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• W2323195793 abstract "Sir: I read with interest the article entitled “The Lower Island Flap Transposition (LIFT) Technique for Control of the Upper Pole in Circumvertical Mastopexy” by Drs. Hammond and O’Connor.1 I respect Dr. Hammond’s experience; I modified my reduction mammoplasty technique and round block periareolar closure based on his work. His techniques have really improved my results. This lower island flap transposition innovation, however, raises two concerns: Is there real improvement shown in photographs (does the end justify the means)? Is there greater relative benefit versus risk of harm to breast tissue and to the patient over time? With regard to benefit versus risk, the central inferior deepithelialized flap is freed from the rest of the gland; then, the lower island flap is sutured at the upper radius of the mound. This divides the anterior pectoral perforators from the residual mound, limiting the pillar blood supply to respective perforators, placing the thinner platform of the nipple-areola complex farther from the pillar blood supply. Isolating the lower island flap may increase ischemia to the nipple-areola complex. As a result, fat necrosis could develop in the buried lower island flap or in the pillars. Although most radiologists can discern the difference between cancerous versus fat necrosis calcifications, it seems imprudent to increase the risk of calcifications by creation and burial of such a lower island flap.2 Also, there is the responsibility of the patient and physician to follow the calcifications, with increased radiation exposure for studies. Why should we do this? We should have a randomized clinical trial of lower island flap transposition versus standard mastopexy techniques with a large number of patients followed more than 2 years, to determine the incidence of nipple-areola complex ischemia/necrosis, calcifications, and real, lasting positive upper pole improvement. With regard to real improvement of the upper pole, on the patient photographs in Figures 1 and 4, the most concave area of the breast is at the level of the inferior end of the pectoral fold, which appears 2 to 3 cm above the superior radius of the mound (nipple-to-base perimeter). The gland indeed has lost upper pole (or upper half mound) fullness, with the maximum loss superior to the upper perimeter of the gland, some 2 to 3 cm above the base diameter at the 12-o’clock position (most visible on lateral photographs). The lower island flap has filled to a small degree the upper base radius; it has not changed the upper concavity at the level of the anterior axillary fold. This very area is the toughest to refill after involution in aesthetic and reconstructive cases. I would not wish residents to think that the lower island flap placed under the central gland solves the problem of lost upper pole concavity, or to attempt this technique before it is proven effective—over years—in peer-reviewed journals. I encourage Dr. Hammond and other plastic surgeons to continue their search for lasting surgical techniques to fill the upper breast concavity, and to publish their results. Just because I do not think this buried lower island flap technique is for me (or new residents), do not “stop.” There will be another, better solution just around the corner—Dennis, you just have not uncovered it yet! Please keep going. DISCLOSURE The author has no financial interest to declare in relation to the content of this communication. D. Miller Wise, M.D. Department of Plastic Surgery The Permanente Medical Group 1425 South Main Street Walnut Creek, Calif. 94596 [email protected]" @default.
• W2323195793 created "2016-06-24" @default.
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• W2323195793 date "2015-04-01" @default.
• W2323195793 modified "2023-09-25" @default.
• W2323195793 title "The Lower Island Flap Transposition (LIFT) Technique for Control of the Upper Pole in Circumvertical Mastopexy" @default.
• W2323195793 doi "https://doi.org/10.1097/prs.0000000000001029" @default.
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