Scar Reduction Mammaplasty Research Articles

Vertical Scar Reduction Mammaplasty Using the Superomedial-Based Pedicle Technique in Gigantomastia.

Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique. We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics. Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief. The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings. IV.

Correlation Between General Satisfaction with the Breasts and Appearance of the Scars in Patients Undergoing Inverted T-Scar Reduction Mammaplasty: A Prospective PROMs-Based Study.

Inverted-T scar reduction mammaplasty is still the most chosen technique for breast reduction even if scars are relevant. Sometimes, surgical scars may be esthetically unpleasant and may cause severe pain, tenderness, sleep disturbances, anxiety, and depression in these patients. This study aimed to assess any possible correlation between general satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty. Secondary aim was to evaluate average variations of BREAST-Q and SCAR-Q at different postoperative times. 121 patients who underwent breast reduction using Pitanguy technique with inferiorly based dermo-adipose flap according to Ribeiro were enrolled in this prospective cross-sectional study. All patients filled the BREAST-Q REDUCTION and SCAR-Q questionnaires in paper form at 1, 6 and 12 months after surgery. BREAST-Q REDUCTION "Satisfaction with breast" scale was also administered preoperatively. Values were exported in Prism 9 for the statistical analysis. Correlation index of Pearson between "Satisfaction with breast" and "Appearance of scar" was 0.09 at 1 month post-operative and - 0.07 and 0.21 at 6 and 12 months PO respectively. "Satisfaction with breast" mean value tends to rise over time. "Appearance of scar" mean value tends to decrease over time. No correlation at different postoperative times between the general satisfaction with the breast and appearance of the scars was found. Data showed that satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty tend to improve over time. 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 .

Vertical Scar Versus Inverted-T Scar Reduction Mammaplasty: A Meta-Analysis and Systematic Review.

Women with macromastia experienced constitutional and psychosocial symptoms which could be improved by vertical scar or Inverted-T scar reduction mammaplasty. The authors conducted the first systematic review and meta-analysis in an attempt to declare the differences of the vertical scar versus the Inverted-T scar reduction technique by comparing the postoperative complications and aesthetic effects. PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases for clinical studies were searched through June 30, 2019. Cumulative analysis was conducted using the Review Manager Version 5.3 software. The summary odds ratio (OR) was estimated using random effect models at 95% confidence intervals (CIs), statistical heterogeneity was tested using the Chi-square test and risk of bias was assessed using the Cochrane Handbook 5.1.0 and the Newcastle-Ottawa scale (NOS). Two randomized controlled trials (RCT) and nine observational comparative studies were included. The vertical scar method was significantly lower than the Inverted-T scar method in overall incidence of complications (OR: 2.06; 95%CI, 1.15 to 3.70; P: 0.002) and wound dehiscence (OR: 4.62; 95%CI, 2.33 to 9.16; P<0.00001). No significant differences in seroma, hematoma, nipple necrosis, fat necrosis and reoperation were noted. Both two breast reduction techniques are equally safe, while the vertical scar approach resulted in a statistically lower rate of overall complications and wound dehiscence. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Our experiences regarding combined use of pedicle plication and dermal flap suspension in inferior pedicle inverted-T scar reduction mammaplasty

Objective: T o present clinical outcomes and experiences regarding combined use of plication and dermal flap suspension of inferior pedicle in inverted-T scar reduction mammaplasty. Method: One hundred and twenty-one cases with bilateral macromastia were operated by using the present technique between March 2008 and November 2017. The cases were reviewed retrospectively regarding demographics, preoperative findings, and postoperative outcomes. Of the 121 cases, 22 were excluded from the study analysis. Results: The mean age of the cases was 39 . 77 years. The mean preoperative diameter of NAC and the mean preoperative distances of midclavicle-to-nipple, nipple-to-IMF and IMF were 6 .54, 33.48, 15. 98 and 25 . 09 cm, respectively. The mean weight of excised tissue per case was 2033 . 32 g. There were three cases with unilateral T-junction dehiscence and two cases with unilateral T-junction necrosis. Furthermore, one case presented with bilateral , and two cases presented with unilateral superficial partial necrosis of NAC. At long-term, six cases had a slight asymmetry, two had bilateral pseudoptosis, and three had bilateral hypertrophic scarring among the transverse incision of the inverted-T scar. One case underwent bilateral excision of lateral dog ears and one underwent surgery due to unilateral fat necrosis at postoperative 3 rd month . Two cases presented with unilateral loss of NAC sensation. The overall satisfaction with the operation was high. Conclusions: The outcomes of this study led us to conclude that the combined use of pedicle plication and dermal flap suspension improves the shape and position controllability of the inferior pedicle, produces a projectile and stabilized breast mound, aids in achieving satisfactory long-term cosmetic outcomes, and prevents breast deformities. Extended operative time can be considered as a disadvantage of the technique.

