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An autodermal sling for breast reduction
Chepla, KJ
Zochowski, CG
Kaufman, BR
CWRU - University Hospitals
2010-03-24
Presenter: Chepla, KJ
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
There are many surgical techniques for breast reduction. Some of the more recent techniques have demonstrated the advantage of parenchymal shaping in providing good long term results. The inverted T or Wise pattern-central (inferior) pedicle technique remains popular because it is safe, reliable, can be used for very large reductions, and is easy to learn. One of its drawbacks is a "bottoming-out" with concomitant loss of superior pole fullness, which we believe is due to the reliance on the skin envelope for glandular support.
We describe an internal dermal sling that prevents glandular migration and helps shape the breast. Rubin (2008) described dermoglandular flaps for patients following massive weight loss. Additionally, the use of acellular dermal allograft has gained acceptance in many types of reconstruction. We have extended these techniques to our design by adding medial and lateral deepithelialized triangles of dermis to the inferior pedicle. Following glandular resection the dermal flaps are sutured to the pectoralis fascia medially, glandular tissue and chest wall laterally, and the central pedicle. The resulting dermal sling is then plicated to shorten the inferior pole, suspend the parenchyma, and tailor breast shape.
The technique may be used in all patients who are candidates for an inferior pedicle Wise pattern procedure. The procedure requires very little additional dissection and does not add significantly to operative time.
Dermal support to decrease tension on skin closure has reduced glandular migration and resulted in stable, long-term superior fullness. Follow-up to date supports maintenance of the suspension and results.
