Background: Augmentation mastopexy of small and
medium sized ptotic breasts presents one of the greatest
challenges to plastic surgeons. That because both these
procedures have opposing effects on the breast parenchyma
and skin. The primary objective of our study is to explore
the reliability of the lower pole triangular dermoglandular
flap sutured to the pectoral fascia in the improvement of the
results regarding both the aesthetic appearance and the long
term maintenance.
Methods: The study was conducted in Royal Hospital,
Cairo, Egypt during the period from June 2013 to December
2015. The study included female patients undergoing augmentation
mastopexy; some were implant-based while others were
based on the autologous breast tissue, depending on the
patient's desire whether to increase the cup size or to retain
the same size. All patients were evaluated by detailed history,
careful physical examination and photographed pre and postoperative.
At the lower pole of the breast, we created a dermoglandular
flap which is triangular in shape. We did not dissect
it deeply from the pectoralis fascia. The flap was kept at the
lower pole in cases of implant-based augmentation. However,
in autologous augmentation, it was freed along the margins
and mobilized to provide upper and medial fullness. After
surgery, all cases were followed up for nine months to assess
the outcomes of the procedure.
Results: Sixty subjects were included in the analysis of
this study. The age of the patients ranged from 22 to 48 years
with a mean age at presentation of 34.1 (6.5) years. All patients
requested to improve the projection of the breast together
with the lifting of the NAC. Thirty-six patients (60%) desired
to increase the cup size and accordingly underwent implantbased
augmentation with mastopexy. Twenty-four patients
(40%) wanted to retain the same size and therefore underwent
auto-augmentation mastopexy. The patients were very satisfied
with the outcome of the operation in most of the cases (54
cases), satisfied in 6 cases, and we had no unsatisfied patients.
Statistically, there was a significant (p < 0.001) reduction
in the cup size during the postoperative follow-up period than
in the preoperative cup sizes. Preoperatively, thirty percent
of patients were cup size A, 45% B and 25% C. Postoperatively,
eighty percent of patients were cup size C and 15% B at all
follow-up visits.
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The maintenance of improvement of ptosis was measured
by the distance between the suprasternal notch (SSN) and 12
O'clock point of the NAC (12'NAC), as well as by the distance
between the 6 O'clock point of the NAC (6'NAC) and the
IMF. The distance between the SSN to the 12'NAC varied
between 31 and 24cm preoperatively (mean±SD: 26.7±2.1cm),
and between 22 and 20cm postoperatively at nine months
(mean ± SD: 21.0±0.8cm), (p-value <0.001). Besides, the
distance between the 6'NAC and the IMF pre-operatively
varied between 8 and 12cm, and at the postoperative followup < br />visits, it ranged from 6.5 to 8cm, (p-value<0.001).
No complications detected in 44 cases (73%), Wound
problems (puckering, infection, dehiscence) in 7 (12%) and
Asymmetry in 9 (15%). All complications resolved by time.
Conclusion: Finally, we can conclude that the triangular
dermoglandular flap proved to (i) provide long-term support
for the nipple- areola complex in its new position, (ii) support
the breast implant inferiorly, and (iii) increase the mass and
the fullness of the upper breast for autologous tissue-based
augmentation. The method presented is simple, efficient and
competent for both implant-based as well as autologous tissuebased
augmentation mastopexy operations.