The Gargano Yin-Yang Breast Reduction Technique. How to Obtain the Ideal Breast Shape, Volume Distribution and Size with Long Lasting Results

Goals/Purpose: Over 100 reduction mammaplasty techniques have been used over the years due to surgeon’s preference but especially due to the unsatisfactory results and needs for improvements of previous techniques.

Reduction mammoplasty is at the same time a reconstructive and an aesthetic procedure. The functional improvement of neck, back, and shoulder pain, as well as psychosocial improvement, satisfy the reconstructive needs. The aesthetic component of the technique on the other hand needs to achieve the “Ideal Breast” in terms of shape, position and volume distribution as defined by anatomy, anthropometry and measurements. To our knowledge no other previously described technique is able to achieve the ideal breast shape and size and maintain it over time as the Gargano Yin-Yang breast reduction technique. The purpose of the study was to demonstrate the effectiveness of the technique to achieve the ideal breast shape, position and volume distribution and also to evaluate the complication rate, operative time, and long- term effects on mammary base, projection and pseudoptosis

Methods/Technique: The Authors pioneered a novel technique and applied it to a series of 185 consecutive patients who underwent breast reductions in the last 5 years.

Patients were stratified for weight, height, BMI, grade of hypertrophy and breast size. Patient who needed mastopexy were not included in the study. Morphometric analysis was performed collecting the following data: nipple projection, mammary base width, position of the new NAC and IMF, nipple-IMF distance. The stability of the breast shape and the lower pole were assessed over time. Photographic documentation with images overlapping were taken before and after surgery. Patients follow up consisted of postoperative visits at 10-14 days and again at 3, 6,12 and 18 months.

The Yin-Yang technique uses the following surgical operative sequences: 1. superomedial pedicle for the nipple, 2. glandular resection pattern with an S- shape on the right breast and exact opposite Z-shape on the left breast, 3. laterally based inferior pole dermoglandular flap. 4. The breast septum is preserved, and the fascia system restored, 5. Gland remodeling is characterized by movement and interdigitation of the two flaps (superomedial NAC pedicle and laterally based flap), the inframammary fold is elevated into a new higher position over the chest wall and the movement of the two glandular flaps allows narrowing of the mammary base, stable lower pole and satisfactory nipple projection. 6. Skin resection is performed with Wise pattern

Results/Complications: The average weight reduction was 1700 g (both breasts combined), and the average operative time was 150 minutes. Patients were followed up for a minimum of 18 months, and the overall complication rate was 6 percent. The mammary base, projection and distance from the inframammary fold to the nipple were measured in patients with more than 1 year of follow-up. The results exhibited unchanged volumes distributions between upper and lower pole. The mammary base and projections measurements did not change over time and an average increase of the nipple to IMF length of only 15 percent for reductions greater than 1200 g per side.

Conclusion: The Yin-Yang technique is an effective and reliable approach to a wide range of breast hypertrophy, allows to achieve and maintain the ideal breast shape, volumes and position with stable results over time for mammary base, projection and pseudoptosis or “bottoming out.” In addition, the complication rate is acceptably low although requires a certain learning curve.