title: Comparison of the Rubin dermal suspension sutures and total parenchymal reshaping technique with a traditional inverted T-scar reduction mammaplasty technique using a superior pedicle.
abstract: Adipose patients, especially after massive weight loss, pose a challenge to the breast surgeon due to the major loss of volume and the inelasticity of the skin. Rubin described a suitable mammaplasty technique for these patients involving dermal suspension sutures and total parenchymal reshaping. With this technique, the tissue of the prominent axillary skin fold typically found in patients with massive weight loss is used to increase the upper pole volume of the breast. To prove the effectiveness of this technique, the current study compared it with a traditional inverted T-scar technique using a superior pedicle, as described by Höhler. This technique usually is used for a different patient clientele that requires reduction mammaplasty. However, because none of the difficult aforementioned preconditions are found in this clientele, it leads to the best possible outcome and represents the authors’ internal “gold standard” for mammaplasty against which all other techniques must be compared. This study retrospectively analyzed the complication rate, lift effect, and upper pole fullness by chart analysis and photometric analysis of 21 Höhler and 24 Rubin mammaplasties. Despite the more challenging patient clientele in the Rubin groups, both therapies achieved a similar lift effect without significant differences (Höhler 4.8 ± 3.3 cm vs Rubin 6 ± 4 cm). In both groups, the upper pole area increased significantly. The ratio of upper pole-to-lower pole area increased from 1.31 preoperatively to 2.1 postoperatively in the Rubin group, suggesting a redistribution of tissue in favor of the upper pole, and it increased from 1.18 to 1.69 in the Höhler group, indicating an even greater increase in upper pole volume in the Rubin group. In conclusion, the technique described by Rubin, despite the dramatically more difficult soft tissue condition of the patients with massive weight loss, results in an outcome similar to that of a traditional reduction mammaplasty technique in terms of increased upper pole volume. It is suitable and preferable for patients who have a lateral axillary roll deformity and can be applied safely for these patients without increasing the complication rate.
  
  
  METHODS
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authors.forename: S U
authors.initials: SU
authors.lastname: Eisenhardt
authors.forename: H
authors.initials: H
authors.lastname: Nienhueser
authors.forename: D
authors.initials: D
authors.lastname: Braig
authors.forename: V
authors.initials: V
authors.lastname: Penna
authors.forename: H
authors.initials: H
authors.lastname: Bannasch
authors.forename: N
authors.initials: N
authors.lastname: Torio-Padron
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000517:prevention & control*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation*; D013536:Suture Techniques; D016896:Treatment Outcome; D015431:Weight Loss; D014945:Wound Healing / Q000502:physiology