Abstract 33. Late Shape Distortion after SPAIR Mammaplasty Secondary to Seroma Induced Scar Contracture

Purpose: Previous reports have documented the safety and efficacy of the short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty. This technique utilizes an inferior pedicle, circumvertical skin resection pattern, and purse-string peri-areolar closure to achieve a stable and aesthetic breast shape. Late breast distortion from seroma formation is rare complication than may occur after an initially satisfactory result. Contraction of the seroma cavity may cause the surrounding breast tissues to deform. The purpose of this case series is to describe the treatment of this unique complication after SPAIR mammaplasty. Methods: The senior author’s database was retrospectively reviewed to identify all cases with late breast shape distortion after SPAIR mammoplasty. Patients treated operatively and non-operatively were statistically compared. Furthermore, a literature search was conducted to identify any further studies reporting this similar complication. Results: Over an 18 year period, 747 SPAIR mammaplasty procedures were performed. Late breast distortion from seroma contracture was identified in 16 patients (2.1%). In seven of these patients (12 breasts), the distortion resolved with non-operative management. In nine patients (17 breasts), persistent shape distortion prompted operative exploration and excision of the seroma cavity. In the operative group, eight patients experienced complete resolution of symptoms, while one patient experienced a mild recurrence and declined further treatment. Conclusion: Late breast distortion due to a contracted seroma cavity after SPAIR mammoplasty is a previously unrecognized complication. Persistent shape alterations may require excision of the seroma cavity. Proper management of this complication allows restoration of an aesthetic breast shape.

Vertical Scar Reduction Mammaplasty

Vertical Scar Reduction Mammaplasty

Vertical Scar Reduction Mammaplasty.

Since 1989, the authors have performed vertical scar reduction mammaplasty on over 3000 patients. In 2006, the authors described their technique. Since then, the authors have made several modifications that they believe have improved both the reliability of the procedure and the outcomes that they are able to achieve. Key modifications are described in this article and the accompanying video.

Long-term changes in nipple-areolar complex position and inferior pole length in superomedial pedicle inverted 't' scar reduction mammaplasty.

Proper nipple-areolar complex position in reduction mammoplasty patients is a challenging problem regardless of the preferred technique. Postoperatively, the nipple-areolar complex is often not located at the most projected area of the breast. This retrospective observational study aimed to find the long-term measurements of the nipple-areolar complex position and inferior pole length after inverted T scar-superomedial pedicle reduction mammoplasty. Forty-eight female patients (96 breasts) were included in this study. The inclusion criteria were that no previous operation should have been done on any of the breasts and both NAC complexes should be at least 30 cm from the midclavicular point. Preoperatively, the distance from the midclavicular point to the new nipple was recorded. All patients were operated on with the inverted T pattern and superomedial pedicle technique. The resection weights, the distance from the midclavicular point to the nipple distance, and the distance from the NAC lower border to the inframammary fold were evaluated postoperatively with an average of 15-month follow-up. The mean preoperative distance from the midclavicular point to the nipple was 34.21 cm for the right breast and 34.26 cm for the left breast. The mean resection weight per breast was 1035 g for the right breast and 1081 g for the left breast. The descent of the NAC was 1.61 cm for the right breast and 1.79 cm for left breast (mean: 1.7 cm) at the end of the follow-up. Additionally, the inframammary length increased 3.31 cm for the right breast and 3.59 cm for the left breast (mean: 3.45 cm). In this study, we found that the new nipple-areolar complex does not go upward but goes downward. However, it was not located at the most projected area of the breast as it was set intra-operatively. This was because the lower pole of the breast sagged more than the nipple: clinically, we observed a nipple superior displacement of 1.75 cm (3.45 - 1.7 = 1.75). According to this calculation, we believe that the new nipple position should be marked at 1.5-1.75 cm below the most projected area of the breast after final shaping so that in the long term, the nipple-areolar complex would be at the proper position. 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 .

