired, and it affects about 10% of the female population. Many operative techniques have been described seeking to correct this deformity, but a unique landmark strategy does not exist yet. Although acceptable results have been reported, every surgical technique has its drawbacks. We describe our 5 years' experience in correcting inverted nipples by using a simple personal approach. Between January 2004 and January 2009, we treated 52 patients presenting with nipple inversion using 2 V-Y dermoglandular flaps performed in the dermoglandular portion of the nipple. This method is effective in the correction of moderate and severe inverted nipple deformities. Follow-up period ranged from 1 to 6 years. Results showed recurrence in 1 case and postoperative complications in 3 patients. The authors have found this to be an ideal procedure for correcting inverted nipple; the use of an easy to perform V-Y flap ensures nipple protrusion and support, lactation, and minimal scars.

Use of the ipsilateral breast in anterolateral chest wall reconstruction

Chest wall ablative surgery often requires autologous tissue transfer to reconstruct the resulting defect. The female breast is commonly of a suitable size to provide anteromedial chest wall coverage as a pedicled dermoglandular flap. In anterolateral defects the latissimus dorsi or serratus anterior flaps are often the preferred choice, in the absence of which free tissue transfer is an alternative technique. However these options may not always be available or suitable. A 90-year-old female presented with a large chest wall mass in keeping with recurrence of oesophageal squamous cell carcinoma in the thoracotomy scar following a previous oesophagectomy. The latissimus dorsi and serratus anterior muscles were transected during the previous thoracotomy. Following complete resection, the ipsilateral breast was used as a rotational dermoglandular flap to provide coverage over the exposed ribs. The use of breast as a local flap is an alternative option in anterolateral chest wall reconstruction.

Reduction Mammaplasty Using Bipedicled Dermoglandular Flaps and Free-Nipple Transplantation

Secondary revisions due to deflation, flattening, and ptosis have been the major concerns after free-nipple breast reduction procedures. This study used a new modification of the standard technique known as the "bipedicled dermoglandular flap method" to reduce reoperation rates. A total of 24 patients were treated with the bipedicled dermoglandular free-nipple method between the years 2004 and 2008. The mean patient age was 45.6 years, and the average body mass index (BMI) was calculated as 27.8 kg/m². In contrast to the standard technique, the superior dermoglandular flap was fixed as backfolded, whereas the inferior flap was fixed directly to the pectoralis fascia together with the superior flap with polydiaxanone sutures. An average breast tissue volume of 1,736 g was removed. One case of seroma and one case of partial nipple graft loss (8%) were observed in the follow-up period. The patients were followed for an average of 32.4 months. Complications such as deflation, flattening, and Regnault's mild (1st degree), moderate (2nd degree), and severe (3rd degree) ptosis were not observed. However minimal glandular ptosis was observed in four cases (16.6%). Central peripheral minimal hypopigmentation was observed in five cases. None of these complications required reoperation. Bipedicled dermaglandular flap modification of conventional free-nipple reduction mammaplasty is a new option for reducing the probable complications of the standard technique.

Minimally Invasive Correction of Inverted Nipples

Numerous techniques have been described for the correction of inverted nipples; their diversity supports the lack of a consistently reliable method. Dermoglandular flaps, open suture, and suction techniques have all been described to combat the "corrected" nipple's propensity to collapse. We present a minimally invasive parenchymal release and percutaneous suture technique that provides sustainable long-term correction of inverted nipples. Thirty-one patients with 58 inverted nipples were treated. The technique, performed under local anesthesia, employs lysis of the foreshortened subareolar fibro-ductal tissue to achieve resting eversion of the nipple using an 18-gauge needle. Through the same needle-access site, a purse-string suture is then placed, exiting the areolar skin and re-entering through the same stitch point every 3 to 5 mm around the circumference of the new nipple-base. An absorbable suture closes the access site over the knot, and 2 crossed absorbable mattress sutures are placed beneath the nipple to complete the correction. Of 27 patients with bilateral and 4 with unilateral, nipple inversion, durable correction was achieved in 1 procedure in 45 of 58 nipples (78%). There were 13 recurrences, of which 11 (19%) were successfully treated under local anesthesia with a second purse-string suture, and 2 (3%) required a third procedure under local anesthesia. There were no late reinversions. There were no cases of infection, nipple ischemia, or other complications. Occasional recurrences are corrected very simply under local anesthesia. Percutaneous release of nipple inversion followed by purse-string suture support performed through "needle-only" access points is a simple, safe, and reliable technique, and should be considered for the correction of inverted nipples.

