title: Postbariatric surgery breast reshaping: the spiral flap.
abstract: BACKGROUND
  After massive weight loss, the breasts have poor shape, projection, and skin elasticity. Breast reshaping is recognized as difficult and may require excess nearby tissues. As the senior author's approach evolved over the past 4 years, breast reshaping with the spiral flap became integral to an upper body lift.
  
  
  METHODS
  After the weight loss has stabilized, body contouring surgery has been performed on 53 patients over a 3-year period. Six patients had mastopexy and/or augmentation only. Eighteen patients had spiral flap breast reshaping as part of an upper body lift. This lift is a reverse abdominoplasty that ends along the inframammary fold incision of the Wise pattern mastopexy and continues laterally to along the back roll. Excess tissue from the epigastrium and lateral back roll is deepithelialized and used for augmentation. These flap extensions of the central breast pedicle are spiraled around the breast for augmentation, shaping, and suspension. When more tissue is needed, saline-filled silicone implants have been used, preferably during a second stage.
  
  
  RESULTS
  Follow up of this initial group ranged from 4 to 28 months with a mean of 11 months. In this initial effort, 14 of the 18 were pleased. In 3 patients, subsequent bilateral saline implants further augmented the breasts. Tip fat necrosis was evident by firmness of the tissues in 3 patients and resolved in all but 1. That 1 patient had operative debridement of the distal 50% of the flaps followed by saline-filled silicone implants. One patient was disappointed with the back scar. Two patients dislike the shape and fill of their breast and have not returned for revision.
  
  
  CONCLUSIONS
  During 3 years of focused clinical activity, we have evolved the spiral flap reshaping with upper body lift into a comprehensive, effective, satisfying, and safe esthetic contouring of the breast and upper torso after massive weight loss performed with an upper body lift.
authors.affiliation: University of Pittsburgh Medical Center and the Hurwitz Center for Plastic Surgery, Pittsburgh, Pennsylvania, USA. drhurwitz@hurwitzcenter.com
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hurwitz
authors.forename: Siamak
authors.initials: S
authors.lastname: Agha-Mohammadi
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D001940:Breast / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D011182:Postoperative Care; D013524:Surgical Flaps; D014182:Transplantation, Autologous