Breast Lift Using “Stacking Flaps” for Auto-Augmentation
Daniel A. Del Vecchio, MD MBA.
Mass General Hospital, Boston, MA, USA.
Proper nipple areola position, aesthetic mound shape, and minimal scarring remain the principal objectives in the choice of mastopexy technique. While inferiorly-based Wise-pattern and vertical scar mastopexy techniques yield safe, reproducible results they can demonstrate settling and descent of the breast parenchyma back into the lower pole of the skin brassiere. This often results in a “bottomed out” lower pole, an under-projecting nipple areola complex, and lack of upper pole fullness.
While the vertical scar-superior pedicle technique has been described in the literature, there may be mechanical and vascular limitations to this technique in maximizing projection of the nipple areola complex and in maintaining upper pole fullness in the long term.
This communication describes the author’s preferred technique using two opposing flaps: a superior based pedicle carrying the nipple areola complex, and an inferiorly-based, de-epithelialized lower pole flap. This inferiorly-based flap is supported by similar perforators that drive the classic inferior pedicle flap, and its tip is sutured to the periostium of the second rib. Acting as an autologous augmentation, the inferior flap is stacked by the superior-based flap carrying the nipple areola complex, resulting in significant mound projection. Proper patient selection, marking, technique and follow up in 23 consecutive cases is described.
METHODS: We define “stand alone” breast lift as a procedure in which only epidermis is removed to reduce the skin brassiere and no breast tissue is resected. Patients in this series did not receive breast augmentation using implants at the time of their lift. Over a 10 month period, 23 consecutive breast lift cases performed in this manner were reviewed. The author's preoperative evaluation, surgical planning, operative technique and results were analyzed. Nipple areola vertical position, anterior projection, and upper and lower pole fullness were analyzed pre and postoperatively at 9-12 months.
RESULTS: There was significant retention of upper pole fullness at 9-12 months when compared to classic mammoplasty results. In addition, projection of the nipple areola complex increased significantly at 9-12 months due to the stacking flaps. By retaining multiple inferior based flap perforators, more aggressive elevation and suture fixation of the inferior flap was possible. The aesthetic results were overall quite satisfactory. Complication rates were less than or equal to those reported in the literature.
Vertical scar breast lift using double opposing “stacking flaps” is a combined variation of the inferior based flap and the superior based flap breast lift techniques. This procedure can be safely performed in selected breast lift patients with acceptable cosmetic results.