Unilateral macromastia in a case of polymastia

Macromastia is a condition of abnormal enlargement of the breast in excess of the normal proportion. It can be unilateral or bilateral and generally manifest at puberty when secondary sexual characters start appearing. Other patients may develop this condition at the time of pregnancy (Gestational macromastia). We present a case of young unmarried girl having unilateral macromastia due to polymastia. Unique feature in this case has been presence of two nipple areola complexes over right breast mound, one at normal site and another just superior to the inframammary crease in the line of embryonic milk line. The affected breast was almost double the size of contra lateral breast. Besides she also had bilateral hypertrophy of axillary breasts. Vertical scar reduction mammaplasty along with excision of axillary breasts was successfully carried out with gratifying results.

Vertical scar versus the inverted-T scar reduction mammaplasty: A 10-year follow-up

A retrospective study was undertaken to evaluate whether the initial outcome of two types of reduction mammaplasty techniques (vertical scar reduction mammaplasty vs. the inverted-T scar reduction mammaplasty) remains stable in the long term: Sixty-nine patients who had undergone breast reduction surgery in the period 1997-2000 at the Department of Reconstructive Plastic Surgery at the Medical Center of Leeuwarden were willing and able to participate in this study. A structured questionnaire was used to assess the degree of patient satisfaction. For subjective evaluation, the Strasser Grading System on photographs at the 3 months after surgery and after long-term follow-up (10 years) was used. The median general appreciation mark for the entire surgical procedure given by patients was 8 (1-10) on a scale from 1 to 10. Forty-six of the 69 patients could be scored according to Strasser: at 3 months in 17 patients (37%) the result was 'good', in 21 patients (46%) 'mediocre' and in eight patients (17%) 'poor'. After 10 years, in 37 of the patients (80%) the result was 'good', in six patients (13%) 'mediocre' and in three patients (7%) 'poor'. At 3 months, there was a higher incidence of bottoming out in the vertical scar group (one on two patients) as compared to the inverted-T scar group (one on 10 patients); however, at the 10-years follow-up bottoming out was 50% in the inverted-T scar group and 20% in the vertical scar group. Despite bottoming out, in both the vertical scar reduction mammaplasty technique and the inverted-T scar reduction mammaplasty technique, high patient satisfaction rates are achieved that remains for years.

Does Knowledge of the Initial Technique Affect Outcomes after Repeated Breast Reduction?

This article examines outcomes following repeated breast reduction using vertical scar reduction mammaplasty. The results of performing repeated breast reduction in patients for whom operative records were available for the previous breast reduction were compared with those for whom these records could not be obtained. A retrospective review of all patients who underwent repeated breast reduction for recurrent symptomatic mammary hypertrophy, inadequate volume reduction during the primary operation, and significant postoperative breast volume asymmetry was performed. Twenty-five patients had repeated breast reduction. The initial technique was known in 13 patients and unknown in 12 patients. The average total reduction per breast (including liposuction) was 658 g (range, 30 to 1150 g). Liposuction was used more often in cases for which the initial technique was unknown (p = 0.000). No patients experienced necrosis of the nipple-areola complex, and there was no significant difference in the complication rates between patients for whom the previous pedicle was known versus those in whom it was unknown (p = 0.220). Using vertical scar reduction mammaplasty, repeated breast reduction is a safe procedure, even when the initial technique is unknown. A vertically oriented, inferior wedge excision of tissue can be safely excised, irrespective of the initial pedicle. For patients with ptosis in whom the nipple-areola complex needs to be transposed superiorly, a carefully planned and de-epithelialized superior pedicle should be used. In addition, liposuction is an important adjunct to achieve volume reduction, while limiting the amount of dissection during repeated breast reduction. : Therapeutic, IV.

Short Scar Reduction Mammaplasty in the Bariatric Patient

Reduction mammaplasty may be necessary even after massive weight loss. Patients typically present with unfavorable breast features such as significant loss of upper pole volume, inelastic skin, and severe ptosis. The most common approach in the United States has been the Wise-pattern inferior pedicle technique, emphasizing skin excision. This report presents the short scar vertical reduction mammaplasty approach for the bariatric patient population. It aims to demonstrate improved outcomes with less scar burden. The study included 15 women (n = 29 breast reductions) with mean age of 41.8 years. All the patients had undergone gastric bypass surgery, with mean weight loss of 109 pounds and mean body mass index of 33.3 kg/m(2). A modified superomedial pedicle vertical mammaplasty technique was used. New nipple position was placed lower than the inframammary fold in accordance with vertical lack of upper pole fullness. Suction-assisted lipectomy was used to contour the inferior pole of the breast before glandular resection. A full-thickness superomedial pedicle and median incision of the upper pole maximized pedicle safety. The mean breast resection was 605 g on the right side (range, 352-945) and 592 g on the left side (range, 360-908). Patient satisfaction was high, with pleasing and stable breast shape at long-term, and a mean patient-related aesthetic ranking of 4.3 of 5.0. No major complications were noted. It is shown that superomedial pedicle vertical reduction mammaplasty can be an alternative approach in bariatric patients, achieving long-term pleasing and stable results with significantly decreased scar burden.

