Improvement of Superomedial Breast Reduction and Mastopexy with a New “Hammock” Flap

Abstract

Oncoplastic breast reduction shares similar aims and principles with esthetic surgery. Superomedial breast reduction provides harmony, symmetry, and satisfactory lower pole projection, but long-term outcomes are not consistently good. We describe our experience with a new hammock-shaped flap, which was combined with superomedial pedicle breast reduction to improve long-term outcomes by enhancing pedicle support and preventing ptosis recurrence. METHODS: From January 2017 to June 2018, 10 patients underwent unilateral breast reduction (n = 7) or bilateral esthetic reduction (n = 3) by a novel approach combining a superomedial pedicle and a perforator-based inferior advancement flap. The flap is based on the inframammary fold (IMF) and fixed to the pectoralis major fascia and the pedicle like a hammock. Preoperative and postoperative (1, 3, 6, 12, and 18 months) measurements included sternal notch-to-superior areola border length, nipple-to-IMF length, and lower pole convexity. Patients rated their satisfaction with breast shape, size, nipple-areola complex position, and lower pole projection at 12 months using a condensed form of the BREAST-Q questionnaire. RESULTS: Esthetic outcomes at 12 and 18 months were good in all patients. There were no complications. Postoperative measurements were stable throughout follow-up. The BREAST-Q scores indicated that most patients were satisfied or very satisfied with their breast(s). CONCLUSIONS: This preliminary series demonstrates that the hammock flap, which is performed with autologous tissue, allows changing IMF position, it is safe, effective, and provides improved pedicle fixation and positioning. This technical refinement seems to afford good long-term outcomes in patients undergoing superomedial pedicle breast reduction and mastopexy.