Suspension by breasts-

The procedure, although requiring a longer operating time and resulting in a significant scar, produces a pleasing breast contour, is safe and reliable, and has a low complication rate. Severe volume deflation with distortion of shape and inelastic skin result in deformities that are difficult to correct. Here, I describe a safe and reproducible breast-shaping technique, using the principles of dermal suspension and controlled parenchymal reshaping, which yields a youthful breast shape in patients with massive weight loss. Four features, manifested in various combinations, characterize breast shape in patients who have lost significant weight: 1 significant and sometimes asymmetric breast volume loss, with a deflated and flattened appearance; 2 dramatic loss of skin elasticity, as well as tremendous skin excess relative to the parenchymal volume; 3 nipple position that is overly-medial; and 4 a prominent axillary skin fold that blurs the border between the lateral breast and chest wall. In the face of these deformities, the surgical goals for breast reshaping include using all available breast tissue and recruiting additional autologous tissue as needed , addressing the nipple position, restoring superior pole projection, reshaping the skin envelope without relying on it for support, eliminating the lateral skin roll, and creating a breast shape with discrete lateral curvature.

Suspension by breasts

Suspension by breasts

Suspension by breasts

Suspension by breasts

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Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. An age, implant volume, ptosis degree matched historical cohort was used as control no gland suspension.

All subjects were followed longer than 1 year postoperatively. Outcome analysis included reintervention rates and objective geodesic changes using objective morphometric parameters as measured by 3D scan analysis.

When gland suspension was compared with ptosis equivalent control groups, gland suspension was associated to a higher upper pole volume increment and higher pole convexity and lower pole morphometry. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. The work cannot be changed in any way or used commercially without permission from the journal.

The surgical adjustments allow for optimal control and predictability while reducing surgical aggressiveness by minimizing mastopexy-related scars. This reduction of scarring satisfies an increasing number of ptotic breast patients for whom such scars are not acceptable. It is evident that such equilibrium is significantly challenged in ptotic breasts where both partial retropectoral and retromammary dissection are indeed needed, yet some component of parenchymal elevation is required.

Gland suspension confers the control to elevate the soft-tissue envelope and reach harmonic implant-parenchyma relationship. The present retrospective control and prospective experimental data collection was submitted by the senior authors and approved by the Ethics Committee at Colic Hospital, Belgrade, Serbia on December 1, Limited personal data were collected including age, preoperative photographic condition, implant type and size, complications, and reinterventions for both control and experimental groups.

In 4 patients, we also performed 3-D morphometric studies evaluating the shortest spherical N-IMF distance before, and 3 months after, the procedure. The patient is marked in a standing position and suspension points are determined according to the following surgical requirements:. If upper pole fullness is requested by the patient, the location of the suspension suture is determined on the breast meridian at the point at which the glandular tissue would best conform to a spherical lower pole.

To determine this point, a pinch, applied at the superior areolar border, is used to pull the skin envelope superiorly, thereby unfolding the infra-mammary fold until the breast lower pole separates from the chest wall and the inframmary fold is fully open.

The position of the nipple is then marked on the upper pole skin Fig. If lateral fullness is requested by the patient, then an accessory suture can be marked at the same height yet displaced over the lateral edge of the pectoralis muscle. Under general anesthesia, the patient is positioned in supine decubitus with their arms by their side.

A 5-cm curved incision is made along the infra-mammary fold, and then the pectoralis muscle inferolateral origin is readily identifiable. Dissection proceeds superiorly over the prepectoral plane and extends over the entire breast footprint. The inferior aspect of the pectoralis major muscle lateral border is then elevated to access the areolar retro-pectoral plane. Medial and lateral muscle origins are attenuated using an electro-cautery with an extended-tip and an under lighted retractor, generating a slight superior muscle retraction.

The suture is placed as illustrated in Figure 1. Now the retracted muscle can be approximated via the suspension point. Similarly, a second accessory suture can be applied to join the glandular tissue to the retracted lateral pectoralis edge see video, Supplemental Digital Content 1 , which displays the gland suspension operative technique.

