title: A new application for increasing breast projection in free-nipple-graft reduction mammaplasty.
abstract: BACKGROUND
  Free-nipple-graft reduction mammaplasty is the procedure of choice in patients with massive breast hypertrophy. Breasts that have undergone free-nipple-graft reduction mammaplasty usually cannot maintain projection. Many modifications of free-nipple-graft reduction mammaplasty have been described to treatment this problem. We describe our modification of the free-nipple-graft reduction mammaplasty.
  
  
  METHODS
  The technique includes two key points: The first is the fold of the midportions of the breast. The second is suturing the midportion of the breast to the fascia of the pectoral muscle. The fold increases breast projection and the suturing helps to obtain long-lasting breast projection.
  
  
  RESULTS
  A total of 16 patients underwent free-nipple-graft reduction with the modified technique between 2003 and 2008. Mean follow-up was 21 months (range = 3-60 months). An average of 2016 g of tissue per breast was excised (range = 1250-2700 g per breast). An average of 4031 g of tissue per patient was excised. All patients had long-lasting, pronounced breast mound projection. Satisfactory breast projection was maintained. No "bottoming out" was seen. The level of satisfaction felt by all patients was very high.
  
  
  CONCLUSIONS
  Long-term projection can be maintained by suturing the half-trianges to each other and to the fascia of the pectoral muscle. One more useful alternative technique for increasing projection in free-nipple-graft reduction has been added with the technique presented.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey. tongucisken@yahoo.com
authors.forename: Tonguç
authors.initials: T
authors.lastname: Isken
authors.forename: Cenk
authors.initials: C
authors.lastname: Sen
authors.forename: Murat
authors.initials: M
authors.lastname: Onyedi
authors.forename: Hakki
authors.initials: H
authors.lastname: Izmirli
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology; D005260:Female; D006801:Humans; D006984:Hypertrophy; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery