Improvement of Superomedial Breast Reduction and Mastopexy with a New “Hammock” Flap

Abstract

Background: Oncoplastic breast reduction shares similar aims and principles with esthetic surgery. Superomedial breast reduction provides harmony, symmetry, and satisfactory lower pole projection, but long-term outcomes are not consistently good. We describe our experience with a new hammock-shaped flap, which was combined with superomedial pedicle breast reduction to improve long-term outcomes by enhancing pedicle support and preventing ptosis recurrence. Methods: From January 2017 to June 2018, 10 patients underwent unilateral breast reduction (n = 7) or bilateral esthetic reduction (n = 3) by a novel approach combining a superomedial pedicle and a perforator-based inferior advancement flap. The flap is based on the inframammary fold (IMF) and fixed to the pectoralis major fascia and the pedicle like a hammock. Preoperative and postoperative (1, 3, 6, 12, and 18 months) measurements included sternal notch-to-superior areola border length, nipple-to-IMF length, and lower pole convexity. Patients rated their satisfaction with breast shape, size, nipple-areola complex position, and lower pole projection at 12 months using a condensed form of the BREAST-Q questionnaire. Results: Esthetic outcomes at 12 and 18 months were good in all patients. There were no complications. Postoperative measurements were stable throughout follow-up. The BREAST-Q scores indicated that most patients were satisfied or very satisfied with their breast(s). Conclusions: This preliminary series demonstrates that the hammock flap, which is performed with autologous tissue, allows changing IMF position, it is safe, effective, and provides improved pedicle fixation and positioning. This technical refinement seems to afford good long-term outcomes in patients undergoing superomedial pedicle breast reduction and mastopexy.

A Modified Dissection of the Superomedial Pedicle

“…6 The long experience over the years reflected in studies shows that it is robust and a reliable pedicle that is also amenable to various modifications, according to each case’s circumstances. 7–9…”

“…6 The long experience over the years reflected in studies shows that it is robust and a reliable pedicle that is also amenable to various modifications, according to each case's circumstances. [7][8][9] Our modification consists of elevating the whole breast at the level of the pectoralis fascia, a relatively avascular plane, from the inframammary fold to the upper pole of the breast and then dissecting marked medial, lateral, and lower limbs. This technique helps save operative time in various ways.…”

“…Afterward, the extent of reduction of tissue from the lateral pillars and above the inframammary fold is decided (Figs. [5][6][7][8][9][10][11]. Optionally, a portion of tissue from the upper pole can be retained and de-epithelialized accordingly, especially in cases of unilateral symmetrization.…”

Longevity of ptosis correction in mastopexy and reduction mammaplasty: A systematic review of techniques

“…These include pillar sutures, permanent and absorbable meshes, lipofilling, dermal or dermoglandular slings, autoaugmentation flaps, and muscular slings. 2 , 3 , 4 , 6 , 9 , 11 , 15 , 16 , 17 , 18 , 20 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 The meshes used were variable and permanent or partially absorbable meshes generally had better outcomes compared to fully absorbable meshes. Hamdi et al.…”

“…These flaps are inferiorly based and secured to the pectoralis muscle or chest wall to provide added support to the breast parenchyma. 4 , 26 , 29 Watfa et al. compared six patients undergoing standard wise pattern superior pedicle mastopexy to 12 patients undergoing the same procedure with the addition of a dermal suspensory hammock flap and found a significant increase in lower pole arc length in the standard mastopexy group but no change in SN-N distance.…”