Vertical Mammaplasty Research Articles

The "Arrow Flap" Technique in Reduction Mammaplasty: Combining Short Scars, Narrow Base, and High and Persistent Breast Projection.

Breast reduction is one of the most common procedures performed by plastic surgeons worldwide. Despite that several techniques have been proposed for management of ptotic or hypertrophic breasts, most of them often deal with too large breast bases, poor breast projection, persistent "dog ears," and a certain percentage of bottoming out. Lower-pole shaping of the breast remains one of the challenge of vertical mammoplasty. The authors report their 5-year-long experience with a modification of the vertical scar technique, the "arrow flap," in which they harvest a double lateral glandular and cutaneous flap, to tighten and better shape the base of the breast and to improve the breast projection with a "double-bra" effect. From April 2015 to February 2019, 75 patients with moderate to severe macromastia/breast ptosis underwent bilateral reduction mammoplasty. Postoperative outcomes showed an overall satisfactory results and low incidence of complications. Two patients presented with an asymmetry between the 2 breasts, and no nipple-areola complex necrosis occurred. One patient reported a wider vertical scar, whereas no bottoming out was observed. All patients reported a stable and durable projection of the breast, with pleasant cosmetic results. By combining short scars and narrow base, we can obtain a pleasant lower pole reshaping of the breast, even in that challenging cases of large and squared breast. The authors believe that this technique provides a useful surgical option, increasing the versatility of the superior pedicle vertical mammaplasty both for mastopexy and breast reduction, even in cases of severe macromastia.

A Review and Measurement Study of the Central Mound Pedicle for Breast Reduction.

Background:The central mound approach to breast reduction has been the subject of recent interest in the literature. However, quantitative evaluation using measurements is lacking. This review was undertaken to objectively evaluate changes in breast dimensions, and to compare the results to a popular alternative method, vertical mammaplasty.Methods:An electronic search was performed using PubMed to identify all publications endorsing the central mound technique. Published lateral photographs were matched for size and orientation, with computer assistance. Measurements included breast projection, upper pole projection, lower pole level, breast mound elevation, nipple level, and breast parenchymal ratio. Results were compared with published measurement data for the vertical technique.Results:Twenty-three manuscripts were identified. Ten included photographs suitable for analysis. On average, breast projection decreased 1.1 cm after central mound breast reduction (P < 0.05). Upper pole projection dropped 0.4 cm (not significant). The lower pole level was raised 2.6 cm (P < 0.05). The nipple level was over-elevated 0.6 cm, on average. The breast parenchymal ratio increased by 0.54. A central mound dissection decreased breast projection. In contrast, publications using a vertical breast reduction demonstrated maintenance of upper pole and breast projection and a modest (<1 cm) increase.Conclusions:For each measurement comparison, the vertical method outperforms the central mound. Because of its anatomy and geometry, measurements show that the vertical method for breast reduction is more favorable than a central mound dissection. This method can also be used safely for secondary breast reductions.

Oncoplastic reconstruction of central lumpectomy defects using the medial pillar island flap

This report presents the medial pillar island flap technique of oncoplastic breast reconstruction of central defects that involve the nipple-areola complex. The procedure was performed in patients who presented with inferior pole redundancy using a vertical mammaplasty pattern. The flap was designed utilizing the territory of the lower pole as an island flap pedicled by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar. Eight patients underwent the procedure with a mean age of 57.6 years. Median breast cup size was D (range: from C to DDD). The mean body mass index was 37.3 kg/m2 (range: from 32.1 to 41.5). The size of the defect ranged from 64 to 150 cm3 (mean, 97.2). Concomitant opposite breast vertical reduction was performed in 6 cases. Flap survival was uneventful. Nipple reconstruction was performed 6 months after radiation treatment in 4 patients. No major complications were encountered. Two patients developed minor wound breakdown after nipple reconstruction. The medial pillar island flap is presented as a safe and reliable option for the reconstruction of central partial mastectomy defects in patients with macromastia or breast ptosis. Internal mammary system provides predictable and robust flap viability while complete separation from the inframammary fold allows for unrestricted mobility. The procedure is designed with vertical scar mammaplasty, which results in a smooth contour to the lower pole. The flap allows for nipple reconstruction using well-vascularized skin paddle. The technique is offered as an alternative oncoplasty option for neoareolar reconstruction.