Scar revision, capsular contracture, hematoma, seroma, and infection were all considered to be complications and were not reinterventions. Continuous variables such as age and implant size were analyzed for both groups using analysis of variance ANOVA.

In our study, when ptosis degrees were segregated we observed frequencies of 2 and 1, which may indicate expected frequencies that could be below 5. Continuous and discrete variables between control and experimental cohorts were evaluated for statistical significance.

Ptotic hypomastia diagnoses at our institution display a steady increase since without significant changes between historical and experimental cohorts. Historical versus experimental samples are specimens that are statistically matched for age, implant size, and ptosis degree Table 1.

The overall reintervention rate was The overall reintervention rate decreases upon gland suspension implementation to The difference observed here is statistically significant via chi-square goodness of fit test evaluation Table 2.

The ptosis-degree—related reintervention rate decreases with respect to historical controls when gland suspension was implemented, except for ptosis grade III Table 2 and Fig. No statistical differences were observed in the groups based on changes in age, implant size or implant type, specifically when glandular suspension and control groups are segregated as reintervened versus nonreintervened subjects.

To determine if age, implant size, or implant type were statistically related to reintervention, between both control and experimental cohorts, the cohorts were pooled and a multiple ANOVA study was conducted to identify possible interactions.

The continuous variables were not found to be statistically dependent on reintervention. Reintervention indications have been tabulated in Table 3. Complication frequencies were statistically similar and not significant for both experimental and control cohorts, which included scar revision, capsular contracture, hematoma, seroma, and infection Table 4.

However, these measurements were done in only 4 patients. As the sample was too small for statistical analysis we consider our observations anecdotal and nonconclusive. Therefore, those patients benefit from glandular suspension. The concept of suspending or quilting sutures has been advocated in different anatomical areas face, abdomen, back, pubis, breast. We attempted to collapse the plane, prevent seroma formation, and confine fibrosis to ultimately determine the long-term relative position among different tissues.

Level 3 dual plane technique involves 2 relevant steps, which are prepectoral dissection and pectoral insertion attenuation. The addition of a suspension suture technique to the dual plane routine actually perches the glandular tissue in the position at which the lower pole skin envelope is stretched. Our observations during the follow-up period support the concept that fixing breast tissue on the upper pole allows progressive bottoming-out of the implant.

As edema subsides, the soft-tissue envelope releases peri-prosthetic pressure and the gravitational distribution of silicone contributes to efficiently fill the lower pole Fig. The gland suspension maneuver in addition to dual plane breast augmentation appears to avoid subsequent mastopexy procedures, except for high ptosis grade candidates.

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Separate multiple e-mails with a ;. Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Article as PDF 1. Published online 19 November Received for publication February 18, ; accepted September 24, Back to Top Article Outline.

Table 1. Table 2. Table 3. Table 4. Video Graphic 1. Kirwan L. A classification and algorithm for treatment of breast ptosis. Aesthet Surg J. Cited Here Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg.

Gryskiewicz J. Swanson E. Dual plane versus subpectoral breast augmentation: is there a difference? Aesthetic Plast Surg.

Reproducible volume restoration and efficient long-term volume retention after point-of-care standardized cell-enhanced fat grafting in breast surgery. Plast Reconstr Surg Glob Open. The subtleties of success in simultaneous augmentation-mastopexy. Mons pubis ptosis: classification and strategy for treatment.

Face lifting in the massive weight loss patient: modifications of our technique for this population. The use of quilting suture in abdominoplasty does not require aspiratory drainage for prevention of seroma. Use of abdominal quilting sutures for seroma prevention in TRAM flap reconstruction: a prospective, controlled trial. Ann Plast Surg.

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Suspension by breasts

Suspension by breasts

Suspension by breasts

Suspension by breasts

Suspension by breasts

Suspension by breasts.

