A Novel Technique for Correction of Bottoming Out Following Inferior Pedicle Breast Reduction | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 13, Volume 43, Issue 1, January 2019, Page 73-78 PDF (15.71 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2019.65159 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Mohamed Farag* ; Eman Y Sadek; Ahmed Ali | ||||
| The Department of Plastic Surgery, Faculty of Medicine, Ain Shams University | ||||
| Abstract | ||||
| Introduction: Bottoming out is a frequent pitfall of breast reduction following inferior pedicle technique. This is attributed to the lack of deep tissue suspension and skin envelope relaxation. The condition is associated with lack of medial fullness and poor projection. The authors present a new technique that depends on redistribution and auto-augmentation rather than resection of tissues. Patients and Methods: The technique was performed in 25 patients who had bottoming out following inferior pedicle breast reduction. The time elapsed from the primary surgery to the corrective surgery ranged from 2 to 4.5 years with a mean of 2.5 years. The used technique consists of deepithelialization and complete division of the lower segment at the infra-mammary fold. The divided lower dermoglandular segment is rolled in a retromammary pocket underneath the pedicle and fixed to the pectoral fascia. The idea is to use this lower segment of the inferior pedicle as an auto-prosthesis. Follow-up period is 12 months. Results: All patients achieved good breast shape with good projection. There were no serious complications. Only two patients developed partial wound disruption. Conclusion: A novel technique for correction of bottoming out following inferior pedicle breast reduction was used with good surgical outcome | ||||
| Keywords | ||||
| Bottoming out; Breast reduction | ||||
| References | ||||
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1- Ribeiro L., Accorsi A. Jr., Buss A. and Marcal-Pessoa M.: Creation and evolution of 30 years of the inferior pedicle in reduction mammaplasties. Plast. Reconstr. Surg., 110: 960-970, 2002. 2- Brink R: Management of true ptosis of the breast. Plast. Reconstr. Surg., 91: 657, 1993. 3- Chalekson C.P., Neumeister M.W., Zook E.G. and Russell R.C.: Outcome Analysis of Reduction Mammaplasty Using the Modified Robertson Technique, Plast. Reconstr. Surg., 110: 1, July 2002. 4- Small K.H., Tepper O.M., Unger J.G., Kumar N., Feldman D.L., Choi M. and Karp N.S.: Re-defining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty, Journal of Plastic, Reconstructive & Aesthetic Surgery, 63: 346e353, 2010. 5- Graf R. and Biggs T.M.: In Search of Better Shape in Mastopexy and Reduction Mammoplasty Discussion by Foad Nahai, Plast. Reconstr. Surg., 110: 1, July 2002. 6- Rohrich R.J., Gosman A.A., Brown S.A. and Reisch J.: Mastopexy Preferences: A Survey of Board-Certified Plastic Surgeons, Plast. Reconstr. Surg., 118: 7, Dec. 2006. 7- Davison S.P., Mesbahi A.N., Ducic I., Sarcia M., Dayan J. and Spear S.L.: The Versatility of the Superomedial Pedicle with Various Skin Reduction Patterns. Plast. Reconstr. Surg., 120: 6, Nov., 2007. 8- Ramirez O.M.: Reduction Mammaplasty with the “Owl” Incision and No Undermining, Plast. Reconstr. Surg., 109: 2, Feb. 2002. 9- Chun Y.S., Lalonde D.H. and May J.W. Jr.: Internal Pedicle Shaping to Improve Aesthetic Results in Reduction Mammaplasty. Plast. Reconstr. Surg., 119: 4, April 1, 2007. 