Managing Complications in Vertical Mammaplasty

In this paper, we describe our experience with the Lejour vertical scar mammaplasty from its description throughout 25 years of practice. Our work aims to focus on reducing vertical scar mammaplasty complications by examining results, studying how to avoid unfavorable consequences, and providing new tips to improve the technique and shorten its learning curve. Complications can be related to patient characteristics and habits, but adhering to a strict surgical protocol is essential to limit other factors. The importance of recognizing and being able to manage the complications is mandatory to have a successful final result and a satisfied patient.

Key points

  • A precise examination of patient is necessary for the choice of the surgical technique.

  • Medical history and patient habits are important prognostic factors of any complications.

  • Mastering a surgical technique and examining the results of its application is the starting point to improve the technique and reduce complications.

Introduction

In 1989, Professor Lejour introduced a new technique of vertical scar breast reduction, which immediately gained popularity and nowadays represents a standard technique worldwide. The most innovative aspect of her technique was the vertical-only scar, which had a double purpose: a more aesthetic outcome, thanks to the reduced scar length, and fewer scar-related complications.

In our center, where Professor Lejour is the former chief of the Plastic and Reconstructive Surgery Department, we immediately adopted the technique and over the years we have modified it by reducing vertical pillars skin undermining, avoiding systematic liposuction, using a superomedial pedicle in large breasts, and adding a horizontal skin resection at the end of the procedure if necessary.

Recently, we analyzed all breast reduction procedures performed between 1991 and 2013 in our center, and we were able to evaluate complications and their management, and we have improved our technique to make it reproducible for all trainees. We share herein our experience and focus on the management of complications of the vertical scar mammaplasty.

Introduction

In 1989, Professor Lejour introduced a new technique of vertical scar breast reduction, which immediately gained popularity and nowadays represents a standard technique worldwide. The most innovative aspect of her technique was the vertical-only scar, which had a double purpose: a more aesthetic outcome, thanks to the reduced scar length, and fewer scar-related complications.

In our center, where Professor Lejour is the former chief of the Plastic and Reconstructive Surgery Department, we immediately adopted the technique and over the years we have modified it by reducing vertical pillars skin undermining, avoiding systematic liposuction, using a superomedial pedicle in large breasts, and adding a horizontal skin resection at the end of the procedure if necessary.

Recently, we analyzed all breast reduction procedures performed between 1991 and 2013 in our center, and we were able to evaluate complications and their management, and we have improved our technique to make it reproducible for all trainees. We share herein our experience and focus on the management of complications of the vertical scar mammaplasty.

Patients and technique selection

Breast reduction has become a very common surgical procedure. It represents nowadays the most performed operation in our institution among general plastic surgery procedures. A good clinical history and physical examination are the key points to a successful breast reduction. Anamnesis has its critical points: history of smoking, diabetes, and a high body mass index (BMI) being the main negative factors affecting wound healing. Age is an important factor in choosing the surgical technique, as well as previous pregnancies. In the vast majority of cases, we use a superior areolar pedicle and vertical scar technique. When faced with a larger breast with high BMI and severe ptosis, we are moving to a superomedial areolar pedicle and a short submammary scar or nipple–areola complex graft.

The modified Lejour technique

The Lejour technique is based on a superior pedicle, on which the blood supply of the areola relies and a central glandular resection, with central suturing of the medial and lateral pillars. The skin is undermined on the vertical scar and the excess skin at the bottom of the scar is sutured by rippling the skin to reduce vertical length. In addition, liposuction has been integrated into the procedure, to better shape the breast, performed for the first time in this kind of surgery.

Since its original description, the technique of superior pedicle vertical scar mammaplasty has been modified, allowing plastic surgeons to benefit from the advantages of this technique while avoiding some associated unfavorable results. The modifications that were brought to the technique were essentially a reduction of the skin undermining, limiting or avoiding liposuction, avoiding tight glandular stitches, and adding a small horizontal scar for very large breasts at the end of the operation.

Technique, materials, and methods

We recently carried on a review on the evolution of the technique, complications and outcomes comparing 3 periods: 1991 to 1996, 1996 to 2007 and 2008 to 2013. This cohort includes a series of 1030 consecutive patients who underwent operations at the University Hospital Brugmann, Brussels. The study consisted of a review of the medical charts. The modified Lejour technique with only a vertical scar was used in 57% of our patients and a short horizontal scar was added in 43% of the patients operated between 2008 and 2013.

Patient characteristics (age and BMI) and factors possibly associated with an increased risk of postoperative complications such as diabetes and smoking, were recorded. The weight of the resection for each breast (in grams), the elevation of the nipple–areola complex, and the experience of the surgeon (senior: graduated plastic surgeon, junior: surgeon in training) were recorded.

During the operation, all patients were given a dose of antibiotics (amoxicillin and clavulanic acid or cephazolin), which was continued for 24 hours postoperatively. A suction drain was inserted through the scar or through a separated incision in the anterior axillary line. The wound dressing was changed 48 hours after the surgery and the drains were removed when it collected less than 30 mL/d. After leaving the hospital, all patients were seen in consultation every week during the first month and then after 3, 6, 12, 24, and 36 months. The stitches were removed at 3 weeks postoperatively.

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Nov 21, 2017 | Posted by in Dental Materials | Comments Off on Managing Complications in Vertical Mammaplasty
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