Sunday, October 10, 2004

Improving Immediate Shape And Long Term Stability In Vertical Scar Breast Reduction By The Dermal Suspension Flap Technique

Oliver Scheufler, MD, Dirk J Schaefer, MD, Martin Haug, MD, Gerhard Pierer, MD, PhD, and Klaus Exner, MD, PhD.

Despite enthusiastic reports about vertical scar reduction mammaplasty in the early 90th, many surgeons still feel uncomfortable with this technique for several reasons. Of significant concern for the patient and surgeon alike is the distorted breast shape immediatly after surgery with excessive upper pole fullness, and contracture with considerable wrinkling at the lower pole. Although this usually resolves with time, additional surgery for correction of residual skin excess or contour deformities is not uncommon. This has promted many surgeons to adhere to more predictable inverted T-scar techniques. To obtain an acceptable breast shape immediately after surgery we have modified several aspects of the original vertical scar technique. Incorporation of a superiorly pedicled dermal flap allows even distribution of the lower pole skin excess and acts as an „inner brassiere“ to maintain breast shape. In addition, the technique abandons liposuction, wide undermining, and inner suspension sutures. In 50 patients with moderate breast hypertrophy a total of 96 breasts were operated with the modified vertical scar technique from 1996 to 2000. Patient age ranged from 18 to 58 years (mean ± SD = 29.2 ± 9.5 years) and body mass index from 20 to 31 (mean ± SD = 22.1 ± 2.8). Breast dimensions were assessed preoperative, 1 week after surgery and at late postoperative follow-up (≥ 2 years) and included jugular notch-to-nipple distance (J-N), areola-to-inframammary fold distance (A-IFM), cup size, and chest circumference. All patients were asked to complete a detailed questionnaire at late postoperative follow-up to evaluate patient satisfaction. The amount of breast reduction ranged from 110 to 1060 g (mean ± SD = 496 ± 215 g). Cup size changed from preoperative C to F cups to postoperative B to D cups with an average decrease of 2 cup sizes after surgery. There was no significant difference in pre- and postoperative chest circumference. Postoperative complications included hematoma in 1%, infection in 0.5%, and fat necrosis in 2%. Comparison of early and late postoperative measurements revealed a slight but not statistically significant increase of the J-N and A-IMF distance. This can be attributed to the postoperative settling of the reshaped glandular tissue. No recurrent ptosis or bottoming out was observed at late postoperative follow-up. Evaluation of the patient questionnaire demonstrated a high degree of satisfaction regarding early and late postoperative breast size, shape, and symmetry. Vertical scar widening or dog ear formation at the lower pole occurred in 15% and required conversion of the vertical scar to a short inverterd t-scar in 5%. In conclusion, the modified vertical reduction mammaplasty with dermal suspension flap improves immediate shaping and long term stability in patients with moderate breast hypertrophy (reduction £ 800 g). The technique meets limitations in cases of massive breast hypertrophy (reduction > 800 g) in which inverted T-scar techniques are prefered.
View Synopsis (.doc format, 99.0 kb)