Breast autoaugmentation

A technique using a posteriorly based dermoglandular flap as an augmentation of the superior hemisphere of the breast combined with a periareolar mastopexy and vertical mastopexy is presented. The advantages of combining a periareolar mastopexy, in terms of reducing the length of the vertical scar and preventing areolar distortion, are explained.

Familial Severe Gigantomastia and Reduction with the Free Nipple Graft Vertical Mammoplasty Technique: Report of Two Cases

: Gigantomastia, characterized by massive breast enlargement during adolescence or pregnancy, is thought to be caused by an abnormal and excessive end organ response to a normal hormonal milieu. The amputation technique with the free nipple-areola graft is the mainstay for severe macromastia, but it has been criticized because it results in a flattened, nonaesthetic breast with poor projection. This report presents two sisters with unusual, excessive breast enlargement. : The measured distance from the sternal notch to the nipple was 50 cm for the first case and 55 cm for the second case. The free nipple graft transplantation based on the vertical mammoplasty technique was used, and an average of 4,200 g of breast tissue per breast was removed. To increase breast projection, superior dermoglandular flaps were used : The follow-up period was 24 months. The patients had long-lasting, pronounced breast mound projection, and the level of satisfaction for both cases was very high. The ideal geometric structure of the breast is rather conical, and the authors believe that reshaping the breast tissue in a vertical plane using the vertical mammoplasty technique may be more effective in the long term and may provide better projection.

Mastopexy utilizing a dermoglandular hammock flap

Background Many procedures have been described in the search for the ideal mastopexy technique, ranging from simple cutaneous reduction, with or without glandular remodelling, to the use of dermal flaps fixed to the pectoral fascia, or even the use of silicone mesh or sheets. Objective We describe a technique that uses a dermoglandular hammock flap to achieve optimal position and shape of the breast; well located, good quality scars that are as short as possible; and satisfactory early- and long-term results. Methods A superior pedicle dermoglandular flap was raised from the lower pole of the breast and transposed to the upper pole. The flap is fixed like a hammock to the pectoral fascia and the wedge-shaped donor defect is closed by approximation and fixation of the medial and lateral pillars with absorbable sutures, thus releasing the tension in the skin suture line. Results Twenty-eight patients aged 19 to 58 years underwent the procedure. Adequate shape and projection were achieved in all cases. Partial dehiscence of the suture line developed in 1 patient. The scar quality was excellent, except in 2 cases in which some degree of temporary hypertrophy occurred. Conclusions In our experience with this technique, we obtained satisfactory position and shape; good quality, well-placed scars; long-lasting results; and preservation of the patient's ability to breast feed. The technique is simple to perform and is indicated in cases of moderate ptosis.

Place de la réduction mammaire à pédicule supérieur dans les gigantomasties

Subject. – The authors present technical details, complications, morphologic and aesthetic results of 26 breast reduction mammaplasty for macromastia (breast reduction more than 1000 g) showing advantages and reliability of technique. Materials and methods. – From January 2000 to December 2001, 223 patients underwent bilateral reduction mammaplasty with superior-based pedicled dermo-glandular flap. In 26 of them the weight of removed mammary tissue was over 1000 g in each breast. These 26 cases were evaluated, and the criteria adopted to analyse the results was morphologic and aesthetic evaluation of patient herself (very good, good, acceptable, unacceptable). Results. – Mean follow-up for all patients was 15 months. Twenty-six patients (mean age 33.2 years) underwent an average weight of 1131 g (930/2200 g) removed per breast. The following complications were observed: 1 Nipple Areolar Complex ischemia without necrosis; three infections (abscess); four delayed wound closure. The patient subjective evaluation of result was: “very good” in 19 cases (73%); “good” in 5 cases (19.2%) and “acceptable” in the others two cases (7.8%). No case was evaluated “unacceptable”. Conclusion. – Superior dermoglandular pedicle mammaplasty represent a very good and reliable solution for the treatment of macromastia, giving satisfactory cosmetics results with good nipple viability without necrosis. This technique is actually our first choice in the management of macromastia.

Modified free nipple graft reduction mammaplasty to increase breast projection with superior and inferior dermoglandular flaps.

Classic free nipple graft reduction mammaplasty often yields flat, boxy breasts with poor projection. The authors modified this technique using superior and inferior pyramidal dermoglandular flaps to increase the fullness and projection of the breast. Six patients (12 breasts) with gigantomastia underwent breast reduction by this method. The results were aesthetically pleasing, with conically shaped breasts and good projection. The technique is easy to perform and it is possible to switch from pedicled nipple-areolar transposition to this method intraoperatively in patients in whom perfusion of the nipple is questionable.