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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1308-1312

The aesthetic outcome of short scar periareolar inferior pedicle reduction mammoplasty technique


1 Department of Plastic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of General Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Plastic Surgery, Kafr Al-Shaikh General Hospital, Kafr Al-Shaikh, Egypt

Date of Submission24-Nov-2018
Date of Decision01-Jan-2019
Date of Acceptance08-Jan-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Basma N Omran
Seedy Salem, Kafr Al-Shaikh
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_370_18

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  Abstract 


Objective
The aim was to determine the esthetic outcome of short scar periareolar inferior pedicle breast reduction (SPAIR) technique.
Background
SPAIR mammoplasty is an effective method of breast reduction created to reduce the amount of cutaneous scar by half and improves breast shape that is stable overtime. This method is applicable to a wide variety of breast problems ranging from simple ptosis to extremes of macromastia.
Patients and methods
Twenty female patients aged 30–50 years were enrolled in this prospective clinical study presented at Menoufia University Hospitals and were scheduled for breast reduction surgery after approval of the local ethics committee and after taking an informed written consent. They were all done by the same technique.
Results
The results obtained using the SPAIR mammoplasty had been satisfying and more esthetic as regards other techniques of breast reduction. The resultant shapes were more rounded in appearance, with excellent projection. The pleasing shape that was created immediately, improved and maintained overtime as the breast settled and resolution of postoperative edema occurs, which is usually completed by 6 months postoperatively.
Conclusion
The SPAIR mammoplasty is an easily applied and technically straightforward technique for breast reduction and that affords the advantages of esthetic shape, reduced scar burden, and stability.

Keywords: breast, reduction, short scar periareolar inferior pedicle reduction mammoplasty, scar


How to cite this article:
Ghareeb FM, El-Kashty SM, Rageh TM, Omran BN. The aesthetic outcome of short scar periareolar inferior pedicle reduction mammoplasty technique. Menoufia Med J 2019;32:1308-12

How to cite this URL:
Ghareeb FM, El-Kashty SM, Rageh TM, Omran BN. The aesthetic outcome of short scar periareolar inferior pedicle reduction mammoplasty technique. Menoufia Med J [serial online] 2019 [cited 2020 Jun 1];32:1308-12. Available from: http://www.mmj.eg.net/text.asp?2019/32/4/1308/274266




  Introduction Top


Reduction mammoplasty is a procedure in which a volumetric reduction of the breast is done. It improves the shape of the breast and repositions the nipple–areola complex (NAC) [1].

Patients need surgical intervention for relief of symptoms that may be secondary to their large and ptotic breasts such as neck pain, back pain, shoulder pain, poor posture, and interference with ability to exercise and problems with self-image [2].

The short scar periareolar inferior pedicle breast reduction (SPAIR) technique is based on an inferior pedicle but manages the skin envelope with combined periareolar and vertical skin excision. By combining these elements, an effective method of breast reduction is created that reduces the amount of cutaneous scar by half and yet results in an improved and long-lasting breast shape [3].

The aim of the study was the esthetic outcomes of the SPAIR technique.


  Patients and Methods Top


Twenty female patients aged 30–50 years were enrolled in this clinical study, presented to the Menoufia University Hospitals and scheduled for breast reduction surgery after approval of the local ethics committee and after taking an informed written consent. They all had done by the same technique.

Thorough history was obtained including personal and family history. Local examinations of the breast as regards palpable masses, nipple deformities, and skin quality were done. Clinical lymph node assessment was also done.

Routine laboratory investigation including complete blood count, renal function tests, liver function tests, fasting and postprandial blood sugar, and coagulation profile were done and recorded.

Breast ultrasound and/or mammography were done for all patients to exclude any associated breast problems which may interfere with the procedure.

The SPAIR mammaplasty bases the blood supply to the nipple and areola on an inferior pedicle with parenchyma being removed from around the periphery of the pedicle. After marking of the breast skin is resected in a circumvertical pattern that limits the scar to the central portion of the breast [Figure 1]. The procedure is begun by injecting the margins of the proposed incisions and the areas to be initially de-epithelialized with a diluted solution of lidocaine with epinephrine [Figure 2] using a multidiameter areola marker; a circle measuring 52 mm in diameter is marked on the existing areola. Initial incisions around the areola, inferior pedicle, and periareolar pattern are now made. The specimen removed has the shape of an elongated horseshoe [Figure 3]. The redundant inferior pole skin is plicated upon itself to create a smooth rounded inferior pole contour.
Figure 1: Marking design of the technique.