High Grade Gynecomastia: Surgical Correction and Potential Impact on Erectile Function

Gynecomastia denotes benign enlargement of the male breast. It is a common belief that gynecomastia is stigmatizing and may frequently cause social embarrassment and psychological stress. It is possible that this may reflect on erectile function of the afflicted. High grade gynecomastia requires radical breast tissue excision and skin reduction ending up in aesthetically unappealing scars. The purpose of this study is to evaluate the reduction mammaplasty using no vertical scar technique in males with high grade gynecomastia; as regards technical refinements and outcome in the hope of providing a cosmetically appealing solution to this condition. This study also reports on the effect of high grade gynecomastia on erectile function, as well as the effect of surgery. Fifteen male patients with gynecomastia underwent breast reduction using the "no vertical scar reduction mammaplasty." Erectile function was evaluated before and after surgery. Surgical outcome and erectile function. All patients but one were satisfied with the outcome. Complications were minimal and manageable. Eleven out of 15 patients had a preoperative International Index of Erectile Function (IIEF) score less than 20 denoting erectile dysfunction. All but one (n = 10) showed improvement in their IIEF score following surgery. The difference between pre-operative IIEF (average 17.8) and postoperative (average 23.5) was statistically significant. The "no vertical scar reduction mammaplasty" is a reliable technique in cases with gynecomastia and significant ptosis. It has the added benefits of avoiding the vertical scar, hiding the transverse scar in the shadow of the inferior aspect of the breast, with minimal complications. Gynecomastia as a condition causing a feminized outlook may have a negative impact on self confidence and body image. We suggest that this may have a potential negative effect on erectile function, that can be improved by adequate surgical correction.

Superior and Superomedial Pedicle Wise-Pattern Reduction Mammaplasty

Our center has refined a wise-pattern superior and superomedial pedicle breast reduction technique with predictable quality outcomes giving high patient satisfaction and a very low complication or revision rate. Fifty patients who underwent bilateral superior or superomedial pedicle wise-pattern breast reduction were included in the study. Demographic and perioperative data were collected, as were details of complications. A 21-item postal questionnaire was used to evaluate satisfaction with outcome parameters. The superomedial pedicle technique was used in 86% reductions, and the superior pedicle in 14%, and the mean weight removed from the breasts was 778 g (range, 244-1766 g). Mean patient satisfaction with outcome parameters, as well as maintenance of shape was excellent, as were mean improvements in symptoms of macromastia. No patient required a revision procedure. Superior and superomedial pedicle wise-pattern scar reduction mammaplasty with the technique presented predictably gives excellent results and patient satisfaction, with long-term preservation of shape.

Vertical Scar Reduction Mammaplasty: The Fate of Nipple-Areola Complex Position and Inferior Pole Length

Vertical Scar Reduction Mammaplasty: The Fate of Nipple-Areola Complex Position and Inferior Pole Length

Vertical Scar Reduction Mammaplasty: The Fate of Nipple-Areola Complex Position and Inferior Pole Length

A major advantage of vertical scar reduction mammaplasty is the improved long-term projection of the breasts. In their experience with more than 1700 cases, the authors have observed the following important trends: Postoperatively, the nipple-areola complex is located higher than one would predict from the preoperative skin markings, and pseudoptosis does not occur. This study was performed to provide objective measurements to confirm these observations. Forty-nine consecutive women had the following measurements taken of their right breast preoperatively and on postoperative day 5: distance from the clavicle to the superior border of the nipple-areola complex; the clavicle to the nipple; and the inframammary crease to the inferior border of the nipple-areola complex. Forty-six women were available for follow-up at 4 years, and measurements were repeated. Compared with preoperative skin markings, the nipple-areola complex was located on average 1.3 cm higher on postoperative day 5 and 1.0 cm higher at 4-year follow-up. The average distance from the inframammary crease to the inferior border of the nipple-areola complex had decreased 0.4 cm at 4-year follow-up. Compared with preoperative skin markings, the nipple-areola complex was located significantly higher at both early and long-term follow-up. The authors have adjusted their skin marking technique so that the superior border of the nipple-areola complex is marked at the level of the inframammary crease. At 4 years, the distance from the inframammary crease to the inferior border of the nipple-areola complex was significantly shorter, and pseudoptosis did not occur after vertical scar reduction mammaplasty.

