The Crossed Dermal Flaps Technique for Breast Reduction

Plaza, Rafael de la; Cruz, L. de la; Moreno, Carlos; Soto, L. Dominguez

doi:10.1007/s00266-004-0370-4

Cited by 20 publications

(3 citation statements)

References 8 publications

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“…A major advantage of this principle is that it exchanges vulnerable skin for reliable well-vascularized tissue that has not been undermined [9]. Many other studies have introduced other modifications to Wise pattern reduction mammoplasty, like the use of cross dermal flap [10], three triangular dermal flaps [11], and the triangular lipodermal flaps at the caudal end of each breast pillars described by. Khalil et al [1] to act also as an internal dermal sling, thus providing better wound healing and maintaining the best breast projection with the provision of optimum aesthetic results.…”

Section: Discussionmentioning

confidence: 99%

Comparing Different Methods Used for Prevention of T-Junction Dehisence in Wise Pattern Reduction Mammoplasty

Morsi

Badawy

lmahalawy

et al. 2020

The Egyptian Journal of Plastic and Reconstructive Surgery

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Introduction:The female breast is regarded as a symbol of femininity. The aesthetically pleasing breast will be of a size proportional to the body, be tear drop to conical in shape, and have the nipple positioned at the anterior most position. Deviations from normal size, shape, and symmetry are interpreted as unattractive. Wise pattern reduction mammoplasty is commonly used procedure for aesthetic and functional purposes. The use of the superomedial pedicle has increased over the past decade, as it has many reported benefits. The combination of the superomedial pedicle with the traditional Wise-pattern skin resection has gained increasing popularity for its versatility and ability to achieve significant aesthetic results. Wound problem complications remain relatively common, as well as the tendency of the outcome to deteriorate in some cases, with loss of projection and bottoming out of the lower breast pole. T-junction necrosis and infection are the most common complications encountered. The aim of this work is to compare between 2 modifications of Wise pattern technique for reducing T-junction dehiscence involving marking and incising an inverted V flap Along the Inframammary fold at the breast meridian and triangular lipodermal flap and finally to select the one of either technique to get the best results.Methods: This is a Prospective randomized comparative study including 30 female patients all complaining of breast hypertrophy and seeking reduction mammaplasty. The patients are divided randomly using a close envelope randomization method into 2 groups. Group (A) will include 15 patients to undergo Wise pattern reduction mammoplasty with inverted V flap. Group (B) will include 15 patients to undergo Wise pattern reduction mammoplasty with triangular lipodermal flap at the caudal end of the breast pillars.Follow-up is scheduled at the end of the first, second, and fourth postoperative weeks and checking the T junction for occurrence of dehiscence or not and assessing the degree of dehiscence. Patient satisfaction questionnaire then was presented to the patients.Results: The rate of major and minimal wound dehiscence was lesser in triangular lipodermal flap than in inverted V flap though statistically insignificant. Wound healing complications increased with increased BMI of the patients. Moreover, most of the patients were satisfied by overall outcomes with satisfaction rate of 93.3% in triangular lipodermal flap and 83.3% in inverted V flap. 275 Conclusion:The triangular lipodermal flap could be the future preferred technique as a modification to Wise pattern reduction mammoplasty for prevention or reduce the incidence of T junction complications.

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Section: Discussionmentioning

confidence: 99%

Comparing Different Methods Used for Prevention of T-Junction Dehisence in Wise Pattern Reduction Mammoplasty

Morsi

Badawy

lmahalawy

et al. 2020

The Egyptian Journal of Plastic and Reconstructive Surgery

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“…This correlated with the results of our study in which T-junction morbidity was higher in breast resections >750 g. Overall, this was statistically not significant because T junction morbidity was considerably lower when compared with other published studies due to differences in technique and adherence to selection criteria. De la Plaza et al (11) described a crossed dermal flap technique in WRM, in which two rectangular areas under each breast pillar were de-epithelized and crossed, then fixed to the IMF. They reported that 14% required further surgery to excise small folds in addition to liposuction at the extreme of the scars.…”