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 .

Vertical Mammaplasty with Retromammary En Bloc Breast Suspension.

In a vertical mammaplasty, various types of pedicles have been proposed for the nipple-areola transposition. The preparation of any type of nipple-areola flap necessitates disconnecting the nipple-areola from the breast gland, except for the pedicle bearing glandular part. These flap-dependent techniques not only impair the functions of the breast but also do not provide enough fullness to the upper pole. No specific nipple-areola flap preparation is made. Reduction is obtained by a transverse excision from the lowermost part of the breast gland. Apart from this, no cut into the gland is needed. Liposuction, wide skin elevation and extended retromammary dissection permit the en bloc suspension of the breast. The study enrolled a total of 85 patients with 170 breasts. Mastopexy or minor reduction less than 100gr was applied for 49 breasts; moderate reduction, 100-399gr, for 67 breasts; and a large reduction of more than 400gr for 54 breasts. No complete or incomplete nipple-areola necrosis was seen. The success rate for achieving upper pole fullness was compared between groups for reduction amount, age and body mass index (BMI). The functions of the breast organ are preserved in the en bloc suspension technique. In patients with dense breasts, a good upper pole fullness was achieved with a high success rate. Young patients and patients with a body mass index below 25 are suitable for this technique. However, the same success rate could not be achieved in elderly patients with fatty breasts. 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 .

P155. “Medial wing Hemi-mastopexy”: An innovation to avoid medial pole emptiness in reduction mammaplasty

Introduction: In heavier breasts, there is a greater lower outer parenchymal distraction resulting in relative emptiness medially. The default excision of the horizontal-V medial wing parenchyma in wise-pattern or vertical mammaplasty may either maintain or worsen this emptiness. We present a technical innovation to avoid such loss of volume.

Photometric Evaluation of Long-term Changes in Breast Shape after Breast Augmentation and Vertical Mammaplasty.

Background:Little information is presently available regarding the long-term effects of breast augmentation and mammaplasties on breast shape. Existing studies typically use 1-dimensional measurements and mean follow-up times seldom exceed 1 year.Methods:Twenty women were studied: breast augmentation (n = 5), mastopexy (n = 5), augmentation/mastopexy (n = 5), and breast reduction (n = 5). For mammaplasties, a vertical method using a medial pedicle and intraoperative nipple siting was used in all cases. A 2-dimensional measurement system was used, with computer-assisted matching of lateral photographs of the right and left breasts. Measurements were evaluated at 3 times: before surgery, 1 year after surgery, and 10 years after surgery.Results:Breast implants significantly increased breast projection and upper pole projection. The nipple level was unchanged. The lower pole level dropped. These changes were preserved at 10 years. Vertical mastopexy provided a modest increment in breast projection and upper pole projection. The nipple level and lower pole level were raised significantly. Augmentation/mastopexy boosted breast projection and upper pole projection, and also elevated the nipple and lower pole level. Breast reduction changes were similar to mastopexy, but with greater elevation of nipple level and lower pole level, which were usually lower to start with. Implants increased upper pole convexity. Nipple overelevation was avoided by intraoperative nipple siting just below the breast apex.Conclusions:These measurements provide new information regarding the long-term effects of breast augmentation and vertical mammaplasties. This information may be used by plastic surgeons in procedure selection and patient counseling.

