Mammary Cone Research Articles

Structural Mastopexy: Volume Displacement in Breast Reshaping.

Although in breast reshaping, the restoration of a suitable mammary cone is the main goal of the procedure, long-lasting upper pole fullness preservation is the most common weak point of all mastopexy. Mastopexy is a challenging procedure, and a surgical procedure to create desirable long-lasting results has not been well standardized. In this paper, the authors report their experiences in structural mastopexy procedures, describing three different adipo-glandular flaps, each repositioned as auto-prosthesis to reshape upper pole contour in patients affected by a severe degree of breast ptosis. A 6-year retrospective iconographic-chart and review was performed on 89 patients undergoing mastopexy between January 2016 and December 2021. Surgical candidates reported grades 2 and 3 of ptosis following Regnault classification. Minimum follow-up was 24 months. Pre- and postoperative data for all patients were collected in the same standard conditions. 89 patients affected with bilateral breast ptosis were included in the study, for a total of 178 breasts. Patients' mean age at the time of surgery was 40.45 years, ranging between 28 and 59 years. Follow-up ranged between 2 and 6 years with an average of 47.13 months. Out of 89 patients, 50 underwent general anesthesia, and the remaining 39 underwent local anesthesia. Among the 178 treated breasts, 10 (17.8%) experienced minor complications: No major complications were reported. Autologous tissue displacement, collecting parenchyma wherever surplus can be recruited, permits the transfer of extra tissue to the lack of volume, recontouring satisfactory breast shape and ensuring long-lasting results. 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 .

Mastopexy Autoaugmentation by Using Vertical and Triangular Flaps of Mammary Parenchyma Through a Vertical Ice Cream Cone-Shaped Approach.

Mastopexy autoaugmentation by using an extended vertical flap and two transverse triangular flaps of mammary parenchyma was performed through an adjustable vertical ice cream cone-shaped approach. A vertical rectangular flap with the length of the inferior pole and thickness of the mammary parenchyma was supported at the inframammary fold. Dissection of the vertical flap was extended underneath the areola until the projection of its upper limit, adding 4-5cm to the length of the vertical flap. A triangular flap supported on its lower half with 4-6cm long and thickness of the vertical pillar was dissected on both vertical pillars. Patients were followed up for 2years. The vertical rectangular flap filled the upper pole and central breast. The triangular flaps apart from filling the lower pole increased the mammary cone projection. The medial rotation advancement of the triangular flaps created a transverse support girdle at the lower pole, maintaining the vertical flap into position. In addition, fixation of the vertical flap along its entire length avoided long-term down-displacement of the breast. A keel resection of mammary parenchyma was performed in the larger breast in mild or moderate asymmetries. Mastopexy autoaugmentation through an adjustable vertical approach using vertical and triangular flaps of mammary parenchyma filled the upper pole and central breast and reshape the lower pole, recovering the breast contour. It provided long-term stabilization of the mammary cone without a breast implant or fat transfer. 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 .

High- and Extra-High-Profile Round Implants in Breast Augmentation: Guidelines to Prevent Rippling and Implant Edge Visibility.

Rippling and implant edge visibility after breast augmentation depends on several factors. Among the most relevant are breast soft tissue thickness, particularly the retroareolar mammary parenchyma, and implant profile. They were correlates to prevent these occurrences. Thirty patients underwent breast augmentation through subfascial dissection involving the pectoralis, serratus, external oblique, and rectus abdominis fascias. The thickness of the retroareolar mammary parenchyma distributed patients into two groups. Group I: patients with thickness equal to or greater than 4.0cm received high-profile 85% fill round implants. Group II: patients with thickness up to 3.9cm received extra-high-profile 100% fill round implants. MRI was performed preoperatively and 5years after augmentation to evaluate breast tissue changes and implant contouring. Seventeen patients with high-profile implants and thirteen patients with extra-high-profile implants had noticeable improvement of the breasts without the occurrence of rippling or implant edge visibility. A natural appearance of the breast, increased mammary cone, balanced upper and lower pole contouring was maintained at 5years postoperatively. MRI performed 5years after breast augmentation validated patient clinical outcomes not evidencing implant deformities, or soft tissue thinning, parenchymal atrophy or chest wall deformities. The adequate correlation between retroareolar mammary parenchyma thickness with high-profile 85% fill and extra-high-profile 100% fill textured round implants was of utmost importance in preventing rippling and implant edge visibility. The wide fascial support, width of the implant smaller than the breast diameter, and soft cohesive gel-filled implants were co-adjuvant factors in preventing rippling and implant edge visibility. 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 .

Retro-Areola Distally Based Flap in the Management of the Full Expression of Tuberous Breast: A Simple Strategy to Resolve a Weak Point of the Deformity.

