Versatility of the Superomedial Pedicle in Managing the Massive Weight Loss Breast: The Rotation-Advancement Technique

Abstract

The superomedial pedicle is a versatile, well-vascularized pedicle that allows for glandular plication of the lower pole and autoaugmentation of the upper pole once rotated. Parenchymal shaping through plication and suspension of the breast mound should improve breast shape over time, theoretically reducing the incidence of recurrent ptosis as breast shape relies less on the often inelastic skin envelope. It applies a familiar and reliable technique, with certain modifications, to improve results and maintain shape in the long, deflated, massive weight loss breast.

Reduction Mammaplasty, Obesity, and Massive Weight Loss

“…23 This complex contour deformity stems from an unstable tissue envelope, resulting in ptotic, flaccid, laterally displaced breasts with flat upper poles and loose inframammary folds. [22][23][24] Little literature exists on revision breast contouring in the massive weight loss patient after breast reduction surgery.…”

“…Breast shape is frequently affected, becoming more ptotic, with medialization of the nipples, development of lateral chest wall rolls, and flattening of the upper pole. [22][23][24] Patients commonly seek consultation to reconstruct their breast deformities following massive weight loss. 25 Outcome data concerning satisfaction with appearance of breasts have been reported following breast reduction and, in separate studies, following massive weight loss.…”

Vertical Mastopexy and Lateral Intercostal Artery Perforator (LICAP) Flap With Pectoralis Muscle Sling for Autologous Tissue Breast Augmentation in the Bariatric Patient

“…[11][12][13][14] In fact, several authors have adapted the technique of pillar creation and suturing in their mastopexy operation after massive weight loss, yet still using a Wise pattern for skin excision. 15 As it is shown in this report, it is unnecessary to incur a medial breast scar, which may at times be unsightly. As for the pedicle choice in mastopexy after massive weight loss, it is the author's opinion that medial pedicle seems to provide the flexibility in shaping the breast, even when a long transposition of NAC is needed, in contradistinction to a superior pedicle that would require folding of the flap with possible vascularity compromise.…”

Dermal Suspension and Parenchymal Breast Reshaping after Massive Weight Loss

“…Many procedures exist to treat the deflated breast after massive weight loss, including short scar mastopexy techniques and combined augmentation/ mastopexy. [1][2][3][4][5][6][7] However, achieving long-lasting results with these techniques in the setting of severe skin laxity can be challenging. The goals for mastopexy after massive weight loss include obtaining a youthful, well-contoured breast with upper pole fullness, proper nipple positioning, and a long-lasting aesthetic result.…”