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A consecutive group of 73 patients presenting ptotic hypomastia were jointly categorized and underwent implant placement, dual plane dissection level 3, and gland suspension maneuver. An age, implant volume, ptosis degree matched historical cohort was used as control no gland suspension. All subjects were followed longer than 1 year postoperatively. Outcome analysis included reintervention rates and objective geodesic changes using objective morphometric parameters as measured by 3D scan analysis.

When experimental and control cohorts were segregated according to ptosis grade, gland suspension maneuver was associated to a lower frequency of subsequent ancillary mastopexy procedures reintervention rate for all ptosis grades except ptosis grade III.

When gland suspension was compared with ptosis equivalent control groups, gland suspension was associated to a higher upper pole volume increment and higher pole convexity and lower pole morphometry. The addition of gland suspension to implant dual plane breast augmentation appears to be a clinically beneficial maneuver with measurable contour impact and appears to avoid subsequent mastopexy procedures, except for high ptosis grade candidates.

The surgical adjustments allow for optimal control and predictability while reducing surgical aggressiveness by minimizing mastopexy-related scars. This reduction of scarring satisfies an increasing number of ptotic breast patients for whom such scars are not acceptable. It is evident that such equilibrium is significantly challenged in ptotic breasts where both partial retropectoral and retromammary dissection are indeed needed, yet some component of parenchymal elevation is required.

Gland suspension confers the control to elevate the soft-tissue envelope and reach harmonic implant-parenchyma relationship. The present retrospective control and prospective experimental data collection was submitted by the senior authors and approved by the Ethics Committee at Colic Hospital, Belgrade, Serbia on December 1, Limited personal data were collected including age, preoperative photographic condition, implant type and size, complications, and reinterventions for both control and experimental groups.

In 4 patients, we also performed 3-D morphometric studies evaluating the shortest spherical N-IMF distance before, and 3 months after, the procedure. The patient is marked in a standing position and suspension points are determined according to the following surgical requirements:.

If upper pole fullness is requested by the patient, the location of the suspension suture is determined on the breast meridian at the point at which the glandular tissue would best conform to a spherical lower pole.

To determine this point, a pinch, applied at the superior areolar border, is used to pull the skin envelope superiorly, thereby unfolding the infra-mammary fold until the breast lower pole separates from the chest wall and the inframmary fold is fully open. The position of the nipple is then marked on the upper pole skin Fig. Placement of gland suspension suture. The index finger is placed over the preoperative marking that now indicates the height pectoralis muscle blue dot where the deep glandular surface must be suspended to the anterior pectoralis surface.

If lateral fullness is requested by the patient, then an accessory suture can be marked at the same height yet displaced over the lateral edge of the pectoralis muscle. Under general anesthesia, the patient is positioned in supine decubitus with their arms by their side. A 5-cm curved incision is made along the infra-mammary fold, and then the pectoralis muscle inferolateral origin is readily identifiable. Dissection proceeds superiorly over the prepectoral plane and extends over the entire breast footprint.

The inferior aspect of the pectoralis major muscle lateral border is then elevated to access the areolar retro-pectoral plane. Medial and lateral muscle origins are attenuated using an electro-cautery with an extended-tip and an under lighted retractor, generating a slight superior muscle retraction.

Now the retracted muscle can be approximated via the suspension point. Similarly, a second accessory suture can be applied to join the glandular tissue to the retracted lateral pectoralis edge see video, Supplemental Digital Content 1 , which displays the gland suspension operative technique. Scar revision, capsular contracture, hematoma, seroma, and infection were all considered to be complications and were not reinterventions.

Continuous variables such as age and implant size were analyzed for both groups using analysis of variance ANOVA. In our study, when ptosis degrees were segregated we observed frequencies of 2 and 1, which may indicate expected frequencies that could be below 5. Continuous and discrete variables between control and experimental cohorts were evaluated for statistical significance. Ptotic hypomastia diagnoses at our institution display a steady increase since without significant changes between historical and experimental cohorts.

The overall reintervention rate was The overall reintervention rate decreases upon gland suspension implementation to Reintervention rate distribution over ptosis grade categorized by patients in experimental vs.

