Mastopexy Technique Following Explantation Utilizing a Unique Lateral Dermoglandular Flap for Breast Reshaping
With the rise in cases of Breast Implant Illness (BII), explantation without desire for replacement is becoming increasingly popular. After implant removal, the patient is left with deflated breasts comprised of excess skin and often minimal breast tissue. This creates a challenge for the plastic surgeon as the ultimate goal is still to have an aesthetic, well-shaped breast.
There is a paucity of literature describing reproducible techniques for reshaping the breast after explantation. Mastopexy is currently the main technique used, and some authors have also described auto-augmentation and fat grafting as adjuncts. However, there are few papers that outline a detailed solution to this challenging surgical problem. Thus, we present a novel mastopexy technique for breast reshaping following explantation using a lateral dermoglandular flap.
Methods/Technique:
We describe a step-by-step review of this unique surgical approach, beginning with initial breast markings, en bloc implant and capsule removal (in the case of BII), design of the lateral dermoglandular flap, inset and final closure. This technique was used in a total of 65 women between 2019 and 2021. A retrospective chart review was performed on this series of patients with variables of interest including age, date of initial implant placement, time until explantation, implant fill type, volume of implant removed, reason for explantation and post-operative complications.
Results/Complications:
Using this technique, all patients demonstrated retained lateral breast shape and volume, improved medial fullness, lifted nipple areolar complex, and overall breast symmetry post-operatively. All patients reported happiness with their decision to proceed with explanation. Only one desired her implant to be replaced, as her reason for implant removal was not BII. The only complication in a three-year period was hematoma in two cases. Overall, all patients were satisfied with the size and shape of their breasts after explantation and reconstruction using this technique.
Conclusion:
We describe a novel lateral dermoglandular flap as a useful technique for breast reshaping after explantation. Our technique elegantly provides medial fullness, lateral definition, as well as reinforcement and repositioning of the inframammary fold. In our experience, this is a reliable technique that produces consistent aesthetic results following breast implant removal.