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Figure 2: De-epithelialization of the inferior flap.

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Figure 3: Excised tissue as an elongated horseshoe pattern.

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  Results Top


The SPAIR technique was done for 20 cases from 30 to 50 years old who were operated upon in the Plastic Surgery Department, Menoufia University Hospital, between April 2016 and October 2018.

The patient's characteristics and preoperative data were as follows. The average age of the patients was 40.5 years with a range of 30–50 years old [Table 1]; the BMI was 32.878 ± 5.702 with a range of 26–42.8; the average height in meters was 1.590 ± 0.053 m with a range of 1.51–1.67 m. The average body weight was 82.308 ± 12.336 kg with a range of 64.3–103 kg. The average of nipple-to-supra sternal notch distance was 31.167 ± 2.588 cm with a range of 27–40 cm; the average internipple distance was 23.250 ± 1.357 with a range 20–25 cm; the average base width was16.8 ± 1.749 with a range of 13–19 cm; the average areolar diameter was 6.633 ± 1.165 with a range of 4.5–8.3 cm, and the average areola to inframammary fold was 12.8–3.186 with a range of 7–18 cm and there were no radiological finding abnormalities [Table 2]. The specific complaints related to macromastia and psychological complaint (shape and embarrassment) represented most of the patient's complaints (90%, 18 cases) [Table 3].
Table 1: Age distribution

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Table 2: Patient's characteristics and preoperative data

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Table 3: Patient complaint

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The pleasing shape that is created immediately only improves with time as the breast settles and swelling resolves, a process that is usually complete by 6 months postoperatively. In most instances, scars are usually fully mature at 6 months to 1 year postoperatively [Figure 4], [Figure 5], [Figure 6], [Figure 7].
Figure 4: Preoperative picture.

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Figure 5: Postoperative after 3 months.

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Figure 6: Preoperative picture.

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Figure 7: Postoperative after 1 month.

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As regards the complications, there were no complete or partial NAC necrosis as well as hematoma development in any of the cases postoperatively, only two (10%) cases had wound dehiscence and treated by dressing only; 10 cases had excellent results (50%), eight (40%) cases had good result and there was no poor result [Table 4].
Table 4: Summary of results of the short scar periareolar inferior pedicle reduction mammoplasty technique

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Postoperative complications

No single case of major complications including hematoma, partial or complete necrosis of NAC, and/or skin flap necrosis were recorded in any of the cases included in this study; there were only two cases of wound dehiscence.

Regarding the patient's satisfaction after the surgical procedure, 6 months postoperatively each patient was asked to answer the questionnaire and to give her answer a score from 1 (very disappointed) to 10 (very pleased) regarding each item, which included the new breast size, breast shape, breast symmetry, scars, nipple sensation, symptom relief, bra and cloth fitting, and overall satisfaction [Table 5].
Table 5: Patient satisfaction questionnaire

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The results obtained using the SPAIR mammoplasty has been satisfying to both the patient and the surgeon. As the operative steps are essentially the same in all patients the technique is easily learned and applied.


  Discussion Top


The introduction and the popularization of the vertical scar technique by Lassus and later by Lejour brought important refinements to the existing techniques in the 1970s and the 1980s. Lejour reported no nipple necrosis, provided that the nipple was not transposed more than 9 cm vertically [4],[5].

Hammond [3] explains that short scar periareolar inferior pedicle breast reduction is an easily straightforward technique for breast reduction and mastopexy that affords the advantages of esthetic shape, reduced scar burden, and stability overtime.

In this study, the weight of the resected tissue was from 420 to 1560 g/breast. This was approximate to the weight of the tissue resected. In the study of Hammond [3] it was 500–1650 g/breast.

Wrye [6] in 2003 in a study of 49 patients, who underwent inferior pedicle reduction mammoplasty surgeries, found out that performing reduction mammoplasty without the use of closed suction drainage is safe and is preferred by the patients.

It was decided according to the policy and procedures in the Plastic Surgery Department in Menoufia University Hospital that it is safer to insert a closed suction drain in every case to give better chance to get rid of the wound discharges and eliminate dead space especially in cases with large breasts which are more common in our community.

