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 AIRPT
- Centro Ricerche sulla Plasticità Tessutale - Roma
Reduction
Mammoplasty
Durability of Shape with a Combined Technique
PASQUALE
FRUSCELLA
Institute
for Research into Tissue Plasticity
ROME
K.W.
: Reduction Mammaplasty - Drooping of the Gland - Dermal Preservation
- Action of Gravity
Related
Arguments: Additive
Mastoplasty 1 - Additive
Mastoplasty 2 - Body
Profile.
The correct execution of modern techniques in reduction
mammoplasty produces excellent and immediate results.
The surgeon who operates respecting anatomical and physiological
precepts of the breast, and with a proper knowledge of an
affirmed technique, can adjust the skin with precision, modelling
it to the reduced glandular contents, in conformity with the
various patterns that have been proposed. However, the ultimate
evaluation of the operative result does not depend on the
immediate outcome: the prognosis must be deferred for at least
one year, by which time the new shape of the breast will reveal
eventual merits or defects of the technique employed.
The
crucial point of reductive breast surgery is neither the volumetric
reshaping nor the glandular modelling, which should conform
to specific aesthetic canons, but the guarantee of the
durability of the result.
Thus it is necessary that the technique utilised exploit valid
devices in order to offset the force of gravity which, in
the course of the months following the operation, may again
cause the breast to sag.
The goal to be achieved - to limit the gradual drooping
of the gland - pays no consideration to the pathogenesis
of mammary sagging and must therefore be predetermined both
when reducing hypertrophic breasts, in which sagging is the
result of increased weight and volume, as well as in breasts
that droop due to parenchymal hypotrophy and tissue lassitude.
In either case it is simply a question of fashioning the breast
to regular proportions, providing resistance to the forces
of gravity.
Pursuing this aim, and with a knowledge of the principles
of embryology, anatomy and physiology of the breast, we have
ascertained that in order to achieve a good substantial result
in reductive mammoplasty, at least three conditions are necessary:
Maximum
conservation of the dermis.
Vertical
direction of the flaps.
Maximum
mobility of the pedicle bearing the nipple.
Based on these assumptions, we have long rejected techniques
which involve extensive undermining and generous removal of
the skin, and so compromise the suspensory ligaments of Cooper
and subtract the dermis, which is the most reliable and resistant
tissue.
If dermal preservation is a necessary condition to maintain
suspension and trophism, the direction of the cutaneous
and glandular flaps is indispensable for the future stability
and shape of the breast. A horizontal arrangement of the flaps
is prejudicial to achieving a conical shape and also offers
a larger surface to the action of gravity. This produces breasts
that tend to flatten and slide downwards, forcing the nipple
into an upward position, owing to an anchorage that is not
adequate for the flap proportions.
Flaps with vertical direction are more in harmony with
the goal of achieving a conical shape.
We utilise the dermal flap of Skoog in association with a
quadrangular dermal-fat flap, obtained from the lower part
of the breast - as suggested by Maliniac and others for breast
reconstruction after mastectomy - and also based on the submammary
fold - as proposed by Ribeiro.
This flap, inserted into the retromammary space, presents
the following advantages:
It consists
of tissue that is not susceptible to sagging thanks
to its firm anchorage to the pectoralis muscle, and therefore
it is preferable to glandular tissue, which is heavier and
more difficult to stabilise.
Its
median and vertical collocation respects the intent of creating
a cone-shaped breast.
It can
be curved along its upper edge, in order to carry more substance
in the case of hypotrophic breasts, nevertheless forming a
conical shape.
It does
not resorb but, on the contrary, gains in volume if
the patient puts on weight, since it possesses its own circulation.
With
its extensive de-epithelialised surface it favours adhesion
and suspension of the gland.
References
Bertelli
JA, Pereira JFV: The inframammary island flap:Anatomical basis.
Ann Plast Surg 32:315, 1994
Biesenberger
H: Eine neue Methode der Mammaplastik.Zentralbl Chir 55:2382,
1928
Bolger
WE, Seyfer AE, Jackson SM: Reduction mammaplasty using the
inferior glandular "pyramid" pedicle: Experiences
with 300 patients. Plast Reconst Surg 80:75,
1987
Caldeira AML: Nova abordagem de sustenac¸a˜o nas
mamoplastias. Comunication to the Jornada Paulista de Cirurgia
Plastica. Brazilian Society of Plastic Aesthetic and Reconstruction
Surgery, Sa˜o Paulo, Brazil, June 2, 1994
Cardosa
AD, Cardoso AD, Pessanha MC, Peralta JM: Three dermal pedicles
for nipple-areola complex movement in reduction of gigantomastia.
Ann Plast Surg 12:419, 1984
Elsahy
NI: The hexagonal technique for mastopexy and reduction mammoplasty.
Aesth Plast Surg 6:107, 1982
13.
Erol O ¨ O, Spira MA: Mastopexy technique for mild to
moderate ptosis. Plast Reconstr Surg 65:603, 1980
Fruscella
P: La Mastoplastica Riduttiva Eseguita con una Tecnica Combinata.Rivista
Italiana di Chirurgia Plastica, 15:349,1983.
Fruscella
P: Lipoexeresi in Chirurgia Plastica. Minerva Ginecologica,
41: 195, 1989.
