Risk Comparison Using Autologous Dermal Flap and Absorbable Breast Mesh on Patient Undergoing Subcutaneous Mastectomy with Immediate Breast Reconstruction

Modified Bidirectional Adipodermal Mastopexy, Nipple-sparing Mastectomy, and Direct-to-implant Reconstruction in Patients with Significant Ptosis

“… 6 , 17 Three inferiorly based adipodermal pedicle reports describing leaving subareolar tissue behind 6 , 13 , 14 to support NAC perfusion, one of which required a second surgery for removal. 6 Although the descriptions of the superiorly 22 , 25 and medially based adipodermal pedicles 21 also included reports that described leaving behind subareolar tissue, none of the described bidirectional approaches included this modification. Direct comparison of these different techniques is difficult given that the approaches are applied to different patient populations (therapeutic versus prophylactic surgery), may require one (DTIR) or two (TE) procedures, and may or may not leave behind subareolar tissue (Table 2 ).…”

“…The literature review identified 25 articles (Table 3), which fell into several reconstructive patterns. Most studies described a discrete, unidirectional, or bidirectional adipodermal flap through which the NAC was supported and repositioned 6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and used a Wise or vertical mastopexy pattern for skin retailoring. Other studies did not commit to a unidirectional adipodermal pedicle and kept most attachments intact, [32][33][34][35] which limited the extent of nipple repositioning possible.…”

“…Some studies modified the mastopexy pattern to eliminate the T-junction and placed an incision in the IMF 6,17 or across the breast 18,19,28,35 to reduce the incidence of mastectomy flap/T-junction necrosis. The adipodermal flaps described were inferiorly based (9)‚ 6,12-19 bidirectional (8), 23,[27][28][29][30][31] superiorly based (4), [22][23][24][25] medially based (2), 20,21 and no direction specified (4). [32][33][34][35] The inferiorly based Fig.…”

“…Some studies modified the mastopexy pattern to eliminate the T-junction and placed an incision in the IMF 6,17 or across the breast 18,19,28,35 to reduce the incidence of mastectomy flap/T-junction necrosis. The adipodermal flaps described were inferiorly based (9)‚ 6,12–19 bidirectional (8), 23,27–31 superiorly based (4), 22–25 medially based (2), 20,21 and no direction specified (4). 32–35 The inferiorly based adipodermal pedicle reports included four descriptions that were not Wise-patterns, 6,17–19 eliminating the vertical scar and placing the scar across the center of the breast 18,19 or at the IMF.…”

“…We reviewed all published reports on this topic to come to some conclusion as to what the best strategy might be. Using the methodology described in the Methods section, we identified 25 original publications 6,12–35 that described an approach to NSM and simultaneous mastopexy in patients with ptosis. We discuss our outcomes compared with previous reports describing therapeutic NSM and immediate mastopexy, focusing on publications with the largest case numbers (Table 3).…”