A New Technique of Mastopexy for Mastoptosis: With the Upturned Glandular Flap

Background

The mastopexy is one of the common surgeries in breast plastic surgery. There are many kinds of conventional surgeries for the breast ptosis. The perfect surgical results are difficult to obtain, due to the influence of many factors such as type of ptosis, degree of ptosis, age, tissue elasticity, etc. Although there were many reports on correcting mastoptosis, most of them were aimed at breast dysplasia or breast hypertrophy in the past. There were few reports on correcting breast ptosis with normal development and proper volume. In order to obtain better surgical results, the author designed a new technique with the tongue-shaped breast tissue flap to correct moderate breast ptosis in normal volume without no need for mesh or any other foreign material. After the preliminary experience was obtained, the professional report was carried out once [1]. We have continued to perform this kind of operation together with plastic surgeons in other hospitals in recent years. The further improvements have been made to this technology. We believe that it is more satisfactory and stable in correcting moderate mastoptosis with this special technology. This method has better practical value and spreading value.

The appearance and shape of the breasts are the very important for women. The necessary conditions for breast fullness and good projection plump breasts are: appropriate tissue volume, sufficient tissue density and elasticity, and strong support structure. Breast ptosis is perceived as unattractive and thus is one of the common reasons for the presentation of women to the plastic surgeon [2]. There were loose skin, atrophy and soft of glands, downward movement of nipple areola, and overall breast flatness in the drooping breast. These problems can be effectively solved by appropriate mastopexy technique. The purpose of a mastopexy is to restore the perfect shape and volume of the breast. This will improve the patient's quality of life and her self-confidence will be regained.

Discussion

The ideal effect of mastopexy should be: The breast had good shape and bilateral symmetry; The nipple areola feels good; Retention of breast elasticity and good skin tension; The incision is concealed and the scar is less; It's not easy to relapse. In general, the breast ptosis is divided into the following groups [5]: 1 - Mastoptosis with breast hypertrophy. 2 - Mastoptosis with breast hypotrophy. 3 - Mastoptosis with breast normotrophy. The corrective techniques chosen are different according to the various types of ptosis. The breast reduction with resection of glandule mammary tissues was made in the patients of the first groups. In the second group the augmentative mammaplasty took place. The mastopexy or/and augmentative will be chosen in the third group patients.

Its correction by mastopexy presents one of the greatest challenges to the breast surgeon aiming at a pleasant full conical shape and stability of the results [6]. In order to achieve a projection and fullness effect, implants are a more common and effective method. However, the mastopexy with or without the use of implants being indicated, several considerations have to be taken into account: the wishes of the patient, age of the patient, degree of ptosis, parenchymal volume, covering tissue, quality of the tissue, pocket implant, and resulting scars etc [7]. For normally volume breasts, the addition of breast prostheses will inevitably result in a too large of the breast volume after surgery, increasing the chance of drooping again.

Skin resection, repositioning of the nipple-areolar complex (NAC) and gland recombination are the key steps for successful breast fixation [8]. Current mastopexy techniques rely on incisions on the breast to correct ptosis. Trading a ptotic breast for a visibly scarred breast can be a difficult choice [9]. Initially, simple crescent- shaped incisions were used for mastopexy. After technical improvement by many plastic surgeons, some different incisions have been gradually developed, for example T incision and a vertical incision [10], concentric round incision [4], Y-shaped incision [11], fish-shaped incision [12], L-shaped incision [13] and so on. There are three currently accepted skin patterns used for mastopexy: wise or T pattern, vertical and concentric [14]. In the main, skin incisions are usually selected by both the doctor and the patient. The patient's willingness is even greater. Concentric round incisions around the areola become the first choice for many patients in recent years. The increasing demand for minimum scar techniques has led to wider use of periareolar approaches for breast manipulation [15].

In general, the position of the NAC is critically important to the aesthetic appearance of the breast. In the case of ptotic breast, the severity of the ptosis is evaluated according to the position of the nipple in relation to the inframammary fold [16]. The NAC was relocated to its proper position by depending on changes in the skin incision and the reorganization of the glands. The method of lifting the NAC by skin incision alone is not very effective in the long term. For the effective and stable lifting of the NAC, the remolding of the glands is the most critical.

The reorganization of glands is the most important step in mastopexy. The reorganization method is mostly decided by the plastic surgeon. Early methods were mostly simple glandular sutures, but were phased out due to poor results. Later, many technology were developed, such as glandular rotation overlapping technology [17], double-flap technology [18], triple flaps procedure [6], Z- shaped tissue flap transfer [19] , gland stacked technique [20] etc. These techniques are all shaped by the transfer and redistribution of breast tissue and recombination with wise or T pattern, vertical incisions. Larger incision scars are their obvious disadvantage.

In order to effectively solve the problems of skin resection, the NAC repositioning and gland recombination, we developed a new method for mastopexy. The tongue-shaped gland flap of the lower part of the breast is made in the concentric round incision. Then the tissue flap is upturned for 180°and filled into the posterior clearance of the breast. For the sake of overcoming the shortcomings of the large base of the breast and the overall flatness of the breast in the periareal incision, a special procedure must be completed. It is that a firm suture of the glands on both sides of the lower part should be made.

The upper glands are usually significantly elongated in the breast ptosis. At first, we tightened the upper gland by rotating the gland flap. Experience has shown that the NAC's lifting effect was not obvious with this method. After improvement, a longitudinal incision was made in the upper gland, and then the lateral suture was performed so that the length of the upper gland was immediately shortened. After such treatment, the NBC's lifting was more secure. The main technical points of this procedure: shorten the upper breast length, fill the middle of the breast and reduce the breast circumference. This technique provides a good projection and fullness without the need for implants. The results were stable in the long term.

Conclusion

For mastoptosis with normal volume breast, satisfactory surgery results can be achieved through the recombination of breast tissue and the tightening of the lower pole without placing the prosthesis. The design is ingenious, operation easily, flexible, natural breast shape after surgery, and the effect is accurate for the method of correcting mammary ptosis with tongue tissue flap. It is a safe, effective technique, with high predictability, a low complication rate, reliable effect and high patient satisfaction. This surgery approach provides a new stratagem for correcting mastoptosis.