Fruscella
P: Modellamento Chirurgico del Profilo Corporeo.Atti del 38°
Congresso Nazionale della Società Italiana di Chirurgia
Plastica, 1989.
Fruscella
P: Chirurgia Estetica: Aspetti Generali e Orientamenti Attuali
delle Tecniche Chirurgiche di Ringiovanimento Corporeo.Bollettino
della Federazione Ordine dei Medici, settembre 1990.
Fruscella P: Correzione del Capezzolo Introflesso. 5°
Congresso Nazionale della Società Italiana di Chirurgia
Ambulatoriale e Day Surgery, ottobre 2000.
Fruscella
P: Morfodinamica delle Pieghe Corporee. Le Tecniche Anti-Età
2003, 2° Meeting Associazione Italiana Ricerche sulla
Plasticità Tessutale. Roma 24 Maggio 2003
Fruscella
P: Morphodynamics and Surgical Correction of the Bodys Creases,
Folds, and Wrinkles. Aesth. Plast. Surg.28:37-44, 2004.
Georgiade
GS, Riefkohl RE, Georgiade NG: The inferior dermal-pyramidal
type breast reduction: Long-term evaluation. Ann Plast Surg
23:203, 1989
Hakme
F: Te´cnica em "L" nas ptoses mama´rias
com confecc ¸a˜o de retalhos cruzados. Rev Bras
Cir 73:87, 1983
Hoffman
S: Recurrent deformities following reduction mammaplasty and
correction of breast asymmetry. Plast Reconst Surg 78:55,
1986
Hollander
E: Die Operation der Mammahyperthrophie und der Ha¨ngebrust.
Dtsche Med Wschr 50:1400, 1924
Lalardrie
JP, Mouly R: History of mammaplasty. Aesth Plast Surg 2:167,
1978
Lassus
C: An "all-season" mammoplasty. Aesth Plast Surg
10:15, 1986
Lima
JC: Our experience in breast reduction. VI Congresso IPRS,
Paris, 1975
Maillard
GF: A Z-mammaplasty with minimal scarring. Plast Reconst Surg
77:66, 1986
Martins
PDE: Periareolar mammaplasty with flap transposition. Rev
Soc Bras Cir Plast 6:1, 1991
Mathes
SJ, Nahai F, Hester TR: Avoiding the flat breast in reduction
mammaplasty. Plast Reconst Surg 66:63, 1980
McKissock
PK: Reduction mammaplasty with a vertical dermal flap. Plast
Reconstr Surg 49:245, 1972
Nicolle
FV, Chir M: Improved standards in reduction mammaplasty and
mastopexy. Plast Reconst Surg 69:453, 1982
Parenteau
JM, Regnault P: The Regnault "B" technique in mastopexy
and breast reduction: A 12-year review. Aesth Plast Surg 13:75,
1989
Peixoto
G: Reduction mammaplasty: A personal technique. Plast Reconst
Surg 65:217, 1980
Pers
M, Nielsen IM, Gerner N: Results following reduction mammaplasty
as evaluated by the patients. Ann Plast Surg 17:449, 1986
Pitanguy
I: Breast hypertrophy. In: Transactions of the International
Society of Plastic Surgeons, Second Congress, London. Livingstone:
Edinburgh, p 502, 1960
Pitanguy
I: Mamaplastias. Estudo de 245 casos consecutivos e apresentac¸a˜o
de te´cnica pessoal. Rev Bras Cir 42:201, 1961
Regnault
P: Reduction mammaplasty by the B technique. Plast Reconst
Surg 53:19, 1974
Ribeiro
L: A new technique for reduction mammaplasty. Plast Reconst
Surg 55:330, 1975
Robbins
TH: A reduction mammaplasty with the areolanipple based on
an inferior dermal pedicle. Plast Reconstr Surg 59:64, 1977
Schultz
RC, Markus NJ: Platform for nipple projection: modification
of the inferior pedicle technique for breast reduction. Plast
Reconst Surg 68:208, 1981
Schwarzmann
E: Die Technik der Mammaplastik. Chirurgie 2:932, 1930
Skoog
T: A technique of breast reduction. Transposition of the nipple
on a cutaneous vascular pedicle. Acta Chir Scand 126:453,
1963
Snyder
GB: The combined use of the Strombeck pattern and the McKissock
keyhold pattern in marking macromastia. Plast Reconstr Surg
65:231, 1980
Souza
Pinto EB, De Almeida AEF, Cardim Reyes MF: Dermoadipose and
adenadipose flaps in mammoplasty. Aesth Plast Surg 7:101,
1983
Strombeck
JO: Mammaplasty: Report of a new technique based on the two-pedicle
procedure. Br J Plast Surg 13:79, 1961
Thorek
M: Possibilities in the reconstruction of the human form.
NY Med J 116:572, 1922
Weiner
DL, et al.: A single dermal pedicle for nipple transposition
subcutaneous mastectomy, reduction mammaplasty, or mastopexy.
Plast Reconstr Surg 51:115, 1973
Williams
G, Hoffman S: Mammoplasty for tubular breasts. Aesth Plast
Surg 5:51, 1981
Wise
RJ: A preliminary report on a method of planning the mammaplasty.
Plast Reconstr Surg 17:367, 1956
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© 2009 Centro
Ricerche sulla Plasticitą Tessutale.
Associazione
Italiana Ricerche sulla Plasticità Tessutale
via
Parenzo, 12
00198
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