Fig 5 - uploaded by Shady N Hayek
Content may be subject to copyright.
Patient presenting 2 years after standard vertical mammaplasty for secondary correction of small irregular ANC, increased lower pole fullness, long vertical scar, and ''dog-ear'' that becomes exaggerated when the arm is elevated. Correction is performed with a circumvertical design and superior dermoglandular pedicle. The area of subdermal undermining and liposculpture isoutlined. Maximal skin.
Source publication
Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skep...
Similar publications
Background:
Limited scar Lejour technique for breast reduction is conventionally used to remove less than 500 g of breast tissue per breast, but is effective for greater macromastia. Plastic surgery residents gain limited experience with this technique, and it is infrequently performed in the United States. To understand technique selection, we su...
Citations
... Many refinements and modifications of vertical scar mammaplasty are applied to make it a user-friendly technique and reduce the risk of dog-ear formation and pronounced skin puckering [15,16]. ...
Background
Macromastia is
the abnormal enlargement of the female breast, which causes physical and psychological stress for women’s health. Reduction mammoplasty is the only definite treatment of macromastia; several studies document its positive impact on women’s physical, social, and intimate well-being. The Wise pattern skin technique is a popularized technique among plastic surgeons for all varieties and sizes of breast reductions. However, this technique poses some drawbacks: lack of projection, reduced upper pole fullness, and late bottoming. The introduction of the vertical scar reduction mammaplasty increases the level of patients’ expectations and satisfaction. Many plastic surgeons tried several modifications of the vertical scar technique to eliminate its two common disadvantages: excessive lower pole length and double bubble appearance.MethodsA retrospective study was conducted for 139 female patients between the years 2016 and 2020 who underwent a modified owl technique reduction mammaplasty, analyzing patients and operative data to identify the relationship between the modifications of the adopted technique, complication rate, and patients’ satisfaction.ResultsMean follow-up was 17 months. Mean age for all patients was 34 years (range between 19 and 59 years). Early complications such as hematoma and seroma occurred in 4 patients. No total or partial nipple‐areola complex losses were recorded.Conclusions The modified owl technique herein presented seems a safe alternative for reduction mammaplasty in moderate macromastia and in selected cases of severe macromastia, where breast fullness is concentrated in the lower pole.Level of evidence: Level IV, therapeutic study
... 3,[6][7][8][9][10][11] Benefits of vertical versus inverted T-shaped closure have been discussed by multiple authors. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Aesthetic patients undergoing explantation are especially suitable for lollipop mastopexy versus an inverted T with its additional scars. ...
Unlabelled:
The treatment of patients requiring explantation of breast prostheses is a complicated clinical issue, for which a consensus regarding the best way forward is still evolving. We believe that simultaneous salvage auto-augmentation (SSAA) is a viable option for the treatment of patients with explantation.
Methods:
Sixteen cases (32 breasts) were reviewed over a 19-year period. The management of the capsule is based on intraoperative findings and not on preoperative evaluation because of the poor interobserver correlation of Baker grades.
Results:
The mean age and clinical follow-up duration were 48 years (range: 41-65) and 9 months, respectively. We observed no complications, and only one patient underwent unilateral surgical revision of the periareolar scar, under local anaesthesia.
Conclusions:
This study suggests that SSAA with or without autologous fat injection is a safe option for women undergoing explantation, with potential aesthetic and cost-saving benefits. In the current climate of public anxiety regarding breast implant illness, breast implant-associated atypical large cell lymphoma, and asymptomatic textured implants, it is anticipated that the number of patients desiring explantation and SSAA will continue to increase.
... 4 In 1923, Lotsch described the inverted-T-shaped periareolar skin incision with the horizontal branch slightly above the submammary fold as an alternative approach to breast reduction with resection of the adipose-glandular breast tissue in the central and lower part of the breast. 11,12 This became one of the most commonly used surgical techniques, as described by Pitanguy in 1961. As a result, an inverted-T-shaped scar is obtained. ...
Background
Mastopexy combined with silicone implant placement is one of the most frequently performed plastic surgeries. Various techniques have been developed to increase the degree of patient satisfaction after surgery. The goal is to give the breasts a harmonious shape, generating the smallest scars possible. The Breast Evaluation Questionnaire (BEQ 55) was developed in 2006 as a tool for assessing the satisfaction and comfort of patients with the general appearance of the breasts.
Objectives
The objective of this study was to compare the degree of satisfaction of patients undergoing mastopexy using the inverted-T technique vs. the short-scar technique by the BEQ 55.
Methods
The BEQ 55 was administered in the pre- and postoperative periods to 200 patients who underwent mastopexy performed by the first author between October 2013, and September 2017. One hundred patients underwent the short-scar technique, and 100 patients underwent the inverted-T technique.