Tuberous breast is a rare congenital deformity which is likely to appear in various clinical forms, the worst being characterized by severe hypoplasia. This clinical expression may represent one of the greatest challenges in breast surgery due to malformation memories that restrict the reshaping of the mammary cone that would not otherwise be solved through a simple breast augmentation. To improve the quality of the final results correction of the tuberous aspect often requires the use of adipo-glandular flaps frequently described in the literature to reconstruct the inferior mammary pole which works efficiently, even though a typical depression often remains between the inferior border of the areola and the closer skin to recall the memory of the tuberous aspect. Between September 2006 and March 2014, 71 patients with tuberous breasts underwent surgical procedures to repair the deformities. The mean patient age was 18.6 years (ranging between 17 and 23). A periareolar approach, adipo-glandular flaps, and dual plane subpectoral breast implant placements were used in all the cases. All the procedures were performed in a single stage under local anesthesia plus sedation. Follow-up ranged from 6 months to 6 years. The authors propose the use of a retro-areola glandular flap to resolve the typical residual depression of the final mammary aspect thus to overcome the malformation completely. 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 .

Running Circular Suture Technique for Reduction Mammaplasty and Mastopexy

Many reports have described various technical aspects of reduction mammaplasty and mastopexy procedures. The authors present their technique, which combines a number of techniques already described in the literature regarding repositioning of the nipple-areola complex, reduction of the diameter of the base of the breast, and long-term retention of mammary cone projection. This study evaluated the results for patients of various ages and phenotypes in terms of scar dimensions, breast positioning, and patient satisfaction in the short, medium, and long terms. Mammaplasty was performed using the inverted T technique. The preoperative skin markings differed from those described in the literature in that they did not use the future position of the nipple-areola complex as the main reference point. A running circular suture was used to fix the breast to the pectoralis major fascia and to reduce the diameter of the base of the breast, resulting in a reduced horizontal scar in the inframammary fold. The skin-marking technique allowed for better postoperative breast symmetry regardless of preoperative variations in shape and volume. The outcomes were considered satisfactory in the majority of cases by both the patient (p=0.78) and the physician (p=0.58). Adequate fullness of the upper pole was maintained in 94.7% of the breasts. The described technique results in a reduced diameter of the base of the breast, repair of ptosis, repositioning of the nipple-areola complex, and long-term upper pole fullness. Complications can occur with any technique, but it is important to choose a technique with good quality outcomes overall. 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 .

Mammaplasty with L–incision

Background The cutaneous sequelae resulting from mastopexy and reduction mammaplasty are serious drawbacks for patients, particularly young women, and physicians who are dissatisfied with extensive postoperative scarring. Objective The author reports on an L-incision technique that involves a base resection with an upper transposition of the nipple-areolar complex (NAC) to yield good shape and projection, short scars, and preservation of lactation. Methods Preoperative markings were made to aid estimation of the amount of breast tissue to be excised, to establish anatomic landmarks ensuring breast symmetry, and to position the scars. Breast reduction was performed by means of perpendicular excision of the lower pole and transverse amputation of the base from the pectoral aspect of the breast. In wider breasts, a vertical keel was excised to decrease the circumference of the base. In mastopexy, the lower pole was preserved as a superiorly based flap and used to fill the upper pole. The new site of the NAC was marked bilaterally, slightly lower than the apex of the new mammary cone, with the downward rotation of the breast during the early postoperative period taken into consideration. Results The described L-incision procedure was performed in more than 500 patients between 1996 and 2003, with good results and a low rate of complications. Nipple sensitivity was generally preserved unless lesions of the lateral branches of the intercostal nerves were present. No lactation problems were reported by the 9 patients who breastfed babies after undergoing surgery. Twenty-seven patients underwent revision procedures to correct scar hypertrophy, areolar enlargement, asymmetry, persistent ptosis, or correction of “dog-ear.” Conclusions The L-incision technique is a safe, reliable procedure that results in good breast shape and projection with inconspicuous scars. It can be used in a wide variety of applications, including correction of breast hypertrophy, ptosis, and asymmetries.

Mammaplasty: a new approach.

In this paper, the authors demonstrate a single stitch that brings together and encircles the mammary base at the aponeurosis of the musculus pectoralis major, closing the mammary base while elevating the mammary cone and achieving better projection of the superior poles.

Ultrasound-assisted lipoplasty (UAL) in breast surgery.

Breast surgery has evolved significantly since the increased demand for reduced scars led to the development of minimal incision techniques. Ultrasound-assisted lipoplasty (UAL) presents important advantages when compared to traditional liposuction, such as preservation of connective structures and significant skin retraction capability. Other factors such as a favorable side-effect profile, satisfactory aesthetic results, and virtually inconspicuous scars have led us to utilize UAL in virtually all of the different breast surgery modalities carried out in our practice. Important aspects of patient selection, markings, surgical technique, and postoperative care are outlined. Ultrasonic energy is applied through superficial tunnels that lie radial to the mammary cone, with preservation of elements such as the areola, mammary ducts, and the central part of the breast's base which contains the perforators that supply the gland. Deep treatment should be applied onto adipose tissue regions and should preferably be performed in the peripheral and subcutaneous layers of the breast, with conservation of the central glandular cone to ensure maintenance of anterior projection. In selected cases, UAL is a valuable adjunct to procedures such as symmetrization, reduction mammaplasty, and breast reconstruction, permitting both volume reduction and shaping through three-dimensional retraction of connective tissue and skin. The excellent preliminary results support new indications and future developments of the technique.

