Mammaplasty with a circular folded pedicle technique

Abstract

Breast reduction surgery is one of the most challenging and difficult procedures that the surgeon faces in plastic surgery. Besides the frequent asymmetry, ptosis, and flaccidity, the patient's expectation is usually higher than what the surgeon can offer only because breasts are the most important prominence of the female silhouette. Even in an aged patient with overweight, large breasts and projected abdomen asking only for reduction without interest in cosmetic results, the image of sensual breasts is present and the surgeon must be prepared because she will demand it. On the other hand, we do not have conditions to define the perfect breast shape because there are no rigid criteria. Every epoch, every climate, and every culture has established a distinct concept of the ideal breast. Recent concerns deal with obtaining long-term breast projection and minimized scarring. It is important not only to reduce, but also to redistribute, support, and stabilize the breast tissue. The author devised a central convergence of the breast tissues by a circumareolar dermo-glandular pedicle folded on itself. Aft er cutaneous glandular excision in the inferior pole and glandular undermining under the perimeter of the pedicle, the pedicle is folded on itself to produce direct elevation of the nipple-areolar complex into its subsequent position, to act as a central support and to promote the global mobilization of the breast and surrounding thoracic skin. Only aft er completing the central pedicle will the extension and direction of the scars be determined in the inferior pole. Since the first publication in 1992, this technique has evolved to become more selective and eff ective. One of the most important advances was the creation of a turned down flap based on the inframammary fold to fill and lower it in cases where the inframammary fold is too high and depressed. This flap was named the "Longacre Reverse Flap" [1, 2] and act as strut and a expander of the breast base in the inferior pole. © 2009 Springer-Verlag Berlin Heidelberg.