5023 Strategies for Achieving Breast Upper Pole Fullness

Friday, May 6, 2011: 9:30 AM
Humberto Palladino, MD, Dept. of Surgery / Division of Plastic Surgery, Mayo Clinic, Rochester, MN, Francisco Agullo, MD, Dept. of Surgery, El Paso Cosmetic Plastic Surgery Center and Texas Tech University HSC - El Paso, El Paso, TX and Sadri Ozan Sozer, MD, Plastic Surgery, El Paso Cosmetic Plastic Surgery Center and Texas Tech University HSC - El Paso, El Paso, TX

Multiple techniques have been described in an attempt to improve breast-contouring procedures. Of the many techniques described the inability to obtain fullness in the upper pole and descent of the breast mass known as secondary dropout, is a common deficiency. We propose the use of a dermal breast fat flap of great mobility with of without lateral chest extensions for autologous breast augmentation. This flap can be easily mobilized and secured to the infraclavicular region providing excellent mobilization and stable superomedial fullness. .


From March 2007 to March 2010 a total of 105 patients underwent reduction mammaplasty (n=23) and mastopexy (n=82) using the proposed technique. Volume of tissue excision and additional procedures were recorded. Preoperative and postoperative pictures were obtained. Patient and surgeons satisfaction were documented. Patients were followed for a period between 12 and 24 months.

The skin envelope is marked in a modified Wise pattern. The nipple is preserved through a superior pedicle or a central mound. The remaining Wise pattern is deepithelialized and incised down to the chest wall circumferentially. The resulting dermal fat flap is easily mobilized to the infraclavicular area and shaped in the form of an implant.


Comparing preoperative and postoperative pictures, all of the cases resulted in significant improved size, contour and position of the breast, enhancing symmetry and projection. The average amount of tissue removed in the reduction mammaplasties was 430 grams per breast. Autologus augmentation using a lateral chest wall dermal fat flap was performed in 25 post-bariatric mastopexy cases. No major complications were recorded. Minor complications included delayed wound healing in 15 patients and hematoma in two patients.


The proposed technique offers a durable result with optimal superomedial fullness while allowing for a simple mobilization and increased versatility.

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