title: Respecting the aesthetic unit in autologous breast reconstruction improves the outcome.
abstract: BACKGROUND
  In postmastectomy breast reconstruction, a patchwork-like appearance and a double-bubble phenomenon may result from scar contracture and the possible destruction of the normal inframammary fold during mastectomy. Restoring an age-related breast ptosis can be difficult, and often contralateral breast surgery has to be performed to achieve symmetry. The purpose of this article is to present a technique that respects the aesthetic unit in autologous reconstruction, improves the outcome, and minimizes secondary surgery.
  
  
  METHODS
  The area between the resected mastectomy scar and the marked inframammary fold is deepithelialized. The inferior skin margin of the flap is sutured to the lower line of the deepithelialized area, which corresponds to the inframammary fold of the contralateral side. The degree of ptosis can be adjusted by insetting greater or lesser amounts of skin. From December of 2000 to June of 2004, 12 patients underwent secondary breast reconstruction using this technique. The patients' ages ranged from 39 to 63 years (median, 51 years). Three patients had reduction mammaplasty of the contralateral breast.
  
  
  RESULTS
  Mean patient follow-up was 14.7 months (range, 4 to 45 months). There were no free flap failures. Cosmetic evaluation of the reconstructed breasts by two independent plastic surgeons showed good results with regard to symmetry in 10 patients and fair results in two patients. Concerning visibility of the inferior scar, 11 patients had a good result and one patient had a fair result. All patients had a good result in terms of age-appropriate ptosis.
  
  
  CONCLUSIONS
  The authors' technique facilitates the formation of an age-appropriate ptosis. Altogether, the aesthetic unit of the breast is restored.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, Ludwig Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery, Innsbruck, Austria. petra.puelzl@uibk.ac.at
authors.forename: Petra
authors.initials: P
authors.lastname: Pülzl
authors.forename: Thomas
authors.initials: T
authors.lastname: Schoeller
authors.forename: Gottfried
authors.initials: G
authors.lastname: Wechselberger
mesh_terms: D000328:Adult; D002921:Cicatrix; D004954:Esthetics; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome