Abstract
The vertical sculpted pillar technique evolved from incorporating different maneuvers that collectively result in a stable breast cone fashioned from carefully tailored breast tissue. The key concept is to visualize and shape the volume of the breast tissue that one leaves behind, not the tissue that is taken away. To determine the best pedicle, a simple preoperative maneuver is performed. If the nipple-areolar complex (NAC) easily glides upward to its new position, then the superior pedicle popularized by Lassus [1, 2] via a vertical approach is used. Otherwise, if the NAC cannot be manipulated in this manner, then we convert to the superomedial pedicle popularized by Hall-Findlay [3, 4]. The other rule of thumb is that if the NAC is below the “the mosque dome” portion of the keyhole, then we begin to think in terms of a superomedial pedicle as opposed to a strictly vertical one. The sculpting of the medial and lateral pillars is modified from the technique of Chiari [5]. Other unique features of this technique include the shaping sutures in the superior pole of the breast, originally described by Marchac [6, 7], and the lateral shaping suture, described in an unpublished communication with Alex de Souza, a Brazilian plastic surgeon. Lastly, the reflected inframammary fold (the “A-point” of Pitanguy) becomes the superior-most point of attachment of the new areola, not the nipple.
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1 Electronic Supplementary Materials
In-Office Deflation Video. This is a 42 year-old patient presented with capsular contracture from 18 year old saline implants, and wanted to be smaller. Suction tubing is attached to a 6 mL syringe and an 18-gauge needle. After local infiltration, the 18-gauge needle is placed into the IMF, with the other hand stabilizing the implant. The volume of saline is recorded and correlated with the original saline implant volume (MP4 192512 kb)
Video 16.1
Breast Volume and Shape Changes Immediately After Saline Deflation . These are three-dimensional images of a 41 year-old patient who underwent preoperative saline deflation. On the left, the patient is shown with her intact saline implants. The right image is immediately after deflation. Note the deflated upper and lower poles and retraction of the nipples. The soft tissue irregularities in the lower pole immediately after deflation are the reason why immediate revision is not as precise as waiting 3 weeks for the irregularities to resolve (MP4 15512 kb)
Video 16.2
Breast Volume and Shape Changes 3 weeks Post Saline Deflation. These are three-dimensional images of the same 41 year-old patient. The left image is immediately after deflation, and the right image is 3 weeks after deflation. The breast volume increases, which is especially noticeable in the lower pole. The soft tissue irregularities have smoothed out as the skin contracts and the parenchymal volume increases due to the elastic breast recoil. On average, the breast volume increases 14.4%; and the notch to nipple distance decreases 0.57 cm in the interval 3 weeks (MP4 15581 kb)
Video 16.3
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Wu, C., Grotting, J.C. (2018). Vertical Sculpted Pillar Reduction Mammoplasty. In: Hamdi, M. (eds) Vertical Scar Mammaplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55451-7_16
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DOI: https://doi.org/10.1007/978-3-662-55451-7_16
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