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• W2086235451 abstract "Sir: We reported the dermal bra technique for reduction mammaplasty and correction of ptosis in 2003.1 The W-shaped mammary gland resection technique has been applied clinically as a modification of this technique since 2001, based on the following anatomical features: the blood supply of the inferior gland is more sufficient than the superior gland,2 and the anterior and lateral branches of intercostal nerves run anteroinferiorly. A W-shaped glandular resection was performed on the upper part of the breast. The starting point was located on the sternum edge of the fourth intercostal space. The cutting line ran inferolaterally, reversed superiorly at the level of the nipple, and then ran along the edge of the dermal bra. The lateral lowest point was at the level of the nipple. The endpoint was at the intersection of the anterior axillary line and the fourth intercostal space. In very large breasts, the medial lowest point might shift inferiorly, and care should be taken to avoid injuring the deep branches of the lateral subcutaneous branches of the fourth intercostal nerve. After resection of the gland was finished, the remaining gland presented three peaks (A, B, and C glandular flaps from medial to lateral). The B and C flaps were rotated medially. The B flap was sutured to the A flap, and the C flap was sutured to B. Thus, the base of the breast was reduced and a projective breast mound was created. If the dermal bra was not sufficient to cover the remaining gland, a knitted polypropylene mesh could be used as a substitute for the dermal bra as described by Goes. We studied 38 patients (76 breasts) ranging in age from 16 to 55 years, whose preoperative breast volume ranged from 686 to 1820 mm3 and whose weight of the gland excised ranged from 348 to 1475 g. The short-term complications included postponed wound healing in three breasts, fat necrosis in two breasts, subcutaneous fluid accumulation in two breasts, and no response to pressure of the nipple-areola and no sensitivity to touch in one breast. Twenty-seven patients were followed up from 6 to 24 months, and 25 patients acquired satisfactory appearance. Only one patient presented a slightly wider scar around the areola and mild asymmetry. The secondary treatment was performed 1 year later and a satisfactory result was acquired. One patient who had immediately sensed a decrease of nipple-areola sensation postoperatively complained of a permanent loss of the sensation of the right nipple-areola (Fig. 1).Fig. 1.: Preoperative (left) and 1-month postoperative (right) views of a woman who underwent W-shaped mammary gland resection reduction mammaplasty.The modifications in this technique include the following. The B and C flaps were revolved medially and superiorly, diminished the mammary base, increased the degree of mammary protrusion, and avoided the result of flat breast. The medial part of the W shape could extend inferiorly to increase the amount of removed mammary tissue without injuring the lateral cutaneous branch. Mammaplasty was not completely dependent on the dermal bra; it was performed before fixation of the dermal bra, diminishing the possibility of secondary ptosis. To avoid injuring lateral cutaneous branches of the fourth intercostal nerve, resection of the lateral group of the glandular tissue should not surpass the 4-o’clock position for the left breast and the 8-o’clock position for the right breast. Jiaming Sun, M.D. Ke Guo Weiwei Li, M.D. Plastic Surgery Division Wuhan Union Hospital Affiliated with Tongji Medical College Huazhong University of Science and Technology Wuhan Qun Qiao, M.D. Plastic Surgery Division Beijing Union Hospital Affiliated with China Union Medical University Beijing, China DISCLOSURE None of the authors has a financial interest in anything related to the publication of this article." @default.
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• W2086235451 date "2008-11-01" @default.
• W2086235451 modified "2023-10-05" @default.
• W2086235451 title "W-Shaped Mammary Gland Resection for Reduction Mammaplasty" @default.
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• W2086235451 doi "https://doi.org/10.1097/prs.0b013e31818823b1" @default.
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