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

Abstract

Breast contouring surgery after massive weight loss is challenging because of unfavorable features such as inelastic skin, volume depletion, loss of upper pole fullness, and significant ptosis. An approach is presented for autoaugmentation using a lateral intercostal artery perforator (LICAP) flap secured with a pectoralis muscle sling, along with mastopexy based on vertical scar principles. In a total of 8 patients (average age: 39.3 years, range: 29-57; average body mass index: 30.8 kg/m2, range: 25.7-39.1) with breast ptosis and volume depletion after a mean weight loss of 121.9 pounds (range: 80-210), LICAP flap (n = 16) was used with turnover flap design to increase breast volume under a pectoralis muscle sling. Vertical design mastopexy (n = 16) was achieved at the same time, resulting in an L-shaped final scar. All the patients were followed for at least 1 year after the surgery. Patient satisfaction was high at long-term follow-up (average: 16.8 months, range: 12-24), with stable and pleasing breast shape and a mean patient ranking for aesthetic outcome of 4.2 (of 5). None of the patients developed any flap necrosis or fat necrosis. An alternative approach is described for the combined treatment of breast ptosis and volume loss in the bariatric patient, with promising long-term results. The muscle sling seems to help prevent tissue descent, without evidence of pseudoptosis at long term. It is shown that vertical scar techniques can be successfully used even in bariatric patients.

Extended Fasciocutaneous Flaps for Autologous Augmentation Mastopexy With Upper Body Lift After Massive Weight Loss

“…6 Extended fasciocutaneous flaps may be designed, taking advantage of large intercostal perforators often present in MWL patients, to perform autologous mastopexy augmentation safely and reliably while simultaneously improving circumferential upper body contour. [5][6][7] Lateral intercostal artery perforators are based on the costal segment, and can facilitate design of a shorter flap for use in mastopexy. Both options minimize the donor-site morbidity attached to myocutaneous flap reconstructions requiring sacrifice of underlying muscles such as the latissimus dorsi.…”

Superior Pedicle Mammaplasty without Parenchymal Incisions after Massive Weight Loss

“…This is an inferior pedicle technique used primarily for aesthetic purposes. Subsequently to Ribeiro's technique, other no-implant breast reshaping techniques were described, but all of them determined incisions to the breast parenchyma (13,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) (Table 6). In addition, several articles have claimed to increase upper pole fullness or breast projection without an implant.…”

The Extended Superomedial Pedicle: Advancing Mammaplasty Techniques

“…The superomedial technique also allows plication of the medial and lateral pillars with the benefits of a vertical mammoplasty technique [12]. Kim et al recently showed minimal complications and high patient satisfaction using a superior pedicle autoaugmentationmastopexy technique [13]. Since this technique does not bring in tissue from outside the breast, patients who have insufficient breast volume and still desire upper pole fullness will require implant augmentation or alternative techniques.…”

“…The superomedial technique has been shown to be both safe and reliable with an acceptable complication rate [3,13]. Appropriate flap design with maximizing blood flow will limit the incidence of complications such as tip necrosis.…”