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Combined Breast Reduction Augmentation

  • Ivan Manero
  • Ana Rodriguez-VegaEmail author
  • Trinidad Labanca
Original Article Breast Surgery
  • 10 Downloads

Abstract

Background

Numerous methods have been designed to reduce breasts size and weight. The goal today is to not only to reduce size but also to create a pleasing shape. Breast reduction techniques do not obtain the desired upper pole fullness, and commonly recurrent ptosis develops. To improve and maintain breast shape in the late postoperative period, we combine breast reduction with implants.

Methods

Three hundred and sixty-six patients who underwent combined breast reduction or mastopexy with implants from January 2014 to November 2017 at IM Clinic were retrospectively reviewed. We present the indications, surgical technique, and outcomes of these patients to determine the safety and efficacy of our technique.

Results

No major complications were noted in an average of 2 years of follow-up (range 2 months to 4 years). Minor complications occurred in 61 patients, of whom 46 required revision surgery (12.6%). The most common tissue-related complications were dog ears (7.6%) and poor scarring (4.9%). The most common implant-related complication was capsular contracture (0.8%).

Conclusions

Breast reduction with implants is a reliable option to provide additional volume to the upper pole of the breast to improve long-term breast shape and avoid ptosis recurrence. Our study indicates that the procedure is safe and has complication and revision rates comparable to traditional breast reduction or augmentation mastopexy techniques.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Breast reduction Breast augmentation Augmentation mastopexy 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

