Goals/Purpose: We present a technique for breast hypertrophy and/or ptosis correction based on a vertical access. It is based in two principles: the breast is out the right position and the base of the breast tissue is wide and/or high. This technique maybe used in patients with enough breast tissue avoiding the use of implants.
Methods/Technique: The only marks are: the new nipple position, around 20 do 22 cm form the notch and a 6 to 8 cm horizontal line at the inframamary fold and a vertical line between the areola and the inframamary fold (Fig.1), After a vertical incision and the Schwartzman maneuver at the nipple-areola complex, the breast tissue is divided in two. Lateral and medial flaps are dissected exposing the breast tissue.(Fig.2) The base of the breast cone is marked and ressected. (Fig.3 ) The breast divided base tissue is fixed independently to the pectoralis major muscle in a superiorly position, with 3 to 4 stitches.(Fig.4) At the lateral and medial flaps part of the tissue is used to create a tissue flap that will be crossed and fixed to the chest to sustain the breast.(Fig.5) The skin flaps are approximated with Backhaus clamps to calculate the amount of skin flaps to be ressected to sustain and promote a better breast mound. (Fig.6) The nipple-areola complex is exteriorized.
Results/Complications: Two hundred and thirty-one breast reductions were performed between 2006 and 2011. The mean age was 31.7 years (range, 17 to 68 years). The average notch-to-nipple distance was 25.9 cm (range, 22 to 36 cm). The average weight ressected per side was 456 g (range, 80 to 1500 g). Hundred and ninety seven patients evaluated their results as “very good” (85,2 percent), twenty nine as “good” (12,5 percent), and five as “acceptable” (2,16 percent). There were no “poor” results. The most common complication was scar hypertrophy or enlargement (16 patients). also insufficient breast reduction (two patients) and asymmetry (4 patients). Fig.7,8,9,10)
Conclusion: The vertical approach with no pre mark resection for breast reduction is a reproducible and versatile technique. It represents less complications mainly skin necrosis and bad scarring frequently made possible by mistakes done in pre marking techniques. The breast-adipose flaps enhances the shape and the stability of the long term result.