Results
The first analysis used descriptive statistics. Relative frequencies were used to track the responses corresponding to each technique. There was an increase in the level of patient comfort and satisfaction with breast appearance after surgery in both groups. The short-scar technique was shown to be superior, with statistical significance (p < 0.05) found for the questions evaluating comfort with overall appearance naked, comfort with breast appearance naked and satisfaction with breast appearance.
Conclusions
Both techniques improved the patients’ satisfaction and comfort with their breasts. When the short-scar technique was used, patients were more comfortable with their breast appearance and with their overall appearance naked.
... Marking, infiltration, de-epithelization and liposuction (Figs. 1a, 3a, b) Marking is not characteristic; the new areolar location is often marked as a mosque dome shape as described by Le-jour [1], but a circumvertical pattern [20][21][22] is preferred when the vertical lines remain too long. First, the marked incision lines are cut out superficially on both breasts, as they can be erased. ...
Background
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.Method
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.Patients and ResultsThe study enrolled a total of 85 patients with 170 breasts. Mastopexy or minor reduction less than 100 gr was applied for 49 breasts; moderate reduction, 100–399 gr, for 67 breasts; and a large reduction of more than 400 gr 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).Conclusion
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.Level of Evidence IVThis 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.
... Although breast reduction with inverted T scar is the technique of choice because of reliability among the plastic surgeons, 1 vertical scar breast reduction which enables less scar and longer lasting results, is also welcomed. 2,3 The evolution and history of the vertical scar breast reduction and mastopexy is well described in the literature. 4 The technique was first introduced by Dartique and further developed and popularised by Lassus and Lejour. ...
... 6 While fullfilling the need of more patients, it also gained increasing popularity among surgeons, recently. [1][2][3] In the present article a novel modification of vertical scar breast reduction based on mastopexy with limited inferior pole resection was described. Young patients with large but mild ptotic breasts have consulted us whether lifting their breasts is possible without volume reduction reduction. ...
Many young women are satisfied with their large breasts but suffer from sagging due to heaviness. In this article; we present a novel modification of vertical scar breast reduction based on a special indication.
From January 2006 to May 2012, twenty five individual patients underwent operation using modified technique with superior pedicle and vertical scar. Young women between ages 25-35 years with voluminous breasts who requested mastopexy rather than reduction were selected for the surgery.
The mean patient age was 30 years and body mass index (BMI) was 27.8±1.07 kg/m(2). Mean nipple transposition was 6.5 cm. Mean weight for resected tissue was 415 g for left and 419 g for right breast. Mean operative time was 125 minutes. Patients were followed up for 9-22 months. No serious complications encountered in consecutive patient series. The only complication was permanent wrinkling probably due to vertical closure in 5 of 25 patients which did not resolve during the follow-up period.
We recommend that the Snowman design is a useful tool for superior pedicle breast reduction technique providing good projection and a short scar in selected patients.
... With the patient in the standing position, surgical planning is performed pre-operatively after discussing the case with the oncologic surgeon. A standard circumvertical pattern is marked [37] and is tailored according to breast size and tumor location. For small breasts with no skin excess, the planned incision pattern can be limited to the nipple areolar complex with a minimal infra-areolar component. ...
Introduction:
With the better understanding of breast cancer history and biology, improved diagnostic modalities and the shift towards minimally invasive surgeries, indications for prophylactic mastectomy, skin sparing or skin reducing mastectomies (SSM/SRM) with nipple areolar complex (NAC) preservation coupled with immediate breast reconstruction are gaining popularity. The authors share their experience and conception with mastectomy and immediate alloplastic breast reconstruction with the esthetic circumvertical mammoplasty pattern combined with the dermal barrier buttress flap.
Material and methods:
The described technique was performed for 28 patients presenting for mastectomy and immediate alloplastic breast reconstruction. With close collaboration between the oncologic and plastic surgeons, mastectomy was performed in all cases with the esthetic circumvertical mammoplasty pattern. To achieve safe excision and optimal reconstruction, the standard incisions could be custom designed to fit oncologic requirements and allow the creation of a dermal barrier flap used as a buttress separating the implant from the suture line.
Conclusion:
The circumvertical mastectomy pattern combined with the dermal barrier buttress flap is a versatile option allowing safe reconstruction regardless of the tumor and necessary skin excision location.
... Neste artigo é descrita uma modificação da mastopexia circunvertical/redução do padrão de mamoplastia, para mastectomia e reconstrução mamária imediata com implante 15,16 . A pele entre as linhas de incisão cutânea medial e vertical lateral é desepitelizada, criando uma barreira cutânea na prótese, para reforçar a linha de sutura vertical. ...