References

  1. 1.
    Passot R (1925) La correction esthetique du prolapsus mammaire par la procede de la transposition du mamelon. Presse Med 33:317–318Google Scholar
  2. 2.
    Biesenberger H (1928) Eine neue methode der mammaplastik. Zentralbl Chir 55:2382–2387Google Scholar
  3. 3.
    Arie G (1957) Una nueva técnica de mastoplastia. Rev Iber Latino Am Cir Plast 3:28–35Google Scholar
  4. 4.
    McKissock PK (1976) Reduction mammaplasty by the vertical bipedicle flap technique. Clin Plast Surg 3:309–320Google Scholar
  5. 5.
    Strombeck JO (1960) Mammaplasty: report of a new technique based on the two-pedicle procedure. Br J Plast Surg 13:79–90Google Scholar
  6. 6.
    Dufourmentel C, Mouly R (1961) Plastie mammaire par la methode oblique. Ann Chir Plast 6:45–58Google Scholar
  7. 7.
    Skoog T (1963) A technique of breast reduction: transposition of the nipple on a cutaneous vascular pedicle. Acta Chir Scand 126:453–465Google Scholar
  8. 8.
    Robertson DC (1967) The technique of inferior flap mammaplasty. Plast Reconstr Surg 40:372–377Google Scholar
  9. 9.
    Weiner DL, Aiache AE, Silver L, Tittiranonda T (1973) A single dermal pedicle for nipple transposition in subcutaneous mastectomy, reduction mammaplasty, or mastopexy. Plast Reconstr Surg 51:115–120Google Scholar
  10. 10.
    Regnault P (1974) Reduction mammaplasty by the “B” technique. Plast Reconstr Surg 53:19–24Google Scholar
  11. 11.
    Peixoto G (1980) Reduction mammaplasty: a personal technique. Plast Reconstr Surg 65:217–226Google Scholar
  12. 12.
    Balch CR (1981) The central mound technique for reduction mammaplasty. Plast Reconstr Surg 67:305–311Google Scholar
  13. 13.
    Nicolle F (1982) Improved standards in reduction mammaplasty and mastopexy. Plast Reconstr Surg 69:453–459Google Scholar
  14. 14.
    Labandter HP, Dowden RV, Dinner MI (1982) The inferior segment technique for breast reduction. Ann Plast Surg 8:493–503Google Scholar
  15. 15.
    Hester TR Jr, Bostwick J III, Miller L, Cunningham SJ (1985) Breast reduction utilizing the maximally vascularized central breast pedicle. Plast Reconstr Surg 76:890–900Google Scholar
  16. 16.
    Lassus C (1987) Breast reduction: evolution of a technique—a single vertical scar. Aesthet Plast Surg 11:107–112Google Scholar
  17. 17.
    Lejour M (1994) Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg 94:100–114Google Scholar
  18. 18.
    Benelli L (1990) A new periareolar mammaplasty: the “round block” technique. Aesthet Plast Surg 14:93–100Google Scholar
  19. 19.
    Chiari AJ (1992) The L short scar mammaplasty: a new approach. Plast Reconstr Surg 90:233–246Google Scholar
  20. 20.
    Aiache AE (1999) Arch reduction mammaplasty. Plast Reconstr Surg 103:862–868Google Scholar
  21. 21.
    Hall-Findlay EJ (1999) A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 104:748–759Google Scholar
  22. 22.
    Corduff N, Taylor GI (2004) Subglandular breast reduction: the evolution of a minimal scar approach to breast reduction. Plast Reconstr Surg 113:175–184Google Scholar
  23. 23.
    Hall-Findlay EJ, Shestak KC (2015) Breast reduction. Plast Reconstr Surg.  https://doi.org/10.1097/prs.0000000000001622 Google Scholar
  24. 24.
    Rodier-Bruant C, Wilk A, Rosenstiel M, Nisand G, Meyer C (1995) Does the choice of mammoplasty pedicle influence the shape of reduced the reduced-sized breast? Ann Chir Plast Esthet 40:404–411Google Scholar
  25. 25.
    Graf R, Biggs TM (2002) In search of better shape in mastopexy and reduction mammaplasty. Plast Reconstr Surg 110:309–317Google Scholar
  26. 26.
    Hansen JE (2016) Avoiding the unfavorable outcome with wise pattern breast reduction. Clin Plast Surg 43:349–358Google Scholar
  27. 27.
    De Araujo Cerqueira A (1998) Mammoplasty: breast fixation with dermoglandular mono upper pedicle flap under the pectoralis muscle. Aesthet Plast Surg 22:276–283Google Scholar
  28. 28.
    Frey M (1999) A new technique of reduction mammaplasty: dermis suspension and elimination of medial scars. Br J Plast Surg 52:45–51Google Scholar