Reinterventions rates are lower in all ptosis grades except for ptosis III. No statistical differences were observed in the groups based on changes in age, implant size or implant type, specifically when glandular suspension and control groups are segregated as reintervened versus nonreintervened subjects.

To determine if age, implant size, or implant type were statistically related to reintervention, between both control and experimental cohorts, the cohorts were pooled and a multiple ANOVA study was conducted to identify possible interactions. The continuous variables were not found to be statistically dependent on reintervention. However, these measurements were done in only 4 patients.

As the sample was too small for statistical analysis we consider our observations anecdotal and nonconclusive. Morphometric changes of lower pole over time. The same distance in the early postoperative period is Note slight increase in the long-term follow-up as the breast bottoms out in gland suspension patients.

Therefore, those patients benefit from glandular suspension. The concept of suspending or quilting sutures has been advocated in different anatomical areas face, abdomen, back, pubis, breast.

We attempted to collapse the plane, prevent seroma formation, and confine fibrosis to ultimately determine the long-term relative position among different tissues. Patient year-old, ptosis grade II. Frontal view at preoperative A , and postoperative at 1 year B. Lateral view at preoperative C , and postoperative at 1 year D. Level 3 dual plane technique involves 2 relevant steps, which are prepectoral dissection and pectoral insertion attenuation.

The addition of a suspension suture technique to the dual plane routine actually perches the glandular tissue in the position at which the lower pole skin envelope is stretched.

Our observations during the follow-up period support the concept that fixing breast tissue on the upper pole allows progressive bottoming-out of the implant. As edema subsides, the soft-tissue envelope releases peri-prosthetic pressure and the gravitational distribution of silicone contributes to efficiently fill the lower pole Fig.

See video, Supplemental Digital Content 1, which displays the gland suspension operative technique. The gland suspension maneuver in addition to dual plane breast augmentation appears to avoid subsequent mastopexy procedures, except for high ptosis grade candidates.

Published online 19 November Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. National Center for Biotechnology Information , U.

Plast Reconstr Surg Glob Open. Published online Nov Find articles by Ramon Llull. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Received Feb 18; Accepted Sep Published by Wolters Kluwer Health, Inc. The work cannot be changed in any way or used commercially without permission from the journal. This article has been cited by other articles in PMC. Methods: A consecutive group of 73 patients presenting ptotic hypomastia were jointly categorized and underwent implant placement, dual plane dissection level 3, and gland suspension maneuver.

Conclusion: The addition of gland suspension to implant dual plane breast augmentation appears to be a clinically beneficial maneuver with measurable contour impact and appears to avoid subsequent mastopexy procedures, except for high ptosis grade candidates.

The specific aims of this study were to: 1 Quantify the overall reintervention rate following dual plane implant breast augmentation alone in a historical control cohort versus dual plane implant breast augmentation with gland suspension experimental group. Table 1. Open in a separate window. SURGICAL TECHNIQUE Preoperative Markings The patient is marked in a standing position and suspension points are determined according to the following surgical requirements: If upper pole fullness is requested by the patient, the location of the suspension suture is determined on the breast meridian at the point at which the glandular tissue would best conform to a spherical lower pole.

Description of Intervention Under general anesthesia, the patient is positioned in supine decubitus with their arms by their side. Table 2. Table 3. Table 4. Video Graphic 1.

Supplementary Material. Download video file. Footnotes Published online 19 November Kirwan L. A classification and algorithm for treatment of breast ptosis.

Aesthet Surg J. Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types.

Plast Reconstr Surg. Gryskiewicz J. Swanson E. Dual plane versus subpectoral breast augmentation: is there a difference? Aesthetic Plast Surg. Reproducible volume restoration and efficient long-term volume retention after point-of-care standardized cell-enhanced fat grafting in breast surgery. The subtleties of success in simultaneous augmentation-mastopexy. El-Khatib Mons pubis ptosis: classification and strategy for treatment.

Suspension by breasts

Suspension by breasts