title: Preventing the "bottoming out" and "star-gazing" phenomena in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere.
abstract: BACKGROUND
  The phenomena of "bottoming out" (pseudoptosis) and "star-gazing" (the upward rotation of the nipple-areola complex) is a common postoperative problem when using the inferior pedicle breast reduction technique. Multiple techniques have been described to help prevent this problem, including internal suspension techniques and the use of mesh to support the pedicle. We describe our technique and present a case series in which acellular dermal matrix (AlloDerm(®)) is used as an internal brassiere or sling to support the inferior pedicle and prevent postoperative "bottoming out" and "star-gazing."
  
  
  METHODS
  Twenty-seven patients underwent inferior pedicle reduction mammaplasty through a Wise pattern performed by a single surgeon. In each case, acellular dermal matrix (0.79-2.03 mm thick) was sutured to the chest wall as a sling or internal brassiere to support the inferior pedicle. The pedicle was also plicated in a horizontal fashion to increase the projection of the breast and to improve the position of the nipple-areola complex.
  
  
  RESULTS
  The mean weight of reduction per breast was 850 g. The mean distance from the nipple to the inframammary fold was 16.4 cm. The mean distance from the sternal notch to the nipple was 32.2 cm. Only one patient developed cellulitis and one patient had partial skin flap necrosis. There was no nipple loss. At routine follow-up it was found that the aesthetic breast shape has been retained and pseudoptosis or "bottoming out" was not significant in any patient. The longest follow-up is 29 months.
  
  
  CONCLUSIONS
  The use of an acellular dermal matrix internal brassiere is a safe and effective technique for preventing the "bottoming out" and "star-gazing" phenomena that occurs after inferior pedicle breast reduction. Longer-term follow-up will be required to assess the longevity of these results.
authors.affiliation: Baylor College of Medicine, Clinical Care Center, Houston, TX 77030, USA. Rb140110@bcm.edu
authors.forename: Rodger H
authors.initials: RH
authors.lastname: Brown
authors.forename: Shayan
authors.initials: S
authors.lastname: Izaddoost
authors.forename: Jamal M
authors.initials: JM
authors.lastname: Bullocks
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000601:surgery*; D003094:Collagen / Q000627:therapeutic use*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction; D016896:Treatment Outcome
chemical_list: C440568:Alloderm; D003094:Collagen