In Hammond [3] 2005 drains are placed only in reductions of larger than 800–1000 g breast tissue.

Regarding the complications in this study there were no major complications like total or partial nipple–areola necrosis, no hematomas developed, no wound infection, and no persistent sensory loss. Two cases of partial wound dehiscence were treated conservatively by dressing; none of our cases were unhappy with the scar, they all are satisfied with the scar appearance.

Complications in the Hammond [3] study were most often a minor wound separation that heals secondarily overtime. Fat necrosis can occur at the distal end of the inferior pedicle in larger patients and usually manifests as a periareolar mass noted 3–6 weeks postoperatively. The avascular fat can mature into a well-circumscribed mass over the next 6 months to 1 year and is then removed to ease subsequent cancer surveillance overtime. Shape distortion is uncommon and, when noted, easily treated by removing additional skin in either the vertical or periareolar dimensions. Scar revisions are likewise possible once scarring has matured at 1 year. Persistent periareolar wrinkling can be similarly improved with a periareolar scar revision, excision of the wrinkled skin, and reclosure as before, often without the need for the Gore-Tex suture [3].

Hammond [3], in his study, denotes that in cases of mastopexy and small reductions of less than 500 g, the technique is easily applied and redraping of the inferior skin envelope is not difficult. Being able to make a limited scar makes the procedure appealing to many patients who are reluctant to undergo a more traditional Wise pattern procedure. For reductions of 500–1000 g, the inferior skin redraping requires more finesse but is usually easily accomplished. Patients with an excessive skin envelope for a given breast volume tend to be more problematic in this regard and may require more attention intraoperatively to create the desired breast shape. For reduction of more than 1000 g, it is helpful to have experience with the technique in order to achieve optimal results [3].

In this study, we have nearly the same result in the reduction of small breast 500–1000 g; the skin is more easily accomplished, and for large ones (>1000 g) more effort is required to give good shape and avoid skin wrinkle.

The patient satisfaction was assessed by patient satisfaction questionnaire about breast size, shape, symmetry, scars, sensation of nipple, improved pain, bra and cloth fitting, esthetic outcome, psychological relief, and overall outcome of the surgery they had [Table 5].

Cohen et al. [7] in his study of post-reduction mammoplasty patient satisfaction by using the BREAST-Q scores found that breast reduction surgery offers a vast improvement in patients' satisfaction and health-related quality of life that is maintained throughout the postoperative period regarding the patients' satisfaction with their breasts, psychosocial well-being, sexual well-being, and physical well-being. These findings can assist surgeons in managing patient expectations after reduction mammoplasty [7].


  Conclusion Top


SPAIR technique is an effective method of breast reduction that was created to reduce the amount of cutaneous scar by half and yet results are improved and with long-lasting breast shape that is stable overtime. Esthetically pleasing results are consistently and reliably obtained with few complications. It is offered as an effective method of reduced scar breast reduction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Purohit S. Reduction mammoplasty. Ind J Plast Surg 2008; 41:564–579.  Back to cited text no. 1
    
2.
Chopra K, Tadisina KK, Conda-Green AA, Singh DP. The expanded infra mammary fold triangle improved result in large volume breast reduction. Ind J Plast Surg 2014; 47:65–69.  Back to cited text no. 2
    
3.
Hammond DC. Short scar peri areolar inferior pedicle breast reduction. In: Moustapha H, Dennis CH, Foad N, editors. Vertical scar mammoplasty. Berlin: Springer Verlage. 2005; 6:49–62.  Back to cited text no. 3
    
4.
Lassus CA. 30 year experience with vertical mammaplasty. Plast Reconstr Surg. 1981; 97:373–380.  Back to cited text no. 4
    
5.
Lejour M. Vertical mammoplasty. Liposuction of the breast. Plast Reconstr Surg 1994; 94:100–114.  Back to cited text no. 5
    
6.
Wrye SW. Routine drainage is not required in reduction mammaplasty. Plast Reconstr Surg 2003; 7:111–113.  Back to cited text no. 6
    
7.
Cohen WA, Homel P, Patel NP. Does time affect patient satisfaction and health-related quality of life after reduction mammoplasty? Eplasty 2016; 16:7–21.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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