Mastopexy with Implant after Massive Weight Loss: Results with the Crossed Flaps Plication Technique

Abstract

Background: After massive weight loss in post-bariatric patients, breasts present with sagging, varying degrees of ptosis, empty and flat upper pole (1). In mastopexy with implants, the plication of lateral and medial crossed parenchymal flaps technique and the factors that influence its choice were evaluated.

Methods: 15 patients submitted to gastroplasty before mammaplasty and classified as type one or two according to the Pittsburgh scale for post-bariatric breasts (2), underwent mastopexy with implants and plication of lateral and medial crossed flaps (jacket pattern) (Figure 1).

Results: The mean BMI before mammoplasty was 25.6 (range 21.7 to 30.0). Nipple to sternal notch (N-SN) and nipple to inframammary fold (N-IFM) distances improved after surgery. Although there was a gradual increase in these measurements in post-operative follow-up, N-SN distance improvement was maintained after six months and N-IFM increase was clinically evident as pseudoptosis in some patients. All patients considered the results good or excellent.

Conclusion: When patients desired to increase breast volume and the inferior areolar border to IFM fold distance was less than 8 cm, this technique achieved pleasant results and patient's satisfaction.

References:

1.  Modolin M, Cintra W, Jr., Silva MM, Ribeiro L, Gemperli R, Ferreira MC. Mammaplasty with inferior pedicle flap after massive weight loss. Aesthetic plastic surgery. Oct 2010;34(5):596-602.

2.  Song AY, Jean RD, Hurwitz DJ, Fernstrom MH, Scott JA, Rubin JP. A classification of contour deformities after bariatric weight loss: the Pittsburgh Rating Scale. Plastic and reconstructive surgery. Oct 2005;116(5):1535-1544; discussion 1545-1536.

Figure 1: A - Dissection of medial flap after implant placement in subglandular plane. B - Plication of lateral flap in posterior side of medial flap. C - Plication of medial flap in anterior side of lateral flap. D - Skin resection after plication of crossed flap over the implant.

Figure 2: Mastopexy with round textured silicone implants 275 cc and plication of lateral and medial crossed flaps (jacket pattern), pre and post-operative.

Figure 3: Mastopexy with round textured silicone implants 255 cc and plication of lateral and medial crossed flaps (jacket pattern), pre and post-operative.