  29. 29.
    Ribeiro L (1975) A new technique for reduction mammaplasty. Plast Reconstr Surg 55:330–334Google Scholar
  30. 30.
    Botti G (1999) Vertical scar mammaplasty: stable padding of the superior pole by means of posteriorly based pedicle autoprosthesis. Aesthet Surg J 19:116–123Google Scholar
  31. 31.
    Ding H, Wang B, Gu Y, Zhao Y (2015) The combination of inferior pedicle method and dermal suspension sling technique: one new efficient method for breast reduction. Int J Clin Exp Med 8(4):6613–6620Google Scholar
  32. 32.
    Lalardrie JP (1982) Reduction mammaplasty: general approach and basic considerations. Aesthetic Plast Surg 6:81–83Google Scholar
  33. 33.
    Hinderer UT (1978) Mammaplasty: the dermal brassiere technique. Aesthet Plast Surg 2:1–20Google Scholar
  34. 34.
    Echo A, Guerra G, Yuksel E (2011) The dermal suspension sling: shaping the inferior pedicle during breast reduction. Aesthet Plast Surg 35:608–616Google Scholar
  35. 35.
    Sampaio-Goes JC (2002) Periareolar mammaplasty: double-skin technique with application of mesh support. Clin Plast Surg 29:349–364Google Scholar
  36. 36.
    Sampaio-Goes JC (1996) Periareolar mammaplasty: double skin technique with application of polygalactine or mixed mesh. Plast Reconstr Surg 97:959–968Google Scholar
  37. 37.
    Graf R, Biggs TM, Steely RL (2000) Breast shape: a technique for better upper pole fullness. Aesthet Plast Surg 24:348–352Google Scholar
  38. 38.
    Graf R, Reis de Araujo LR, Rippel R, Neto LG, Pace DT, Biggs T (2003) Reduction mammaplasty and mastopexy using the vertical scar and thoracic wall flap technique. Aesthet Plast Surg 27:6–12Google Scholar
  39. 39.
    Marchac D, de Olarte G (1982) Reduction mammaplasty and correction of ptosis with a short inframammary scar. Plast Reconstr Surg 69:45–55Google Scholar
  40. 40.
    Jansen LA, Backstein RM, Brown MH (2014) Breast size and breast cancer: a systematic review. J Plast Reconstr Aesthet Surg 67:1615–1623Google Scholar
  41. 41.
    Williams PT (2013) Breast cancer mortality vs. exercise and breast size in runners and walkers. PLoS One.  https://doi.org/10.1371/journal.pone.0080616 Google Scholar
  42. 42.
    Eriksson N, Benton GM, Do CB, Kiefer AK, Mountain JL, Hinds DA, Francke U, Tung JY (2012) Genetic variants associated with breast size also influence breast cancer risk. BMC Med Genet.  https://doi.org/10.1186/1471-2350-13-53 Google Scholar
  43. 43.
    Baasch M, Nielson SF, Engholm G, Lund K (1996) Breast cancer incidence subsequent to surgical reduction of the female breast. Br J Cancer 73:961–963Google Scholar
  44. 44.
    Boice JD Jr, Friis S, McLaughlin JK, Mellemkjaer L, Blot WJ, Fraumeni JF Jr, Olsen JH (1997) Cancer following breast reduction surgery in Denmark. Cancer Causes Control 8:253–258Google Scholar
  45. 45.
    Boice JD Jr, Persson I, Brinton LA, Hober M, McLaughlin JK, Blot WJ, Fraumeni JF Jr (2000) Breast cancer following breast reduction surgery in Sweden. Plast Reconstr Surg 106:755–762Google Scholar
  46. 46.
    Brown MH, Weinberg M, Chong N, Levine R, Holowaty E (1999) A cohort study of breast cancer risk in breast reduction patients. Plast Reconstr Surg 103:1674–1681Google Scholar
  47. 47.
    Fryzek JP, Weimin Y, Nyren O, Tarone RE, Lipworth L, McLaughlin JK (2006) A nationwide epidemiologic study of breast cancer incidence following breast reduction surgery in a large cohort of Swedish women. Breast Cancer Res Treat 97:131–134Google Scholar
  48. 48.
    Brinton LA, Persson I, Boice JD Jr, McLaughlin JK, Fraumeni JF Jr (2001) Breast cancer risk in relation to amount of tissue removed during breast reduction operations in Sweden. Cancer 91:478–483Google Scholar
  49. 49.
    Brinton LA, Malone KE, Coates RJ, Schoenberg JB, Swanson CA, Daling JR, Stanford JL (1996) Breast enlargement and reduction: results from a breast cancer case-control study. Plast Reconstr Surg 97:269–275Google Scholar
  50. 50.
    Bray F, McCarron P, Parkin DM (2004) The changing global patterns of female breast cancer incidence and mortality. Breast Cancer Res 6:229–239Google Scholar
