Vertical reduction mammaplasty for severe mammary hypertrophy
Mustafa Akyurek, MD, PhD, Carolyn J. Vaughn, MS.
University of Massachusetts Medical School, Worcester, MA, USA.
BACKGROUND: It is generally accepted that vertical mammaplasty is best suited for small to medium reductions. Vertical scar techniques become less appropriate as the breast gets larger and more ptotic, resulting in a high rate of complications and subsequent revisions. This report presents a modified vertical mammaplasty approach for treatment of severe mammary hypertrophy with improved outcomes and low complication rates.
METHODS: Vertical mammaplasty with reduction of greater than 1000 g per breast was retrospectively analyzed in this study. A total of 42 patients who met this criteria over a three-year period were identified. The key elements of this approach were a) modified breast marking method with accurate placement of the nipple-areola complex, b) use of suction-assisted lipectomy for contouring the inferior pole prior to glandular resection, c) vertical design dermoglandular resection, d) full-thickness superomedial pedicle, e) median incison of the upper pole for easy pedicle inset, f) no skin undermining, and g) vertical or L- type closure without gathering. Patient satisfaction of outcomes was determined by a survey on a scale from 0 (poor) to 5 (excellent). Follow up was 3 to 36 months (mean, 9.2 months)
RESULTS: Mean age was 36.8 years (range, 21 to 64). Mean weight was 180.4 pounds (range, 134 to 267), with mean BMI of 32.5 (range 24.0 to 48.8). Preoperatively, bra cup size was DD or greater (range, DD to I). Postoperatively, there was a decrease of at least one cup size. Mean distance between suprasternal notch to nipple was 38.2 cm (range, 28 to 44). The mean distance between inframammary fold to nipple was 18.2 cm (range, 15 to 22). Mean weight of breast removed was 1122 g on the right side (range, 1002 to 3160) and 1214 g on the left side (range, 1030 to 3050 ). Liposuction contributed to the total amount of breast removal by an average of 320 g (range, 200 to 800). Patient satisfaction was found to be high in this series, with a mean ranking of 4.2 (range, 3 to 5) for overall satisfaction. Complications were few in number and minor in severity. There were 2 cases of localized cellulitis that resolved completely with oral antibiotics, 3 cases of minor wound dehiscence that healed with dressing changes, and 2 cases of nonpainful palpable small breast lumps as fat necrosis which did not require any surgical intervention. There were no instances of any nipple-areola complex necrosis. Revision was necessary in 4 patients to excise the excess skin of resulting dog-ear.
CONCLUSIONS: It is presented in this paper that using a modified vertical scar approach in cases of severe mammary hypertrophy, the outcomes can be improved with reduced scar burden, pleasing breast shape and a low complication rate.
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