Simplified planning and marking of mastopexy and reduction mammoplasty: the circumvertical "Matryoshka" pattern

Like most other aesthetic procedures, particularly in paired organs for which symmetry is critical, the successful outcome of mastopexy and reduction mammoplasty is greatly determined by pre-operative planning. By carefully considering the design of the skin resection and choosing and designing an appropriate pedicle, prevention of skin necrosis, unsightly scars, and shape distortion can be minimized.

Methods:

We present an original skin marking technique that combines the advantages of using a Wise template as the basis for skin marking with those of the vertical mammoplasty pattern together with a limited circumareolar skin excision to shorten the subareolar vertical scar.

Results:

The circumvertical skin marking design we propose mimics a Russian doll silhouette, the “Matryoshka.”

Conclusion:

Incorporating a geometrically based and measurable pre-operative marking certainly offers a great degree of control and consistency.

Keywords:
Breast; Ambulatory surgical procedures; Mammoplasty; Cosmetic techniques; Elective surgical procedures

Authorship

BISHARA ATIYEH

American University of Beirut Medical Center, Beirut, Beirut, Lebanon.American University of Beirut Medical CenterLebanonBeirut, Beirut, LebanonAmerican University of Beirut Medical Center, Beirut, Beirut, Lebanon.

https://orcid.org/0000-0001-8650-491X

ROMEU FADUL JR

Institute Sirio Libanês Hospital, Sao Paulo, SP, Brazil.Institute Sirio Libanês HospitalBrazilSao Paulo, SP, BrazilInstitute Sirio Libanês Hospital, Sao Paulo, SP, Brazil.

https://orcid.org/0000-0003-3768-7582

NATASHA HABR

https://orcid.org/0000-0002-6407-4784

FADL CHAHINE ^**Autor correspondente: Fadl Chahine, Trad Hospital and Medical Center, Beirut - Lebanon, E-mail: Fadel@Chahine.md

Trad Hospital and Medical Center, Beirut, Beirut, Lebanon.Trad Hospital and Medical CenterLebanonBeirut, Beirut, LebanonTrad Hospital and Medical Center, Beirut, Beirut, Lebanon.

https://orcid.org/0000-0002-4215-1347

Conflicts of interest: none.

Institution: American University of Beirut Medical Center, Beirut, Lebanon.

*Corresponding author: Fadl Chahine, Trad Hospital and Medical Center, Beirut - Lebanon, E-mail: Fadel@Chahine.md

SCIMAGO INSTITUTIONS RANKINGS

Institute Sirio Libanês Hospital, Sao Paulo, SP, Brazil.Institute Sirio Libanês HospitalBrazilSao Paulo, SP, BrazilInstitute Sirio Libanês Hospital, Sao Paulo, SP, Brazil.

Trad Hospital and Medical Center, Beirut, Beirut, Lebanon.Trad Hospital and Medical CenterLebanonBeirut, Beirut, LebanonTrad Hospital and Medical Center, Beirut, Beirut, Lebanon.

Figures

Figures (10)

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Figure 1
A. Diagrammatic representation of the Russian doll - “Matryoshka”; B. “Matryoshka” profile; C. Wise template drawing (in red) with final breast marking.

Thumbnail

Figure 2
Illustration of the “Matryoshka” breast marking based on the Wise template. Controlled periareolar skin excision is limited by the vertical diverging limbs of a standard Wise pattern and allows shortening of the vertical scar.

Thumbnail

Figure 3
A. Wise template drawing along standard measurements and reference points and planes. Upper border of the wise pattern is at the intersection of the breast meridian with the anterior projection of the inframammary fold (yellow line); B. Periareolar line drawing guided by the Wise template; C and D. Lejour’s maneuver for marking of lateral and medial pillars. E and F. Lower border of skin marking 2 fingers above the existing inframammary line.

Thumbnail

Figure 4
A, B and C. Marking of transverse inferior excision converting the pattern to an inverted “T”. Wise pattern (in red) determines the periareolar line. Upper limit of the inferior elliptical excision is at 7-8cm (in yellow) on the marked medial and lateral pillars borders; D, E, F and G. De-epithelialized dermal flap at the lower border of the medial and lateral pillars anchored inferiorly at the chest wall allowing closure at the “T”-junction without tension; H. Primary healing; I, J and K. Early post-operative result.

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Figure 5
A 30-year-old healthy non-smoker patient presented 1-year post-partum complaining of large breasts and sought breast reduction. A circumvertical “Matryoshka” design was planned. 160g was resected from the lower pole of each breast. The patient’s (A) preoperative markings are shown along with photos (B) preoperatively, as well as upon (C) immediate follow up and (D) at 6 months to show the stability of the result. The patient is reportedly satisfied and pleased with the shape.

