The Butterfly Technique: A Retrospective Study for Labia Minora Reduction Using an Integrated Approach

Abstract

Background: In recent years, the demand for genital plastic procedures has increased. Of those, the reduction of the labia minora has become very popular. Several techniques are described, with all its advantages and disadvantages. The aim of this study is to introduce a novel approach combining de-epithelialization with wedge resection. Methods: In this retrospective study, we included patients seen between September 2011 and April 2014 with hypertrophic labia minora. The surgical technique consisted in an integrated approach of de-epithelialization and wedge excision. Patients were examined for early and late postoperative complications. Furthermore, patient satisfaction was evaluated at the final follow-up. Results: A total of 17 labioplasties (Franco type II-IV) in 10 patients with a mean age of 29 ± 12 years (range 20-62 y) were performed. Three patients experienced wound-healing problems, requiring surgical revision. After a median follow-up of 39 ± 6 months (range 28-48 mo), a high overall patient satisfaction has been achieved (8.6 ± 1.1). No dyspareunia, hypertrophic scarring, or micturition problems have been reported. Conclusions: By using our integrated approach, hereby called the "butterfly technique," the neurovascular supply remains preserved, and an efficient volume reduction can be achieved with a concealed scar. Nevertheless, suture techniques and suture materials have to be tested to reduce the incidence of wound dehiscence rate.

An Algorithm for Labia Minora Reduction Based on a Review of Anatomical, Configurational, and Individual Considerations

“…Accurate understanding of the labial neurovascular system may improve the surgical approach and outcome of labium reduction. (24,37,38) Salmon has been the first to record the labial vascular 5…”

“…(10,11,20,29,31,45,46) Suspension of the lateral most tip of the minor labium my help plan and execute the reduction. (21,31,38) Edge resection or trimming involves the straightforward amputation of protuberant tissues. It additionally reduces the labial free rim length (Figure 4A) and is adaptable to virtually any labial size or shape.…”

“… 29 Because of the wide spectrum of patient considerations and expectations, every patient's aesthetic or functional goals ought to be identified before a surgical technique can be decided on. 7 10 16 21 29 34 38 …”

“…Accurate understanding of the labial neurovascular system may improve the surgical approach and outcome of labium reduction. 24 37 38 Salmon has been the first to record the labial vascular system by his meticulous and systematic radiographic studies of the integumental vascularization, in 1936. 39 He found the anterior one-third of the labia minora to be perfused by a branch deriving from the external pudendal artery and the posterior two-thirds by small internal pudendal branches that run perpendicular to the labial long axis ( Fig.…”

“… 10 11 20 29 31 45 46 Suspension of the lateral most tip of the minor labium may help plan and execute the reduction. 21 31 38 …”