title: Four flap suspension technique for prevention of bottoming out after breast reduction.
abstract: OBJECTIVE
  Bottoming-out deformity is accepted as the most important disadvantage of inferior pedicle breast reduction. For prevention of this deformity, different techniques are used in combination with inferior pedicle. In this study, we aimed to prevent bottoming-out deformity by producing an internal bra effect through combination of inferior pedicle technique with 2 superior and 2 inferior dermal flaps that were raised from each side of the pedicle.
  
  
  METHODS
  Thirteen patients whose medical records became available during the follow-up period at Ankara Training and Research Hospital from January 2010 to January 2015 were included in this study. We retrospectively obtained patient medical records including demographic characteristics and clinical data. Superior dermal flaps were planned on both sides of the pedicle 2 cm inferior to the lower border of areola and inferior dermal flaps were planned 6 cm inferior to the superior dermal flaps. The superior and inferior dermal flaps were secured to the periosteum of the 2nd and 4th ribs respectively with permanent sutures.
  
  
  RESULTS
  Preoperatively, the average distance between the inframammary fold and areola was 13.9 cm (range, 11-18 cm). The average amount of breast parenchymal resection was 745 g (range, 612-1,496 g). The average distance between the inframammary fold and the lower border of the areola was 7.9 cm (range, 7.5-9 cm) on the postoperative first-year measurements.
  
  
  CONCLUSIONS
  In conclusion, according to our study, suspension technique to prevent bottoming-out deformity is associated with an easier technique without the need for alloplastic or allogenic materials. Since fixation is performed to the ribs instead of soft tissues like the pectoral fascia or muscle, we believe that this fixation is more long lasting and can be an effective alternative to other suspension techniques.
authors.affiliation: Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Kankaya
authors.affiliation: Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey.
authors.forename: Melike
authors.initials: M
authors.lastname: Oruç
authors.affiliation: Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey.
authors.forename: Nezih
authors.initials: N
authors.lastname: Sungur
authors.affiliation: Okmeydani Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Istanbul, Turkey.
authors.forename: Özlem Çolak
authors.initials: ÖÇ
authors.lastname: Aslan
authors.affiliation: Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Gürsoy
authors.affiliation: Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey.
authors.forename: Kadri
authors.initials: K
authors.lastname: Özer
authors.affiliation: Ankara Training and Research Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Koçer
keywords: Breast reduction; Flap; Mammaplasty; Suspension