Breast reshaping following massive weight loss: principles and techniques.
Management of the breast following massive weight loss for both reconstructive and aesthetic reasons poses unique challenges that are often inadequately addressed with traditional techniques. The breast mound is often unstable and deflated, with a loose inelastic skin envelope and ill-defined boundaries that blend into similar lateral chest wall, arm, and upper abdominal contour irregularities. Because this has become more common recently with the increasing prevalence of massive weight loss patients desiring body contouring, the purpose of this review was to discuss modifications to traditional breast techniques that have been proposed for these patients. It has become apparent that mammaplasty techniques in the massive weight loss patient should rely more on extensive glandular manipulation for shape preservation rather than relying on the skin envelope for shaping. Such techniques include parenchymal plication, suspension, and autoaugmentation. This will improve the likelihood of maintained shape and symmetry in an otherwise difficult patient population.
Losken
Albert
A
Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery, Emory University.
D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015431:Weight Loss
Livingston EH. Obesity and its surgical management. Am J Surg. 2002;184:103–113.
Mitchell JE, Crosby RD, Ertelt TW, et al. The desire for body contouring surgery after bariatric surgery. Obes Surg. 2008;18:1308–1312.
Zook EG. The massive weight loss patient. Clin Plast Surg. 1975;2:457–466.
Atiyeh BS, Dibo SA, Hayek SN. Contouring of the male anterior chest following bariatric surgery and massive weight loss. Aesthet Surg J. 2008;28:688–696.
Gusenoff JA, Coon B, Rubin JP. Pseudogynecomastia after massive weight loss: Detectability of technique, patient satisfaction, and classification. Plast Reconstr Surg. 2008;122:1301–1311.
Song AY, Jean RD, Hurwitz D, Fernstrom MH, Scott JA, Rubin JP. A classification of contour deformities after bariatric weight loss: The Pittsburgh Rating Scale. Plast Reconstr Surg. 2005;116:1535–1544.
Haeck P, Swanson JA, Iverson RE, et al. Evidence-based patient safety advisory: Patient selection and procedures in ambulatory surgery. Plast Reconstr Surg. 2009;124 (Suppl 4S):6S–27S.
Kenkel J. Body contouring surgery after massive weight loss. Plast Reconstr Surg. 2006;117 (Suppl 1):3S–83S.
Hatef DA, Kenkel JM, Nguyen MQ, et al. Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg. 2008;122:269–279.
Hallock GG, Altobelli JA. Simultaneous brachioplasty, thoracoplasty and mammoplasty. Aesthetic Plast Surg. 1985;9:233–235.
Colwell AS, Driscoll D, Breuning KH. Mastopexy techniques after massive weight loss: An algorithmic approach and review of the literature. Ann Plast Surg. 2009;63:28–33.
Losken A, Holtz DJ. Versatility of the superomedial pedicle in managing the massive weight loss breast: The rotation-advancement technique. Plast Reconstr Surg. 2007;120:1060–1068.
Rubin JP. Mastopexy in the massive weight loss patient: Dermal suspension and total parenchymal reshaping. Aesthetic Plast Surg. 2006;26:214–222.
Lockwood T. Reduction mammaplasty and mastopexy with superficial fascial system suspension. Plast Reconstr Surg. 1999;103:1411–1420.
Frey M. A new technique of reduction mammaplasty: Dermis suspension and elimination of medial scars. Br J Plast Surg. 1999;52:45–51.
Qiao Q, Sun J, Liu C, Liu Z, Zhao R. Reduction mammaplasty and correction of ptosis: Dermal bra technique. Plast Reconstr Surg. 2003;111:1122–1130.
Colwell AS, Breuing KH. Improving shape and symmetry in mastopexy with autologous or cadaveric dermal slings. Ann Plast Surg. 2008;61:138–142.
Rubin JP, Gusenoff JA, Coon D. Dermal suspension and parenchymal reshaping mastopexy after massive weight loss: Statistical analysis and concomitant procedures from a prospective registry. Plast Reconstr Surg. 2009;123:782–789.
Graf RM, Mansur AE, Tenius FP, Ono MC, Romano GG, Cruz GA. Mastopexy after massive weight loss: Extended chest wall-based flap associated with a loop of pectoralis muscle. Aesthetic Plast Surg. 2008;32:371–374.
Homström H, Lossing C. The lateral thoracodorsal flap in breast reconstruction. Plast Reconstr Surg. 1986;77:933–943.
Hamdi M, Van Landuyt K, Blondeel P, Hijjawi JB, Roche N, Monstrey S. Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss patients. J Plast Reconstr Aesthet Surg. 2009;62:65–70.
Kwei S, Borud LJ, Lee BT. Mastopexy with autologous augmentation after massive weight loss: The intercostal artery perforator (ICAP) flap. Ann Plast Surg. 2006;57:361–365.
Zienowicz RJ, Karacaoglu E. Augmentation mammaplasty by reverse abdominoplasty (AMBRA). Plast Reconstr Surg. 2009;124:1662–1672.