The expanded inframammary fold triangle: Improved results in large volume breast reductions

ABSTRACT

Context: The inferior pedicle, Wise-pattern reduction mammaplasty is the most popular technique for breast reduction because of its reproducible results and reliability. However, complication rates in super obese patients or patients receiving large volume reductions are high, ranging from 35 to 78%. These complications include delayed healing, infection, seroma, nipple-areolar complex necrosis, fat necrosis and development of hypertrophic scars. Aims: This study aimed to determine whether a modification to the standard Wise-pattern reduction technique, an expanded inframammary fold skin triangle, produces improved outcomes in high-risk large volume breast reduction patients. We report that this modification leads to improved outcomes by decreasing wound complications and improving aesthetic appearance. Settings and Design: Twenty-two patients received the inferior pedicle Wise-pattern reduction mammaplasty, which was modified to include an 8 cm wide inferior pedicle. This pedicle was de-epithelialized and an 8 Χ 3 cm ² triangle of skin was preserved at the inferior base to reduce tension at the triple point, inverted T-closure. Materials and Methods: A retrospective review was performed on all patients who underwent reduction mammaplasty with the expanded inframammary fold (eIMF) technique as well as all patients who received the standard wise pattern technique. Statistical Analysis Used: A student t-test was performed for both reduction populations using SPSS software package. Statistical significance was defined as P < 0.05. Results: The average patient age was 32.25 years old (range 18-59), average BMI was 35.0, and average tissue mass removed per breast was 1378.39 g. The modified technique was found to produce a statistically significant (P < 0.05) increase in the amount of breast tissue removed (693.96 g increase in the left and 571.21 g in the right) as well as a statistically significant (P < 0.05) reduction in dehiscence (75% reduction) and post-operative infection (44.10%). Conclusions: This method is an easily reproducible and reliable technique that produces a favourable cosmetic outcome with acceptable, sustainable results in high-risk reductions in obese patients.

KEY WORDS

Inverted T-closure - breast reduction - Wise pattern mammaplasty

• 1 Radosa JC, Raadosa MP, Baum S, Mavrova R, Camara O. Reduction Mammaplasty for symptomatic macromastia: Which factors influence the post-operative outcome. Arch Gynecol Obstet 2013; 287: 715-22
• 2 Hunter-Smith DJ, Smoll NR, Maarne B, Maung H, Findlay MW. Comparing Breast-Reduction Techniques: Time-to-Event Analysis and Recommendations. Aesthetic Plast Surg 2012; 36: 600-6
• 3 James A, Verheyden C. A retrospective study comparing patient outcomes of wise pattern-inferior pedicle and vertical pattern -Medial pedicle reduction mammoplasty. Ann Plast Surg 2011; 67: 481-3
• 4 Roehl K, Craig ES, Gomez V, Phillips LG. Breast Reduction: Safe in the Morbidly Obese?. Plast Reconstr Surg 2008; 122: 370-8
• 5 Champaneria MC, Wong W, Hill ME, Gupta SC. The Evolution of Breast Reconstruction: A Historical Perspective. World J Surg 2012; 36: 730-42
• 6 Gentileschi S, Bracaglia R, Garganese G, Gallucci V, Corrado G, Pacelli F. et al. Immediate Definitve Prosthetic Reconstruction in Patients with Ptotic Breasts. Ann Plast Surg 2013; 70: 144-8
• 7 Akyurek M. Short scar reduction mammaplasty in the Bariatric Patient. Ann Plast Surg 2011; 66: 602-6
• 8 Cruz-Korchin N, Korchin L. Vertical versus wise pattern breast reduction: Patient satisfaction, revision rates, and complications. Plast Reconstr Surg 2003; 112: 1573-8
• 9 Kreithen J, Caffee H, Rosenberg J, Chin G, Clayman M, Lawson M. et al. A Comparison of the LeJour and Wise Pattern Methods of Breast Reduction. Ann Plast Surg 2005; 54: 236-42
• 10 Wolf O, Westreich M, Shalom A. Trends in breast reduction technique. Isr Med Assoc J 2012; 14: 304-6
• 11 Cunningham BL, Gear AJ, Kerrigan CL, Collins ED. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg 2005; 115: 1597-604
• 12 Henry SL, Crawford JL, Puckett CL. Risk factors and complications in reduction mammaplasty: Novel associations and preoperative assessment. Plast Reconstr Surg 2009; 124: 1040-6
• 13 Lin IC, Bergey M, Sonnad SS, Serletti JM, Wu LC. Management of the ptotic or hypertrophic breast in immediate autologous breast reconstruction: A comparison between the wise and vertical reduction patterns for mastectomy. Ann Plast Surg 2013; 70: 264-70
• 14 Di Candia M, Lie KH, Forouhi P, Malata CM. Experience with the wise mammaplasty skin resection pattern in skin-sparing mastectomy and immediate breast reconstruction for large breast volumes. Intl J Surg 2011; 9: 41-5
• 15 Hunter JE, Malata CM. Refinements of the LeJour vertical mammaplasty skin pattern for skin-sparing mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2007; 60: 471-81