A new periareolar mammaplasty: The “round block” technique

The "round block" acts as a keystone supporting the mammary cone. The keystone lies in the dermodermic, glandulo-glandular, and glandulo-musculoperiosteal unions fixed definitively with nonresorbable suture, by a crisscross mastopexy, and by a circular nonresorbable suture of woven nylon included in the periareolar circular dermo-dermic scar block. This technique can be used in numerous types of breast surgery: In cases of ptosis or hypertrophy, it allows the scar to go up to the periareolar circle which is in itself generally inconspicuous. In cases of hypotrophy, the use of the round block technique permits easy access for insertion of the prosthesis as it simultaneously corrects ptosis. In cases of tumoral excision, the round block produces a discreet scar and a more regular breast contour. In all types of mammoplasty, the main goal is to limit the scar. The scar in the submammary fold is visible, particularly when one is lying down. The ideal result is confining the scar to the periarolar area.

Unilateral Reduction Mammaplasty

Various traditional mammaplasty techniques have been suggested for unilateral breast reduction, and an inverted-T incision is still the most popular approach. However, unilaterally performed traditional techniques can rarely provide long-lasting symmetry because the operated and the unoperated breasts react differently to aging, weight changes, and pregnancy. Considerable residual scarring, interference with clinical and mammographic evaluation, and limited versatility are all major drawbacks of traditional procedures. We have performed unilateral mammaplasties on 47 patients with various types of congenital and acquired asymmetries, reducing and sculpturing the breast from the undersurface by means of minimal incisions, always avoiding horizontal scarring in the inframammary crease. Through a vertical infra-areolar incision, the breast is completely detached from the underlying pectoralis fascia and hooked up, thus completely exposing the undersurface of the mammary cone. The breast can thereafter be reshaped according to the size and shape of the contralateral breast by means of a discoid resection and/or selective sectoral removal of excessive subcutaneous tissues; modifications of the basic discoid resection can increase anterior projection of the new breast mound and can change the inclination of the anteroposterior breast axis on the anterior chest wall both on the horizontal and vertical planes. The results show that if criteria for patient selection are carefully respected, the procedure can provide long-lasting symmetry with minimal residual scarring and fully preserve the breast anatomy, function, and vascularization.

The infra-areolar longitudinal incision in reduction mammoplasty

The author presents a reduction mammoplasty technique in which an infra-areolar longitudinal incision is used. The incision can be either one line, without skin removal, or an ellipse, with some skin to be removed. The gland is totally freed from the pectoral muscle and the resection of the mammary cone's base is then done, using pre-established measurements. The skin retracts spontaneously over the remaining breast tissue, which maintains its original shape in a smaller size.

A Z-mammaplasty with minimal scarring.

An improved technique for reduction mammaplasty is described that has the advantage of giving a satisfactory final shape to the breast while producing a minimal scar. The method involves periareolar deepithelialization with displacement of the nipple-areola complex, partial subcutaneous mastectomy at the base of the mammary cone, and a Z-plasty to interlock two triangles of skin left after the removal of a little excess skin in the region above the inframammary fold. The Z-plasty adds skin vertically to the inferior pole, resulting in a better final shape and reducing tension around the areola. Any further excess skin is left to retract spontaneously. The best indications for this operation are in young women with elastic skin free of striae "gravidarum." Our experience now covers 53 patients aged 14 to 30 years with reductions of up to 900 gm per breast, and we have encountered no major complications over a 3-year follow-up period.

The infra-areolar longitudinal incision in reduction mammoplasty.

The author presents a reduction mammoplasty technique in which an infra-areolar longitudinal incision is used. The incision can be either one line, without skin removal, or an ellipse, with some skin to be removed. The gland is totally freed from the pectoral muscle and the resection of the mammary cone's base is then done, using pre-established measurements. The skin retracts spontaneously over the remaining breast tissue, which maintains its original shape in a smaller size.

A versatile standardization for mammoplasty

This report presents a variable standardized technique for reductive mammoplasty, based on techniques used by Pontes and Skoog, which is easily performed, carries low risk, and gives good postoperative results. This method enables the surgeon to perform a greater variety of physiologic mammoplasties, through nipple-areola migration by the dermomammary pedicle, which is transformed easily into a dermolateral pedicle, in order to enable wider breast resections and migration of the nipple-areolar complex over greater distances. The localized submammary undermining permits greater reduction of the mammary cone base and larger filling of the upper pole.This method may be applied in any type of breast, even those which are voluminous, hard, and nonelastic.