Internal Pedicle Shaping to Improve Aesthetic Results in Reduction Mammaplasty

Reduction mammaplasty has been performed utilizing various techniques to achieve reduction in breast volume and to enhance aesthetic shape. The conventional inverted T-scar method is the most widely used technique in breast reduction given its predictability and versatility [1]. Nonetheless, newer surgical techniques have been developed in order to optimize outcome while minimizing associated complications. Pedicle types include inferior, central, superior, lateral, and bipedicle, all of which maintain the blood supply and innervation to the nipple-areola complex [2]–[6]. Cosmetically acceptable placement of scars, although debated, has also been emphasized through additional technical modifications including short scar periareolar inferior pedicle reduction mammaplasty (SPAIR), vertical mammaplasty without inframammary scar, or no vertical scar breast reduction [7]–[10].

Dermafascial Fixation Suture: A Technique for a More Durable Projection with Short-Scar (Vertical) Reduction Mammaplasty

Short-scar reduction mammaplasty has several advantages over the traditional technique, mainly reduced scarring and superior long-term breast shape. Multiple modifications of the short scar reduction mammaplasty technique have been made in an effort to decrease the learning curve while improving the results. The authors present another modification of the short-scar technique for a more durable projection without reliance on a skin envelope. The perimeters of the medial pedicle and the nipple-areola complex are marked, and the medial pedicle is deepithelialized. A 2 x 5-cm skin area at the inferior border of the pedicle is further deepithelialized, then pexied to the pectoralis fascia in a superomedial direction using a nonabsorbable monofilamanet suture with a horizontal mattress suturing technique. Taking the suture bites from the dermis rather than the breast parenchyma for the pexy aims to spare the pedicle's circulation. This durable internal rearrangement of the breast parenchyma with dermafascial pexy further decreases the tension at the nipple-areola complex because the final breast shape no longer relies on the skin closure. Suture spitting at the nipple-areola complex also is prevented with elimination of the purse-string suture because there is no need for a further decrease in the tension with the purse-string suture after the dermafascial pexy. The authors believe that the dermafascial pexy is a concept more than a technique. It incorporates the two strongest structures, the dermis and the fascia, to achieve more durable results not only with reduction mammaplasty, but also with any aesthetic breast surgery that uses the pedicles.

Vertical Scar Reduction Mammaplasty: A 15-Year Experience Including a Review of 250 Consecutive Cases

Vertical scar reduction mammaplasty has the advantage of reduced scar burden and improved long-term projection of the breasts. The technique has been criticized for being restricted to cases of mild to moderate mammary hypertrophy and is considered more intuitive and difficult to learn when compared with more conventional inverted-T scar reduction mammaplasties. This article describes the technique used in the largest reported series of vertical scar reduction mammaplasties performed by a single surgeon. The technique performed in this series uses a mosque dome skin marking pattern; transposition of the nipple-areola complex on a superior or medial dermoglandular pedicle, depending on its position with respect to the skin markings; an excision en bloc of skin, fat, and gland; postexcision liposuction; and wound closure in two planes, with gathering of the skin of the vertical wound. A chart review of 250 consecutive patients treated between November of 2000 and December of 2003 was performed. The average reduction per breast (including liposuction) was 636 g (range, 60 to 2020 g). Complications were minimal (5.6 percent of breasts), with no nipples being lost, attesting to the safety of this technique. This technique for vertical scar reduction mammaplasty has been applied to breast reductions of all sizes and has consistently produced good breast shape, with an operation that is shorter to perform and leaves less scarring than standard breast reductions. This technique is straightforward and easy to learn, and offers a safe, effective, and predictable way for treating mammary hypertrophy.

Galactorrhea complicating wound healing following reduction mammaplasty

Galactorrhea complicating wound healing following reduction mammaplasty occurs rarely; only isolated cases have been reported in recent years. We report the case of a 25-year-old woman who presented with delayed healing and dehiscence of surgical wounds 3 weeks following vertical scar reduction mammaplasty. During surgical debridement, spontaneous discharge of milk in the wound was noted. Serum prolactin levels were high, and she was treated with carbegoline, a dopamine agonist, which suppressed the prolactin secretion and led to rapid cessation of lactation. A second debridement and delayed primary closure were performed to achieve a satisfactory postoperative result.