Inverted keel resection breast reduction

Abstract

Patients presenting with breast hypertrophy invariably complain of physical discomfort, especially of the skeletal system. Psychological evaluation many times reveals a state of unhappiness and self-consciousness, and may result in difficult social adaptation. In warm climates, as in Brazil, where participation in outdoor activities and sports is stimulated year-round, and where the media promote the use of lighter and more revealing attire, aesthetic complaints because of large, cumbersome breasts become more relevant. In our country, breast hypertrophy is among the most common contour deformities that present for surgical correction. A personal modification of Arié's technique was initially presented in 1959, and published in the following year [1]. With the description of point A, which is the projection of the submammary sulcus along the midclavicular line, the vertical incision was extended above the nipple-areolar complex, with more satisfactory and longer-lasting results. Soon after, with the same principles, the Pitanguy technique [2], with the inverted keel resection, was developed for the treatment of large breast hypertrophy. These two procedures have served the purpose of approaching most aesthetic deformities of the breast, such as hypertrophy with or without ptosis, and represent the technical basis of many subsequent procedures. The senior author will focus on his techniques for breast reduction and mastopexy that involve the inverted keel approach to resection, covering a personal experience of over five decades. The following principles are emphasized: all resection is limited to the lower pole of the breast; no dissection of parenchyma is done, thus eliminating dead space and maintaining the intimate relationship between skin and parenchyma; the great feasibility of these procedures, allowing easy understanding and replication of the technique. © 2009 Springer-Verlag Berlin Heidelberg.