Introduction: Breast reduction is one of the most prevalent plastic surgery procedures in Syria and the world, bottoming out on the other hand is one of the most happened disadvantages after breast reduction with inferior pedicle technique. Different techniques were used to prevent this deformity after inferior pedicle. In this study we tried to prevent bottoming out by using two crossed dermal flaps suspending the inferior pedicle to the periosteum of the 2nd rib. Methods and materials: 32 patients had breast reduction surgery using inferior pedicle technique at Almowassat University Hospital in Damascus. We divide them into 2 groups, 16 patients each. First group we used crossed dermal flaps with the inferior pedicle and the second group was without these flaps, the dermal flaps had a base on the side of the inferior pedicle base, crossed anterior to it in the middle point between the lower edge of the areola and the IMF and then sutured to the periosteum of the 2nd rib on each side. Results: Preoperatively, the average distance between the inframammary fold and areola was 14.5 cm (range, 11 - 18 cm) in the first group without dermal flaps and 14 cm in the second group with dermal flaps. The average amount of breast parenchymal resection was 790 g (range, 140 - 1600 g). The average distance between the inframammary fold and the lower border of the areola was 8.5 cm (range, 7.5 - 9 cm) on the postoperative first-year measurements in the group with flaps and 10.2 cm (8.6 - 11.4 cm) in the other group. Conclusion: Inferior pedicle suspension using crossed dermal flaps has a real role in preventing bottoming out, without using any allogenic or alloplastic materials, making it one of the considered ways in preventing bottoming after breast reduction.
References
[1]
Cho, M.J., Yang, J.H., Choi, H.G., Kim, W.S., Yu, Y.B. and Park, K.S. (2015) An Idiopathic Gigantomastia. Annals of Surgical Treatment and Research, 88, 166-169. https://doi.org/10.4174/astr.2015.88.3.166
[2]
Davis, G.M., Ringler, S.L., Short, K., Sherrick, D. and Bengtson, B.P. (1995) Reduction Mammaplasty: Long-Term Efficacy, Morbidity, and Patient Satisfaction. Plastic and Reconstructive Surgery, 96, 1106-1110. https://doi.org/10.1097/00006534-199510000-00015
[3]
Mistry, R.M., MacLennan, S.E. and Hall-Findlay, E.J. (2017) Principles of Breast Re-Reduction: A Reappraisal. Plastic and Reconstructive Surgery, 139, 1313-1322. https://doi.org/10.1097/PRS.0000000000003383
[4]
Courtiss, E.H. and Goldwyn, R.M. (1977) Reduction Mammaplasty by the Inferior Pedicle Technique. An Alternative to Free Nipple and Areola Grafting for Severe Macromastia or Extreme Ptosis. Plastic and Reconstructive Surgery, 59, 500-507. https://doi.org/10.1097/00006534-197759040-00004
[5]
Georgiade, N.G., Serafin, D., Riefkohl, R. and Georgiade, G.S. (1979) Is There a Reduction Mammaplasty for “All Seasons”? Plastic and Reconstructive Surgery, 63, 765-773. https://doi.org/10.1097/00006534-197906000-00001
[6]
Rodier-Bruant, C., Wilk, A., Rosenstiel, M., Nisand, G. and Meyer, C. (1995) Does the Choice of Mammoplasty Pedicle Influence the Shape of Reduced the Reduced-Sized Breast? Annales de Chirurgie Plastique Esthétique, 40, 404-411.
[7]
Echo, A., Guerra, G. and Yuksel, E. (2011) The Dermal Suspension Sling: Shaping the Inferior Pedicle during Breast Reduction. Aesthetic Plastic Surgery, 35, 608-616. https://doi.org/10.1007/s00266-010-9632-5
[8]
Ding, H., Wang, B., Gu, Y. and Zhao, Y. (2015) The Combination of Inferior Pedicle Method and Dermal Suspension Sling Technique: One New Efficient Method for Breast Reduction. International Journal of Clinical and Experimental Medicine, 8, 6613-6620.
