5078 Outcome Analysis of Long Term Inferior Pole Support In Augmentation Mastopexy Patients: A 7 Year Follow-up of Internal Autologous Flaps Versus Acellular Dermal Matrix

Friday, May 6, 2011: 11:10 AM
Mark Melendez, MD, MBA, Plastic and Reconstructive Surgery, Nassau University Medical Center, Long Island Plastic Surgery Group, Garden City, NY and Kaveh Alizadeh, MD, MSc., FACS, Plastic and Reconstructive Surgery, Nassau University Medical Center, Long Island Plastic Surgical Group, Garden City, NY
Goals/Purpose: Many augmentation mastopexy patients can develop implant ptosis, traction rippling, widened areola, and nipple dystopia secondary to the weight of the implant and the relaxation of the lower pole skin. Therefore, algorithms focusing on the long term prevention of undesired outcomes need to be addressed. This study examines various techniques to determine how to provide the best long term outcome for preservation of inferior pole support.

 Methods/Technique: This was a prospective cohort study utilizing the same vertical mastopexy technique by one surgeon.  182 patients (age range: 21-48; average follow-up: 3.7 years) were enrolled between 2002 - 2010.  An algorithm was developed to assign the patients to 4 groups:

 1)     Primary patients with minimal parenchymal tissue and overstretched skin required autologous inferior bra (IAB) dermal flap support (N=29).

 2)     Primary vertical mammoplasty technique utilizing a superiomedial pedicle and adequate paranchymal tissue (N=29).

 3)     Primary patients with secondary correction of augmentation mastopexy with autologous internal dermal flap (IAB) (N=27).

 4)     Secondary correction of augmentation mastopexy patients with acellular dermal matrix (ADM) (N=22).

 Objective and subjective parameters were measured. 

 Results/Complications: All patients who received the autologous dermal flap or ADM showed minimal inferior descent of the implant. However, by 3 years, there was a statistically significant difference (p>0.1) in the objective parameters in patients who received either IAB or ADM (groups 2, 3, 4) vs. group 1.  There was a higher incidence of recurrence of capsular contracture in groups 3 and 4 which was not statistically significant.

Conclusion: The Internal Autologous bra dermal flap and Acellular dermal matrix provide alternative strategies to ensure long term inferior pole support of the augmentation mastopexy patients. We describe the anatomic technique for the consistent execution of these two techniques and provide an algorithm for these challenging patients. We believe that these techniques will ultimately lead to better outcomes in all mastopexy patients.

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