Commentary on: Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up

Reduction mammaplasty continues to remain a rewarding procedure with high satisfaction rates among patients of all Body Mass Indes, due to improvement in quality life.1-3 When an inferior pedicle or one of its variations is utilized, loss of upper pole fullness, pseudo-ptosis (bottoming out), and upwards rotation of nipple-areola complex (star gazing deformity) are the most feared concerns. This occurs due to the effect of gravity and lack of lower pole support that lead to downward movement of the breast parenchyma infero-laterally. The authors in this article have demonstrated a technical pearl that can minimize one of the long-term concerns in breast reduction, bottoming out.4 By better supporting the lower pole, one can minimize all other sequale of bottoming out. Even though the number of patients is limited in this study, the design of it is unique and helps the readers understand the descent of the …

Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up.

The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension. Although the pectoralis muscle sling has been subjectively observed to reduce the bottoming-out effect with a bipedicled muscle flap (muscular loop), there has not been a study to objectively or numerically prove it. This study aimed to radiologically evaluate the influence of a pectoralis muscle sling in supporting the chest wall-based flap after a vertical breast-reduction technique. Twenty-one female patients underwent a vertical breast reduction with the chest wall-based flap and were randomly divided into two subgroups. Ten patients were in subgroup (S), which consisted of patients with a muscle sling. Eleven patients without the muscle sling technique were assigned as a control group (C). Periodic radiological examinations were performed at 1, 3, 6, and 12 months and then at 10 years postoperatively to analyze the breast flap and any migration with respect to three titanium clips placed intraoperatively on the chest wall parenchyma flap. Patients in subgroup S had a significantly higher difference in migration of the chest wall-based flaps between the first day and 10 years postoperatively when compared with patients in subgroup C (P < .001), as shown by the distances measured between titanium clip locations. After 10 years of follow-up, there were changes in chest wall-based flap bottoming-out in patients in whom a pectoralis major muscle sling was utilized compared with those patients without it. Thus, a pectoralis major muscle sling seems to provide greater and longer-lasting support to the flap position on the patient's chest. 2 Therapeutic.

Vertical mammaplasty with purse string suture for correction of breast ptosis

Objective To evaluate an improved technique of vertical mammaplasty with purse string suture for correction of breast ptosis and its clinical application. Methods The adjustable markings of vertical mammaplasty was improved with an upper pedicle for the areola, and breast reduction was adapted with the lower part. The breast tissue was lifted and fixed on the second rib level to reshape the breast, which did not rely on the skin, with purse string suture for the lower half of vertical incision. 32 patients with breast ptosis had been operated from May 2009 to February 2014. Results 32 cases were treated with vertical mammaplasty with short scar. The shape of the breasts was strengthen, without obvious scar, and follow-up results of patients were satisfied. Conclusions The vertical mammaplasty with short scar design is simple, operation is convenient, breast shape is plump, and postoperative long-term effect is great. This procedure can be used as one of the feasible operation for breast ptosis correction. Key words: Breast ptosis; Mammaplasty; Purse string suture; Scar

Vertical Scar Reduction Mammaplasty

Vertical Scar Reduction Mammaplasty

Vertical Mammaplasty for Varying Degrees of Reduction

Vertical Mammaplasty for Varying Degrees of Reduction

Analysis of the vertical mammaplasty design in skin-sparing mastectomy and immediate autologous reconstruction