10- Ceydeli A., Louis J., Yu J. and Ritter E.: Lateral Septal Preservation: A Technique to Improve Projection in Inferior Pedicle Reduction Mammaplasty by Preventing Lateral Displacement of the Pedicle. Plast. Reconstr. Surg., 120: 4, 1088-9, Sept 15, 2007. 11- Katsaros J., Harvey I. and Caplash Y.: The triplicated inferior pedicle: A new method for breast reduction and mastopexy Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 63, Issue 7, Pages 1131-1135, July 2010. 12- Brown R.H., Izaddoost S. and Bullocks J.M.: Preventing the ''Bottoming Out'' and ''Star-gazing'' Phenomena in Inferior Pedicle Breast Reduction with an Acellular Dermal Matrix Internal Brassiere, Aesth. Plast. Surg., July 2010. 13- Millard D.R. Jr., Walter R.M. and Lesavoy M.A.: Secondary Correction of the Too-High Areola and Nipple After A Mammaplasty. Plast. Reconstr. Surg., 58: 5, Nov, 1976. 14- Raffel B.: Technique For Correction of Areola Misplacement With No New Scars. Plast. Reconstr. Surg., 88: 5, Nov., 1991. 15- Colwell A.S., May J.W. Jr. and Slavin S.A.: Lowering the Postoperative High-Riding Nipple Volume 120, Number 3, Plast. Reconstr. Surg. Sept., 1, 2007. 16- Hudson D.A. and Skoll P.J.: Repeat Reduction Mammaplasty. Plast. Reconstr. Surg., 104: 2, pp. 401-8, Aug., 1999. 78 Vol. 43, No. 1 / A Novel Technique for Correction of Bottoming Out 17- Mathes S.J.: Plastic Surgery, 2nd ed., 6 (135), 2006. 18- Keck M., Kaye K., Thieme I., et al.: Vertical mammaplasty: postoperative changes, complications, and patient evaluation. Can. J. Plast. Surg., 15: 41-3, 2007. 19- de Araujo Cerqueira A.: Mammaplasty: breast fixation with dermoglandular mono upper pedicle flap under the pectoralis muscle. Aesthetic. Plast. Surg., 22: 276-283, 1998. 20- Qiao Q., Sun J., Liu C., Liu Z. and Zhao R.: Reduction mammaplasty and correction of ptosis: Dermal bra technique. Plast. Reconstr. Surg., 111: 1122-1130, 2003. 21- Baumeister R.G.: Curtain type combined pedicled reduction mammaplasty with internal suspension for extensive hypertrophic and ptotic breasts. Br. J. Plast. Surg., 56: 114-119, 2003. 22- Caldeira A.M. and Lucas A.: Pectoralis major muscle flap: A new support approach to mammaplasty, personal technique. Aesthetic. Plast. Surg., 24: 58-70, 2000. 23- Da Silva G.: Mastopexy with dermal ribbon for supporting the breast and keeping it in shape. Plast. Reconstr .Surg., 34: 403-405, 1964. 24- Lockwood T.: Reduction mammaplasty and mastopexy with superficial fascial system suspension. Plast. Reconstr. Surg., 103: 1411-1420, 1999. 25- Perez-Macias J.M.: Long-lasting evolution of ptosis control after reduction mammaplasty using the hammock technique. Aesthetic. Plast. Surg., 31: 266-274, 2007. 26- Widgerow A.D.: Breast reduction with inferior pedicle fascial suspension. Aesthetic. Plast. Surg., 29: 53-537, 2005. 27- Lewis G.K.: A method of mastopexy with fascia lata transplants. J. Int. Coll. Surg., 26: 346-353, 1956. 28- Goés J.C.S.: Periareolar mammaplasty: Double-skin technique with application of Polyglactine 910 mesh. Rev. Soc. Bras. Cir. Plast., 7: 1-3, 1992. 29- Goés J.C.S.: Periareolar mammaplasty: Double skin technique with application of polyglactine or mixed mesh. Plast. Reconstr. Surg., 97: 959-968, 1996. 30- Goés J.C.S.: Periareolar mastopexy and reduction with mesh support. Breast Surg., 51: 697-708, 1998. 31- Goés J.C.S.: Periareolar mastopexy: Double skin technique with mesh support. Aesthet. Surg. J., 3: 129-135, 2003. 32- Rohrich R.J., Thornton J.F. and Sorokin E.S.: Recurrent Mammary Hyperplasia: Current Concepts. Plast. Reconstr. Surg., 111: 1, Jan. 2003. | ||||
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