  51. 51.
    Regnault P (1966) The hypoplastic and ptotic breast: a combined operation with prosthetic augmentation. Plast Reconstr Surg 37:31–37Google Scholar
  52. 52.
    Gonzalez-Ulloa M (1960) Correction of hypertrophy of the breast by exogenous material. Plast Reconstr Surg 25:15–26Google Scholar
  53. 53.
    Stevens WG, Stoker DA, Freeman ME, Quardt SM, Hirsch EM, Cohen R (2006) Is one- stage breast augmentation with mastopexy safe and effective? A review of 186 primary cases. Aesthet Surg J 26:674–681Google Scholar
  54. 54.
    Stevens WG, Spring M, Stoker DA, Freeman ME, Cohen R, Quardt SM, Hirsch EM (2007) A review of 100 consecutive secondary augmentation/mastopexies. Aesthet Surg J 27:485–492Google Scholar
  55. 55.
    Hedén P (2009) Mastopexy augmentation with form stable breast implants. Clin Plast Surg 36:91–104Google Scholar
  56. 56.
    Spear SL, Pelletiere CV, Menon N (2004) One-stage augmentation combined with mastopexy: aesthetic results and patient satisfaction. Aesthet Plast Surg 28:259–267Google Scholar
  57. 57.
    Davison SP, Spear SL (2004) Simultaneous breast augmentation with periareolar mastopexy. Semin Plast Surg 18:189–201Google Scholar
  58. 58.
    Nahai F, Fisher J, Maxwell PG, Mills DC 2nd (2007) Augmentation mastopexy: to stage or not. Aesthet Surg J 27:297–305Google Scholar
  59. 59.
    Swanson E (2013) Prospective comparative clinical evaluation of 784 consecutive cases of breast augmentation and vertical mammaplasty, performed individually and in combination. Plast Reconstr Surg.  https://doi.org/10.1097/prs.0b013e3182910b2e Google Scholar
  60. 60.
    Calobrace MB, Herdt DR, Cothron KJ (2013) Simultaneous augmentation/mastopexy: a retrospective 5-year re- view of 332 consecutive cases. Plast Reconstr Surg 131:145–156Google Scholar
  61. 61.
    Tessone A, Millet E, Weissman O, Stavrou D, Nardini G, Liran A, Winkler E (2011) Evading a surgical pitfall: mastopexy-augmentation made simple. Aesthet Plast Surg 35:1073–1078Google Scholar
  62. 62.
    Parsa AA, Jackowe DJ, Parsa FD (2010) A new algorithm for breast mastopexy/augmentation. Plast Reconstr Surg.  https://doi.org/10.1097/prs.0b013e3181c725fb Google Scholar
  63. 63.
    Don Parsa F, Brickman M, Parsa AA (2005) Augmentation/mastopexy. Plast Reconstr Surg 115:1428–1429Google Scholar
  64. 64.
    Barutcu A, Baytekin C (2009) One-stage augmentation-mastopexy with Wise pattern and inverted-T scar. Aesthet Plast Surg 33:784–785Google Scholar
  65. 65.
    Persoff MM (2003) Mastopexy with expansion-augmentation. Aesthet Surg J 23:34–39Google Scholar
  66. 66.
    Karnes J, Morrison W, Salisbury M, Schaeferle M, Beckham P, Ersek RA (2000) Simultaneous breast augmentation and lift. Aesthet Plast Surg 24:148–154Google Scholar
  67. 67.
    Stevens WG, Macias LH, Spring MA (2014) One-stage augmentation mastopexy: a review of 1192 simultaneous breast augmentation and mastopexy procedures in 615 consecutive patients. Aesthet Surg J 34:723–732Google Scholar
  68. 68.
    Manahan MA, Buretta KJ, Chang D, Mithani SK, Mallalieu J, Shermak MA (2015) An outcomes analysis of 2142 breast reduction procedures. Ann Plast Surg 74:289–292Google Scholar
  69. 69.
    Khavanin N, Jordan SW, Rambachan A, Kim JY (2014) A systematic review of single-stage augmentation-mastopexy. Plast Reconstr Surg 134:922–931Google Scholar
  70. 70.
    Spear SL, Pelletiere CV, Menon N (2004) One-stage augmentation combined with mastopexy: aesthetic results and patient satisfaction. Aesthetic Plast Surg 28:259–267Google Scholar
  71. 71.
    Chasan P (2018) Reductive augmentation of the breast. Aesthetic Plast Surg 42(3):662–671Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Ivan Manero
    • 1
  • Ana Rodriguez-Vega
    • 1
    Email author
  • Trinidad Labanca
    • 2
  1. 1.Department of Plastic and Reconstructive Surgery Dr. Ivan MañeroInstitute of Plastic SurgeryBarcelonaSpain
  2. 2.Institute of Plastic Surgery Dr. Ivan MañeroBarcelonaSpain

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