‘‘The Dermal Internal Brassiere Flap,’’ A New Modification of Inferior Pedicle Breast Reduction Technic

Abstract

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Our experiences regarding combined use of pedicle plication and dermal flap suspension in inferior pedicle inverted-T scar reduction mammaplasty

“…Its ability to minimize the stretching of the vertical limb of the inverted-T scar, which is widely recognized as the leading cause of pseudoptosis, can be regarded as another advantage of the pedicle plication. 9,10,12,25 Although there is a concern that the plication can lead to arterial insufficiency and venous congestion of the NAC due to the increase of tension over the vascular structures of the pedicle, 20 it is our observation and others that this maneuver can be used reliably, even with the dermal flap suspension techniques. 10,12 Despite the loss of continuity of dermal and subdermal plexuses due to a dermal incision performed to facilitate the plication, only three cases of the present series presented with unilateral (n= 2) or bilateral (n= 1) superficial partial necrosis of the NAC.…”

“…Suspension of the inferior pedicle by using pectoralis major muscle flap, 18 superficial fascial system, 19 autologous dermal flaps, 10,12,[20][21][22] acellular dermal matrix, 23, etc., have been introduced to overcome unintended outcomes of the inferior pedicle. With many specific modifications defined, autologous dermal flaps are the procedure of choice today by most plastic surgeons.…”

“…The authors stated that the technique they used eliminates the requirement for the pedicle plication in terms of preventing pseudoptosis. In another study performed by Temel et al, 20 a similar modification, in which two pairs of quadrangular-and triangularshaped dermal flaps were used to suspend the pedicle to the rib periosteum, was performed in a more extensive series. The authors reported that there were no cases with the development of pseudoptosis and breast asymmetry, and most cases were satisfied with the postoperative appearance of the breasts.…”

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.…”