Skin-sparing mastectomy designs for immediate autologous breast reconstruction include racquet, Wise, and vertical mammaplasty incisions. The vertical design addresses ptosis while maintaining viable skin flaps. This study compares the racquet to the vertical incision. Immediate skin-sparing autologous breast reconstructions by a single surgeon using either vertical or racquet incisions from August 2006 to September 2011 were analyzed. Aesthetic scoring was based on a Likert-scale assessment of scar appearance, shape, preoperative versus postoperative aesthetic comparison, and overall aesthetic outcome. Responses were analyzed using the Mann-Whitney test. Seventy-seven patients (48 racquets and 29 vertical) were included. Patient demographics and complications did not differ. Vertical design reconstructions were used for patients with higher-grade ptosis (p < 0.001). Significantly better-appearing scars (3.8 vs. 3.5; p = 0.04) were observed in the vertical group. Vertical reconstructions showed a trend toward significance in cosmetic improvement compared with preoperative appearance (3.2 vs. 3.0; p = 0.06). There was no difference in shape (vertical 3.6, racquet 3.6; p = 0.86) or in postoperative aesthetic result (vertical 3.6, racquet 3.4; p = 0.41). Shape and overall postoperative aesthetic appearance did not significantly differ despite greater ptosis preoperatively in the vertical group, demonstrating the efficacy of the vertical design in reconstruction. Vertical design reconstructions were rated aesthetically superior to their pre-mastectomy appearance. Significantly better scar scores in the vertical group reflect the camouflaged nature of vertical incisions. These results demonstrate that the aesthetic outcome of the vertical design reconstruction in ptotic breasts is as good as and potentially superior to the racquet design reconstruction in non-ptotic breasts.

A mathematical design in creating the new nipple-areolar complex in vertical mammaplasty.

Summary:Vertical mammaplasty for breast reduction has been widely popularized by Lejour. In her planning for the new nipple-areolar complex, she did not specify a method of drawing the periareolar curve, leaving it to the surgeon’s creativity. We have designed a simple method using mathematics to draw the new periareolar curve consistently and reliably, not requiring any additional or complex devices. This method is easy for those who are accustomed to the Wise pattern to adopt and targets those who prefer formulated preplanned operative markings.

Vertical mammaplasty associated with accelerated partial breast radiotherapy: how oncoplastic surgery techniques associated with modern techniques of radiotherapy can improve the aesthetic outcome in selected patients

Vertical mammaplasty associated with accelerated partial breast radiotherapy: how oncoplastic surgery techniques associated with modern techniques of radiotherapy can improve the aesthetic outcome in selected patients

Prospective Comparative Clinical Evaluation of 784 Consecutive Cases of Breast Augmentation and Vertical Mammaplasty, Performed Individually and in Combination

Despite the growing popularity of breast lift surgery, no published study prospectively evaluates mastopexy and augmentation/mastopexy. Several investigators suggest an inordinate risk in combining augmentation and mastopexy, and recommend staging the surgery in some patients. However, no existing study includes the necessary individual and combined treatment cohorts to allow reliable comparisons of safety and efficacy. This study investigates the clinical outcomes and safety of these cosmetic breast procedures, whether performed individually or in combination. This 10-year prospective study evaluated 759 consecutive women undergoing 784 consecutive cases of breast augmentation (n = 522), mastopexy (n = 57), augmentation/mastopexy (n = 146), reduction (n = 48), and reduction plus implants (n = 11). All patients were treated by the author using submuscular implant placement and vertical parenchymal resection with a medial pedicle and intraoperative determination of nipple positioning. A power analysis confirmed adequacy of the sample sizes. The complication rate was 36.3 percent for augmentation/mastopexy, 33.3 percent for mastopexy alone, and 17.6 percent for breast augmentation alone. Mammaplasties were complicated by persistent ptosis in 9.5 percent of patients. The revision rate after augmentation/mastopexy was 20.5 percent, compared with 24.6 percent for mastopexy and 10.7 percent for breast augmentation. Vertical mammaplasty may be used to correct ptosis in breasts of all sizes. Vertical augmentation/mastopexy provides complication and revision rates that are less than the calculated cumulative rates for the procedures performed separately. The combined procedure offers technical advantages and permits safe single-stage surgery using the vertical technique. Therapeutic, II.