INTRODUÇÃO: A reconstrução mamária imediata com implante de silicone após mastectomia subcutânea tornou-se uma opção válida para médicos e pacientes devido à simplicidade das manobras cirúrgicas, menor tempo cirúrgico, cicatriz mínima e resultados estéticos imediatos. Os implantes submusculares também são recomendados, apesar de exigirem um procedimento cirúrgico mais agressivo. Ambos também podem causar problemas secundários que já foram descritos. Para reduzir esse tipo de problemas, neste artigo é descrita uma modificação da mastopexia circunvertical, redução do padrão de mamoplastia para mastectomia e a reconstrução mamária imediata com implante. MÉTODO: A pele entre as linhas de incisão cutânea medial e vertical lateral é desepitelizada, criando uma barreira cutânea para a prótese para reforçar a linha de sutura vertical. CONCLUSÕES: A técnica garante uma reconstrução segura, com resultados estéticos gratificantes.
... Moreover, use of large prostheses may result in lowlevel breast projection [12]. It is evident at present that the dual dermomuscular pouch created by releasing the inferior fibers of the pectoralis major, leaving the implant inferiorly in a subcutaneous placement, provides satisfying cosmetic appearance, especially with regard to optimal degree of ptosis and appropriate distribution of volume between superior and inferior as well as medial and lateral aspects of the breast [3,13]. ...
... Skin-sparing procedures represent a major advance in immediate aesthetic reconstructions [11]. Saving the skin envelope and inframammary fold improves the reconstructive outcome of a conventional radical modified or simple mastectomy with or without NAC preservation and avoids unpleasant scarring [13]. Increasing acceptance of the oncologic safety of the SSM and immediate reconstruction has prompted refinements in the technique that are designed to minimize the scar burden [11] and improve aesthetic result. ...
Background
Skin-sparing mastectomy (SSM) and skin-reducing mastectomy (SRM) with immediate breast reconstruction (IBR) is oncologically safe and has become increasingly popular as an effective treatment for patients with early stage breast cancer requiring mastectomy. Cosmetic appearance following IBR depends largely on the location of the skin incision, the quantity of breast skin left as well as the pocket for prosthetic placement, whether submuscular, subcutaneous, or both. SRM with Le Jour pattern skin excision has already been described in conjunction with autogenous tissue reconstruction. This technique is not recommended for implant-based IBR because any compromise of skin viability can result in exposure of the implant or expander.
Methods
We propose SRM with a circumvertical skin excision pattern and IBR comprising a de-epithelialized dermal barrier to reinforce the vertical suture line. We performed this technique on 10 breast cancer patients.
Results
Eight patients underwent SSM with IBR using textured anatomical cohesive gel implants. One patient had Becker tear drop implants for both breasts (right SSM with IBR, and delayed left breast reconstruction); and the last patient had completion mastectomies with IBR using Becker tear drop implants. None of the patients developed complications.
Conclusion
This technique is reliable and safe for implant-based IBR, ensuring minimal scarring and pleasing aesthetic results.
Level of Evidence: Level IV, therapeutic study.
Background:
Augmentation mastopexy focus on restoring the youthful appearance of the female breast. Despite those benefits, there is large scarring to be considered, and the reduction of this side effect is the main goal to enhance the aesthetic result. This article aims to describe a variation of the L-shaped mastopexy technique without complex marking and performed in planes, which brings long-term results for patients undergoing this approach.
Methods:
This is a retrospective, observational study, based on a series of cases conducted by the author. The preoperative appointment and the surgical technique are described, and divided into steps according to their components: cutaneous, glandular tissue, and muscular.
Results:
Between January 2016 and July 2021, 632 women underwent surgery. The mean age was 38 years (18-71 years). The mean volume of implants was 285cc (175-550cc). All the implants used were round with a nanotextured surface. The mean tissue resected from each breast was 117g (5-550g). Follow-ups ranged from 12 to 84 months, and photographic documentation was performed from 30 days after surgery. Complications totaled 19.30% and were divided into minor - treated with expectant treatment, non-invasive or with the possibility of correction with local anesthesia, corresponding to 10.44%; and major - in which it was necessary to return to the operating room, corresponding to 8.86%.
Conclusion:
Multiplane L-Scar Mastopexy is a versatile and safe technique with predictable results, which allows the systematic treatment of the most diverse breast types, with complications similar to other already described and solidified techniques.
Background:
In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties.
Methods:
A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially.
Results:
A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m2 (21.3-42.7 kg/m2). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%.
Conclusions:
Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties.
