Double flap technique: An alternative mastopexy approach

Abstract

If we review the history of mammaplasty, we see that several techniques have been described. Although the subsequent reduction mammaplasties were probably performed by Dieffenbach (1848), Morestin (1909), and Villarde (1911), the first publication was made by Lexer (1921) describing a technique with nipple areola complex transposition using an inverted Thscar [1-4]. The superiorly based dermal pedicle, the vertical bipedicle dermal flap, the inferior pyramidal free nipple graf, the concentric mastopexy techniques, and Benelli modifications of the old donut mastopexy are some of the techniques described previously [5-11]. Pitanguy [12] described the inverted-Thincision with a superior pedicle carrying the areola. Strombeck [13] used a horizontal bipedicle cutaneous flap; Mckissock [14] described a vertical bipedicle flap. Courtiss and Goldwyn [15] used an inferior pedicle. Lassus [16], Lejour [17], Peixoto [18], Hallfindlay [19], Skoog [20], Qun Qiao et al. [21], and Hinderer [22] described other techniques. Goes [23] used a large sheet of mesh, placed over the entire upper pole. Flowers and Smith [24] described the flip-flap mastopexy technique. Hammond described the short scar periareolar inferior pedicle reduction mam-maplasty [25]. Ali Eed [26] described a technique creating a cone; the nipple areola complex is carried on a subcutaneous inferior pedicle. Some surgeons proposed the L-shaped or J-shaped incision [27-29]. Cerqueira [30] described breast fixation with a dermoglandular upper pedicle flap under the pectoralis muscle. Marchac and de Olarle [31] introduced the concept of upper glandular plication and suspension to the pectoralis fascia. Ribeiro [32] mobilized a chest wall-based flap into the upper pole. Daniel [33] suggested the passage of the flap under an elevated loop of pectoral muscle. Regardless of the degree of ptosis, the theme of a mastopexy is to get long-term maintenance of upper pole volume, to contour the gland, to reposition the nipple areola complex preserving its vascular supply, and to resect the redundant skin. A reasonable solution to the upper pole deficiency is to relocate and secure tissue from the caudal breast into the upper chest. The author s experience showed that there is not only one perfect technique. It is important for the plastic surgeon to improve the technique that he uses. Our goal towards achieving an ideal breast through mastopexy led us to a combination of superior and inferior breast flap approach. It is a modification of Pitanguy s mammaplasty technique of the superior pole. The concept of internal suspension to support the breast is not new [34-37]. However, advantages of this approach are that it fills out the deficient upper breast, it maintains the vascular supply to the breast tissue and the nipple areola complex, it places the nipple areola complex in an acceptable position, it preserves normal sensation, it allows a more comfortable closure, and it avoids exaggerated scar tension. It is a safe and versatile technique suitable for all degrees of breast ptosis. It produces excellent aesthetic and long lasting results and it is an easy procedure to learn. © 2009 Springer-Verlag Berlin Heidelberg.