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. 2021 Oct;10(10):2925-2934.
doi: 10.21037/gs-21-561.

Inverted-T pattern reduction mammoplasty in bilateral breast ptosis: cosmetic and oncological outcomes

Huayu Hu  1   2 , Qingyu Guan  1   2 , Yiqiong Zheng  2 , Yuting Zhong  2   3 , Ningning Min  1   2 , Yufan Wei  1   2 , Rui Geng  2   3 , Chenyan Hong  1   2 , Jie Li  2 , Yanjun Zhang  2 , Xiru Li  2
Affiliations

Inverted-T pattern reduction mammoplasty in bilateral breast ptosis: cosmetic and oncological outcomes

Huayu Hu et al. Gland Surg. 2021 Oct.

Abstract

Background: Breast ptosis is directly caused by Cooper's ligament laxity, with the decline of nipple areola complex (NAC) and mammary parenchyma. Breast cancer with ptosis is always a knotty problem that can hardly be repaired by classic breast conservation surgery (BCS) ending up with a pleasing appearance. We analyzed our 12 years' experience of performing inverted-T pattern techniques to treat bilateral breast ptosis, with or without breast cancer.

Methods: One hundred forty-eight breasts in 74 patients undergoing inverted-T pattern reduction mammoplasty were included in this study. Information about patients' clinical and surgical characteristics, complications, NAC sensitivity, cosmetic and oncological outcomes were collected and retrospectively analyzed.

Results: In the cohort of 57 patients with pure breast ptosis, the mean body mass index (BMI) was 25.2 kg/m2, and the mean weight of resected tissue from the left and right breast reductions were 744.9 and 756.7 g. In the cohort of 17 patients diagnosed as breast cancer with ptosis, the mean BMI was 25.1 kg/m2, and the mean weight of resected tissue were 504.1 g for left and 535.6 g for right side. The majority of repairs were performed for tumors located in the upper outer (58.8%), mostly with inferior or superomedial pedicles (90%). All the upper inner tumors were repaired with inferior pedicles. Minor complications such as seroma (8.1%), NAC epidermolysis (8.1%), delayed wound healing (4.1%) were detected postoperatively. Partial NAC necrosis occurred in one patient (1.4%). 82.4% of all the patients rated "very satisfied" or "satisfied" as the final cosmetic outcomes. NAC sensitivity was "very high" and "high" in 82.4% patients. No local occurrence, distant metastasis and mortality occurred in tumor patients.

Conclusions: The inverted-T pattern reduction mammoplasty is a reliable technique to treat bilateral breast ptosis with a low complication rate. For cases with breast cancer, this technique can achieve both satisfying cosmetic outcomes and oncological safety.

Keywords: Breast ptosis; breast cancer; invert-T pattern; reduction mammoplasty.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/gs-21-561). XL serves as an Editor-in-Chief of Gland Surgery from May 2017 to April 2022. YZ serves as an unpaid Associate Editor of Gland Surgery from March 2018 to February 2023. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Surgical technique and markings. (A) Preoperative skin markings depict a Wise pattern. Details of drawing are described in Methods. (B-E) Design of inferior, superior, superomedial and vertical bipedicle.
Figure 2
Figure 2
Deepithelialization according to preoperative skin markings and dissection of surrounding skin (A-D). The inferior pedicle was incised with a scalpel down to pectoralis major fascia. The excess breast tissue and subcutaneous fat was resected en bloc with the superior pole.
Figure 3
Figure 3
A 32-year-old woman with an invasive ductal carcinoma located in upper outer quadrant as well as a grade I (Regnault method) breast ptosis. An inverted-T pattern breast reduction using an inferior pedicle was performed. Preoperative (A) and 4 weeks postoperative photos (B) were illustrated. The patient rated “very satisfied” for the appearance. This image is published with the patient’s consent.
Figure 4
Figure 4
A 33-year-old woman, with pure ptosis grade II by Regnault, received a superomedial-pedicle reduction mammoplasty. Preoperative (A) and 4 weeks postoperative photos (B,C) were shown. The patient was “very satisfied” with the breast shape. This image is published with the patient’s consent.
See this image and copyright information in PMC

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