Mastopexy After Massive Weight Loss: Extended Chest Wall–Based Flap Associated with a Loop of Pectoralis Muscle

Graf, Ruth; Mansur, Alexandre Elias Contin; Tenius, Fernando Pundek; Ono, Maria Cecília Closs; Romano, Giovana G.; Cruz, Gilvani Azor de Oliveira e

doi:10.1007/s00266-007-9062-1

Cited by 36 publications

(15 citation statements)

References 4 publications

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“…7,8 Then, pseudoptosis easily becomes evident with the bulkiness in the lower pole. Influenced by the Riberio's 16 chest wall-based flap to treat the upper pole, and the recommendation by Daniel 17 that the inferiorly based breast flap could be tunneled under a muscle sling, Graf and Biggs published and popularized this muscle sling concept and proved the long-term durability of the result.…”

Section: Discussionmentioning

confidence: 99%

“…Influenced by the Riberio's 16 chest wall-based flap to treat the upper pole, and the recommendation by Daniel 17 that the inferiorly based breast flap could be tunneled under a muscle sling, Graf and Biggs published and popularized this muscle sling concept and proved the long-term durability of the result. 7,8 This article describes for the first time that a LICAP flap can be inset to the retroglandular region under a pectoralis muscle sling. One may have the concern that the LICAP flap can be compressed under the sling, leading to vascular compromise and fat necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…6 Graf and Biggs 7 were the first to show long-term improved results with the use of a pectoralis muscle sling in breast reduction and mastopexy, using the sling to suspend a flap of breast tissue 7 or lateral limb of Wise design. 8 This report describes a modified technique of autologous tissue breast augmentation in the bariatric patient, using a LICAP flap that is secured by a pectoralis muscle sling, in addition to a mastopexy based on vertical scar principles of pillar creation and suturing. This article presents the long-term evaluation of the patients at least 1 year after surgery, proving durability of the aesthetic outcome.…”

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confidence: 99%

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Vertical Mastopexy and Lateral Intercostal Artery Perforator (LICAP) Flap With Pectoralis Muscle Sling for Autologous Tissue Breast Augmentation in the Bariatric Patient

Akyürek

2011

Annals of Plastic Surgery

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Breast contouring surgery after massive weight loss is challenging because of unfavorable features such as inelastic skin, volume depletion, loss of upper pole fullness, and significant ptosis. An approach is presented for autoaugmentation using a lateral intercostal artery perforator (LICAP) flap secured with a pectoralis muscle sling, along with mastopexy based on vertical scar principles. In a total of 8 patients (average age: 39.3 years, range: 29-57; average body mass index: 30.8 kg/m2, range: 25.7-39.1) with breast ptosis and volume depletion after a mean weight loss of 121.9 pounds (range: 80-210), LICAP flap (n = 16) was used with turnover flap design to increase breast volume under a pectoralis muscle sling. Vertical design mastopexy (n = 16) was achieved at the same time, resulting in an L-shaped final scar. All the patients were followed for at least 1 year after the surgery. Patient satisfaction was high at long-term follow-up (average: 16.8 months, range: 12-24), with stable and pleasing breast shape and a mean patient ranking for aesthetic outcome of 4.2 (of 5). None of the patients developed any flap necrosis or fat necrosis. An alternative approach is described for the combined treatment of breast ptosis and volume loss in the bariatric patient, with promising long-term results. The muscle sling seems to help prevent tissue descent, without evidence of pseudoptosis at long term. It is shown that vertical scar techniques can be successfully used even in bariatric patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Vertical Mastopexy and Lateral Intercostal Artery Perforator (LICAP) Flap With Pectoralis Muscle Sling for Autologous Tissue Breast Augmentation in the Bariatric Patient

Akyürek

2011

Annals of Plastic Surgery

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“…22,23 Graf et al have described the use of this deepithelialized thoracic wall flap placed through a pectoralis muscle sling in 10 patients. This was used to achieve upper pole fullness and improved lateral contour.…”

Section: Surgical Techniquesmentioning

confidence: 97%

Breast Reshaping following Massive Weight Loss: Principles and Techniques

Losken¹

2010

Plastic and Reconstructive Surgery

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Management of the breast following massive weight loss for both reconstructive and aesthetic reasons poses unique challenges that are often inadequately addressed with traditional techniques. The breast mound is often unstable and deflated, with a loose inelastic skin envelope and ill-defined boundaries that blend into similar lateral chest wall, arm, and upper abdominal contour irregularities. Because this has become more common recently with the increasing prevalence of massive weight loss patients desiring body contouring, the purpose of this review was to discuss modifications to traditional breast techniques that have been proposed for these patients. It has become apparent that mammaplasty techniques in the massive weight loss patient should rely more on extensive glandular manipulation for shape preservation rather than relying on the skin envelope for shaping. Such techniques include parenchymal plication, suspension, and autoaugmentation. This will improve the likelihood of maintained shape and symmetry in an otherwise difficult patient population.

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“…Many procedures exist to treat the deflated breast after massive weight loss, including short scar mastopexy techniques and combined augmentation/ mastopexy. [1][2][3][4][5][6][7] However, achieving long-lasting results with these techniques in the setting of severe skin laxity can be challenging. The goals for mastopexy after massive weight loss include obtaining a youthful, well-contoured breast with upper pole fullness, proper nipple positioning, and a long-lasting aesthetic result.…”

Section: Patient Selectionmentioning

confidence: 98%