Free Nipple Reduction Mammaplasty with a Horizontal Scar in High-Risk Patients (original) (raw)
2002, Aesthetic Plastic Surgery
Women with extremely large and ptotic breasts have many complaints and difficulties during daily life. Conventional reduction mammaplasty techniques are not convenient because the presence of excess tissue beneath and over a long pedicle may cause nipple-areola complex necrosis. These patients mostly have systemic health problems so they benefit from a shorter operative procedure. The amputation method is an option providing rapid surgical operation time and little blood loss but it may lead to a flat, unaesthetic breast with poor projection. In this paper we present an alternative amputation with the use of a backfolded dermoglandular flap and free nipple graft. The inferior pole is amputated. The deepithelialized breast tissue is left on the superior pedicle extending below the 7-cm vertical limb mark. This deepithelialized tissue is tucked to give more central mound projection. The aesthetic outcomes, such as well-rounded breasts with good projection and a hidden scar at the submammary sulcus, have led us to perform this technique, which was first described by the Mansteins in 1997.
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Reduction Mammaplasty Using Bipedicled Dermoglandular Flaps and Free-Nipple Transplantation
Aesthetic Plastic Surgery, 2010
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.
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