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. 2025 Sep 20:46:551-558.
doi: 10.1016/j.jpra.2025.09.008. eCollection 2025 Dec.

Beyond the T-junction: Reinforce strategic sites in superomedial pedicle mammoplasties using a dual dermal flap technique

Clelia Dogny  1 , Matteo Scampa  1 , Tom Membrez  2 , Giulia Frigerio  1 , Patricia E Engels  1 , Daniel Felix Kalbermatten  1 , Dominik André-Levigne  1
Affiliations

Beyond the T-junction: Reinforce strategic sites in superomedial pedicle mammoplasties using a dual dermal flap technique

Clelia Dogny et al. JPRAS Open. .

Abstract

Introduction: Breast reduction using superior or superomedial pedicles provides favorable long-term aesthetic outcomes, particularly regarding breast shape and projection. However, wound dehiscence remains a concern at the T-junction and the vertical-areolar junction, with reported rates ranging from 4 % to 20 %, contributing to a higher postoperative burden, suboptimal aesthetic results, and increased healthcare costs. The development of preventive techniques is a key aspect as scar quality is considered one of the most important factors by patients. Only a few techniques in the literature describe using dermal flaps at high-tension sites to reduce tension and provide additional support and blood supply.

Materials and methods: : A literature review was performed via PubMed using the terms "dermal flap," "dermo-glandular flaps," "de-epithelialized flaps," "breast reduction," "mammoplasty," "scar dehiscence," and "scar complication." We then present a modification of the superomedial pedicle technique that includes two small semi-circular de-epithelialized dermal flaps placed at the T-junction and the vertical-areolar junction. These aim to offload tension and reinforce vascular support at high-risk sites.

Results: Three studies described dermal flap use at the T-junction, reporting a reduction in scar-related complications from 4.3 % to 1.4-2.9 %. However, none addressed the vertical-areolar junction. Our technique is, to our knowledge, the first to reinforce both areas simultaneously.

Conclusion: We propose a simple modification to the standard technique using small dermal flaps at strategic points to reinforce T-inverted scars for superomedial and superior pedicles. Building on previous studies, This approach aims to enhance healing and reduce complications without increasing operative time.

Keywords: Breast reduction; Dermal flap; Reduction mammoplasty; Superior pedicle; Superomedial pedicle; Wound dehiscence.

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Conflict of interest statement

The authors declare no conflicts of interest and received no funding for this work. Written informed consent was obtained from all patients for publication of their data/images.

Figures

Figure 1:
Figure 1
Simplified technique of the Plaza et al. technique.
Figure 2:
Figure 2
Simplified technique of the Domergue et al. technique.
Figure 3:
Figure 3
Simplified drawing of the Kalil et al. technique.
Figure 4:
Figure 4
Preoperative markings.
Figure 5:
Figure 5
Preoperative markings, simplified version.
Figure 6:
Figure 6
Flap in the supero-external extremity of the vertical incision.
Figure 7
Figure 7
Post-operative results.
Figure 8:
Figure 8
Enlarged inferior dermal flap for mastopexy.
See this image and copyright information in PMC

References

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