Predicting Breast Reduction Weight Using the Mass of Breast Ptosis

Background The preoperative prediction of therapeutic breast reduction weights, to achieve both relief of breast weight symptoms and yet achieve excellent breast shape, remains a challenge. Objectives To design a simple clinical method to preoperatively predict and quantify therapeutic breast reduction weights. Methods In 31 women who underwent therapeutic bilateral reduction mammaplasty, the mass of the hypertrophic breast hanging below the inframammary fold was preoperatively weighed and then compared with the mass of the reduction specimen. Thirty patients underwent breast reduction using a superomedial nipple-areolar pedicle. Postoperative breast weight-related symptoms and breast shape findings were then noted. Statistical analysis relied on mean, SD, sample size, Mann-Whitney test for medians, Levene's test for variances and regression analysis. Results The average clinical follow-up was 160 days, with all patients achieving satisfactory breast size and shape from both the patient and surgeon's perspectives. All patients reported improvement of back pain, shoulder pain and lower neck pain. Two breasts developed delayed healing of the lateral skin flap, necessitating debridement and reclosure, followed by uneventful ongoing healing. There was no significant difference in preoperative ptotic breast mass and resectional breast mass (all P>0.05). Conclusions Simple preoperative weighing of the ptotic portion of the hypertrophic breast can serve as a goal for the reduction weight, while creating pleasing breast proportions and improving breast weight-related symptoms. Preoperative quantification of the ptotic breast mass may guide the reduction technique and assist insurance precertification efforts.

L Scar in Reduction Mammaplasty with Dermal Brassiere

In the surgical correction of a ptotic or hypertrophic breast (mastopexy, reduction mammaplasty) the preference for one technique is associated with the choice and experience of the surgeon. The decision as to the type of surgery depends on the anatomic nature, the degree of ptosis, the age of the patient, and, above all, the aesthetic sense of the surgeon. The improvement that the surgeon obtains in shape, volume, and position of the breast must not be compromised by prominent and nonaesthetic scars that alter the final result. Today in mammaplasty, the goal of most surgeons is to give the breast new form, volume, and durable shape with minimal scarring. Starting from these considerations, the author prefers the techniques that involve a vertical or an L scar, which avoid incisions in the so-called hypertrophic areas of the chest (medial and lateral extremities of the submammary fold). The author has used a modification of the Arie technique since 1984 for marked ptosis and hypertrophy. The technique shortens and transforms the long vertical scar into an L-shaped limited scar. The method is based on nipple-areola transposition on a wide superior flap in the new predetermined side (supraareolar dermopexy). The skin of the inferior pole of the breast is deepithelialized to form an inferior dermal or dermo glandular flap for retropectoral dermopexy (dermal brassiere). This flap gives stability to the breast and makes it more durable.