[9]
Zic, R., Vlajcic, Z., Dewing, D., Zambelli, M. and Stanec, Z. (2013) The “Dermal Cage”: A Modification of the Inferior Pedicle Breast Reduction. Aesthetic Plastic Surgery, 37, 364-371. https://doi.org/10.1007/s00266-012-0030-z
[10]
Vlajcic, Z., Martic, K., Budi, S., Roje, Z., Dewing, D. and Zic, R. (2020) The “Dermal Cage”: Inferiorly Based Dermal Flap Technique for Breast Reconstruction after Mastectomy. Journal of Plastic, Reconstructive & Aesthetic Surgery, 73, 486-493. https://doi.org/10.1016/j.bjps.2019.09.021
[11]
O’Grady, K.F., Thoma, A. and Dal Cin, A. (2005) A Comparison of Complication Rates in Large and Small Inferior Pedicle Reduction Mammaplasty. Plastic and Reconstructive Surgery, 115, 736-742. https://doi.org/10.1097/01.PRS.0000152428.43300.19
[12]
Graf, R. and Biggs, T.M. (2002) In Search of Better Shape in Mastopexy and Reduction Mammoplasty. Plastic and Reconstructive Surgery, 110, 309-317. https://doi.org/10.1097/00006534-200207000-00053
[13]
Mizgala, C.L. and MacKenzie, K.M. (2000) Breast Reduction Outcome Study. Annals of Plastic Surgery, 44, 125-133. https://doi.org/10.1097/00000637-200044020-00001
[14]
Hamdi, M., Greuse, M., De Mey, A. and Webster, M.H. (2001) A Prospective Quantitative Comparison of Breast Sensation after Superior and Inferior Pedicle Mammaplasty. British Journal of Plastic Surgery, 54, 39-42. https://doi.org/10.1054/bjps.2000.3456
[15]
Frey, M. (1999) A New Technique of Reduction Mammaplasty: Dermis Suspension and Elimination of Medial Scars. British Journal of Plastic Surgery, 52, 45-51. https://doi.org/10.1054/bjps.1998.3015
[16]
Goes, J.C. (2003) Periareolar Mastopexy: Double Skin Technique with Mesh Support. Aesthetic Surgery Journal, 23, 129-135. https://doi.org/10.1067/maj.2003.18
[17]
de Araujo Cerqueira, A. (1998) Mammoplasty: Breast Fixation with Dermoglandular Mono Upper Pedicle Flap under the Pectoralis Muscle. Aesthetic Plastic Surgery, 22, 276-283. https://doi.org/10.1007/s002669900203
[18]
Baumeister, R.G. (2003) Curtain Type Combined Pedicled Reduction Mammoplasty with Internal Suspension for Extensive Hypertrophic and Ptotic Breasts. British Journal of Plastic Surgery, 56, 114-119. https://doi.org/10.1016/S0007-1226(03)00034-1
[19]
Aydin, H., Tumerdem, B., Onel, D. and Cerci Ozkan, A. (2003) Reduction Mammaplasty Using Inferior Pedicle Technique Combined with Dermal Suspension. Plastic and Reconstructive Surgery, 111, 1362-1363. https://doi.org/10.1097/00006534-200303000-00068
[20]
Widgerow, A.D. (2005) Breast Reduction with Inferior Pedicle Fascial Suspension. Aesthetic Plastic Surgery, 29, 532-537. https://doi.org/10.1007/s00266-004-0119-0
[21]
Pennington, D.G. (2006) Improving the Results of Inferior Pedicle Breast Reduction Using Pedicle Suspension and Plication. Aesthetic Plastic Surgery, 30, 390-394. https://doi.org/10.1007/s00266-006-0040-9
[22]
Perez-Macías, J.M. (2007) Long-Lasting Evolution of Ptosis Control after Reduction Mammaplasty Using the Hammock Technique. Aesthetic Plastic Surgery, 31, 266-274. https://doi.org/10.1007/s00266-006-0188-3
[23]
Goes, J.C. (1996) Periareolar Mammaplasty: Double Skin Technique with Application of Polyglactine or Mixed Mesh. Plastic and Reconstructive Surgery, 97, 959-968. https://doi.org/10.1097/00006534-199604001-00012
[24]
Brown, R.H., Izaddoost, S. and Bullocks, J.M. (2010) Preventing the “Bottoming Out” and “Stargazing” Phenomena in Inferior Pedicle Breast Reduction with an Acellular Dermal Matrix Internal Brassiere. Aesthetic Plastic Surgery, 34, 760-767. https://doi.org/10.1007/s00266-010-9538-2