Section: Discussionmentioning

confidence: 99%

Triangular lipodermal flaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis

2016

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W ise pattern reduction mammoplasty (WRM) is a commonly performed procedure for aesthetic and functional purposes, and for symmetrization procedures in patients undergoing breast reconstruction. The technique provides satisfactory cutaneous reduction in both the transverse and vertical aspect, but at the expense of inevitable lengthier scars with possible risks for cutaneous necrosis at the T junction. This has fueled the ongoing debate over long-versus short-scar techniques. The aesthetic outcome could vary with Wise pattern due to the extent of scarring. However, other factors should be considered including age, breast size, degree of ptosis, quality of breast skin, resected volume and comorbidities. Wound problem complications remain relatively common, as well as the tendency of the outcome to deteriorate in some cases, with loss of projection and bottoming out of the lower breast pole (1-4). T-junction wound dehiscence and infections are the most common complications encountered, with evidence of their impact on surgical outcomes rarely reported in the literature. We describe an additional modification using triangular lipodermal flaps in the WRM technique aiming to reduce dehiscence with scar formation at the T-junction and, thus, a more predictable aesthetic outcome.

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“…Most of these ideas involve decreasing the tension on skin, borrowing properly vascularized tissues from adjacent area & removing glandular tension. Those methods include: Triangular lipodermal flaps [4], Inverted V flap [6], Crossed Dermal Flaps [7] and lastly but not least the use of the new Incisional Negative Pressure Wound Therapy (IN-PWT).…”

Section: Introductionmentioning

confidence: 99%

The Role of Incisional Negative Pressure Wound Therapy in Improving the Outcome of Reduction Mammoplasty, An Egyptian Experience

Kadry

Ashraf

Nan³

et al. 2022

The Egyptian Journal of Plastic and Reconstructive Surgery

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Introduction: "T" junction dehiscence puts a burden on the reputation of breast reduction. A lot of methods have been described to solve this issue but still have their limitations. iNPWT is being popularized in different specialties as a preventive solution to problematic incisions (e.g. knee and hip replacements). It helps prevention of wound complications through reduction of edema decreasing tension on wound edges and increasing vascularity. iNPWT has always been advocated not only to help wound healing but it is also suggested it produces a better scar on the long term.Patients and Methods: Twenty patients presenting seeking breast reduction were included in this study. The Bilateral nature of the breast allowed for the patient to be her own control with randomization of treatment modalities per side. iNPWT was used on one side while on the other side conventional dressing was used. The rate of wound healing complication as well as quality of the scar (using the Manchester score), were the main pillars of this study.Results: This study showed that the incidence of dehiscence in iNPWT group was 35%, while it was 45% in the standard dressing. Though we felt there are numerical and clinical superiority in the incidence and even the depth of dehiscence between iNPWT & traditional dressing, there was no statically significance to support this observation. The Manchester scar score showed a significant higher number in the standard care group with a p-value of (p=0.0114). Conclusion:iNPWT offers an alternative preventative measure for "T" junction problems in Wise pattern reduction mammoplasty. Though it was not statistically significant we still believe that it showed superior results. iNPWT showed improvement in the quality of the scar. Further national studies about its cost effectiveness in developing countries are recommended as well as its uses in other fields of plastic surgery.

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The Crossed Dermal Flaps Technique for Breast Reduction

Cited by 20 publications

References 8 publications

Comparing Different Methods Used for Prevention of T-Junction Dehisence in Wise Pattern Reduction Mammoplasty

Comparing Different Methods Used for Prevention of T-Junction Dehisence in Wise Pattern Reduction Mammoplasty

Triangular lipodermal flaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis

The Role of Incisional Negative Pressure Wound Therapy in Improving the Outcome of Reduction Mammoplasty, An Egyptian Experience

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