3 Recognizing the skin folds below and lateral to the ptotic breasts, his group aimed to build up the breast, “using the loose tissue surrounding it.” 3 They used the Wise pattern 4 and popular McKissock 5 vertical de-epithelialized bipedicle nipple mammoplasty to gather the remaining glandular tissue under the nipple. 1Ĭontemporaneously, Palmer et al preferred to resect only one area at a time because of the extent of each excision. 1 The inferior incision sometimes needed to be carried posteriorly around the trunk to remove undesirable bulk and to correct skin redundancy of the back and arms. 1 He applied the Pitanguy mastopexy with de-epithelialization of the keyhole as well as the whole undersurface of the breast, which was then under turned upward beneath to give it bulk and forward projection. 2 Loosely hanging breasts were “an extremely difficult problem.” 1 He cited others' and his own experiences that normally discarded flaps should be de-epithelialized and placed deep in the breasts.
1, 2 He declared post–weight loss contouring not aesthetic, primarily due to the scars.
1 After a complete examination, all indicated surgical procedures were identified, followed by a coordinated surgical plan, “so that as many as possible can be done simultaneously.” 1 With two or three teams working simultaneously, the arms and breasts could be contoured at the same time as the belt lipectomy. Breast reshaping is best performed during an upper body lift.įollowing the initial success of intestinal bypass surgery for managing obesity in the 1970s, Zook established the foundation for body contouring. We have successfully combine breast reshaping with upper body lift for this difficult deformity after massive weight loss and present two demonstrative examples. Proper inframammary fold construction is pivotal to the upper body lift. The long inframammary scar of the McKissock vertical bipedicle mastopexy forms the junction between the breast and reverse abdominoplasty. When more tissue is needed, silicone implants are used. The spiral flap has been devised for that purpose. When the breasts need enlargement, nearby discard tissue is used for augmentation. This lift is a reverse abdominoplasty that ends along the inframammary fold scar of the Wise-pattern mastopexy and extends laterally along the back roll. More often the breasts are reshaped during an upper body lift. Breasts may be reshaped by mastopexy and/or augmentation three examples are presented. Body contouring is offered after the weight loss is stable. The senior author reviews his experience with 24 patients over the past 4 years.
Mastopexy is difficult and historically includes the use of excess nearby tissues. After massive weight loss, breasts have poor shape, projection, and skin elasticity.