Correction of Nipple Divergence in Reduction Mammaplasty: Pillar Extension Flap

Lateral displacement of the nipple-areola complex becomes more obvious after reduction mammaplasty if it is not corrected. When performing mammaplasty, the Wise or vertical pattern incision lines should encompass the entire areola to prevent positioning of a pigmented area adjacent to the closure line. A high, laterally displaced areola can be repositioned using the circumvertical technique. However, in cases of breast ptosis with a laterally displaced areola, the limbs of the Wise or vertical pattern incision lines need to be modified. Transposition of the nipple-areola complex to a slightly higher location or larger area may also prevent distortion. This article describes a new modification of the vertical limbs of the Wise or vertical pattern mammaplasty that can help improve results. This new technique was used in 16 breasts of 10 patients who underwent reduction mammaplasty. In these patients, the areola extended beyond the Wise or vertical pattern incision lines drawn on the breast. The residual areola on the lateral pillar was excised, and a matching extension was added to the medial pillar (pillar extension flap). No cases of skin necrosis were observed. Six of the ten patients were followed up for at least 6months, and all were satisfied with postoperative breast shape and nipple location. The pillar extension flap is a suitable technique for correction of lateral nipple displacement during reduction mammaplasty. This procedure can be performed alone or in combination with other techniques. 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 .

Prospective outcome study of 106 cases of vertical mastopexy, augmentation/mastopexy, and breast reduction

Patient-reported data, including effects on patient satisfaction and quality of life, have not been rigorously studied in women treated with mastopexy and augmentation/mastopexy. This prospective outcome study evaluates and compares mastopexy (n=36), augmentation/mastopexy (n=47), and reduction (n=20) from the patient's perspective. Over a 5-year period, 125 consecutive women underwent vertical mammaplasties incorporating a medial pedicle. In-person interviews were conducted among 106 women at least 1 month after surgery (response rate, 84.8%). Questions were asked in six categories: patient data, indications, recovery, results, complications, and psychological effects. A follow-up study examined the incidence of subjective nipple numbness. The mean pain rating was 4.5 on a 1-10 scale. Both mastopexy (resection weight<300 g per breast) and reduction patients reported a significant reduction in physical symptoms after surgery (p<0.001). The mean result rating was 9.0 n a scale of 1-10. Expectations were met or exceeded in 91.5% of augmentation/mastopexy patients. The reported complication rate was 15.1%. The incidence of persistent nipple numbness was 10.6%. All procedures reduced breast self-consciousness (p<0.001). A correlation was found between the result rating and a lack of complications (p=0.01). All three breast procedures provide a high level of patient satisfaction (94.3%), improved self-esteem (89.3%), and improved quality of life (69.5%). Mastopexy patients report a symptomatic benefit in addition to correction of ptosis. Vertical augmentation/mastopexy provides a high level of patient satisfaction.

Meridian Pedicle-Based Breast Shaping in Reduction Mammaplasty: A Technical Modification

We present a technical modification of vertical reduction mammaplasty which provides a reliable pedicle that can be used in large and highly ptotic breasts with confidence when compared to vertical mammaplasty techniques without sacrificing conical breast shape and projection, in contrast to Wise pattern reduction techniques. Thirty-two patients under general anesthesia were operated on using this modification between 2008 and 2012. The surgical technique is as follows: after general anesthesia induction and local anesthetic infiltration, skin incisions are made according to preoperative drawings. The breast meridian is prepared by superior and inferior plication of the vertical pedicle, including two dermal and one central attachment to the chest wall. Lateral and medial tissue resections are performed, thus preparing medial and lateral pillars after skin undermining. The pillars are sutured to the meridian to reconstruct a projectile conical breast shape. Inverted-T scar (87.5%, n=28) and vertical scar (12.5%, n=4) were used for closure. All patients were satisfied with the outcome regarding breast projection, shape, and size at 12 (n=30) and 24 months (n=15) after surgery except for 12 cases that needed reoperations: 2 cases for bottoming out and lower pole deformity, 2 cases needed more reduction by liposuction or re-excision, and 8 scar revisions. Early and late results (up to 2 years) regarding breast shape and projection were found to be satisfactory while providing a reliable pedicle with less postoperative drainage. 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.