Thumbnail

Figure 6
A 44-year-old healthy non-smoker multi gravid patient presented with the complaint of breast asymmetry, as well as sagging of her breasts. She had initially specifically requested a Benelli mastopexy as she feared the scars. Upon extensive counseling, she agreed to undergo a circumvertical “Matryoshka” mastopexy. The patient’s (A) preoperative markings are shown along with photos (B) preoperatively, as well as follow up (C) at 5 months. The patient is reportedly very satisfied and pleased with the scars as well as the shape of her breasts.

Thumbnail

Figure 7
A 34-year-old healthy but heavy smoker patient presented complaining of sagging breasts and not desiring any reduction in breast shape. She was counseled about the need for smoking cessation and was offered a circumvertical “Matryoshka” mastopexy in combination with Hamdi’s volume distribution mastopexy. The patient’s (A) pre-operative markings are shown along with photos (B) preoperatively, as well as (C) upon immediate follow up and at 2 months (D). The patient is reportedly very satisfied and pleased with the scars as well as the shape of her breasts.

Thumbnail

Figure 8
A and B. Circumvertical - “Matryoshka” pattern for mastopexy. Periareolar line drawn with wise vertical limbs of 2.5cm; C. Superior pedicle de-epithelialization and excision (or de-epithelialization) of the lower pole skin; D, E and F. Stages of areolar suturing maintaining adequate diameter with no tension. Note circular areola without teardrop deformity and absence of pleating; G. Scar quality at 4 weeks.

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Figure 9
A. Circumvertical “Matryoshka” pattern for mastopexy; B and C. Periareolar and vertical scars 2 years postoperative.

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Figure 10
A. Patient with ptosis and previous breast augmentation; B. Simultaneous augmentation mastopexy with the circumvertical “Matryoshka” pattern early result; C, D and E. Result at 4 months.

Figure 1 A. Diagrammatic representation of the Russian doll - “Matryoshka”; B. “Matryoshka” profile; C. Wise template drawing (in red) with final breast marking.

Figure 2 Illustration of the “Matryoshka” breast marking based on the Wise template. Controlled periareolar skin excision is limited by the vertical diverging limbs of a standard Wise pattern and allows shortening of the vertical scar.

Figure 3 A. Wise template drawing along standard measurements and reference points and planes. Upper border of the wise pattern is at the intersection of the breast meridian with the anterior projection of the inframammary fold (yellow line); B. Periareolar line drawing guided by the Wise template; C and D. Lejour’s maneuver for marking of lateral and medial pillars. E and F. Lower border of skin marking 2 fingers above the existing inframammary line.

Figure 4 A, B and C. Marking of transverse inferior excision converting the pattern to an inverted “T”. Wise pattern (in red) determines the periareolar line. Upper limit of the inferior elliptical excision is at 7-8cm (in yellow) on the marked medial and lateral pillars borders; D, E, F and G. De-epithelialized dermal flap at the lower border of the medial and lateral pillars anchored inferiorly at the chest wall allowing closure at the “T”-junction without tension; H. Primary healing; I, J and K. Early post-operative result.

Figure 5 A 30-year-old healthy non-smoker patient presented 1-year post-partum complaining of large breasts and sought breast reduction. A circumvertical “Matryoshka” design was planned. 160g was resected from the lower pole of each breast. The patient’s (A) preoperative markings are shown along with photos (B) preoperatively, as well as upon (C) immediate follow up and (D) at 6 months to show the stability of the result. The patient is reportedly satisfied and pleased with the shape.

Figure 6 A 44-year-old healthy non-smoker multi gravid patient presented with the complaint of breast asymmetry, as well as sagging of her breasts. She had initially specifically requested a Benelli mastopexy as she feared the scars. Upon extensive counseling, she agreed to undergo a circumvertical “Matryoshka” mastopexy. The patient’s (A) preoperative markings are shown along with photos (B) preoperatively, as well as follow up (C) at 5 months. The patient is reportedly very satisfied and pleased with the scars as well as the shape of her breasts.

Figure 7 A 34-year-old healthy but heavy smoker patient presented complaining of sagging breasts and not desiring any reduction in breast shape. She was counseled about the need for smoking cessation and was offered a circumvertical “Matryoshka” mastopexy in combination with Hamdi’s volume distribution mastopexy. The patient’s (A) pre-operative markings are shown along with photos (B) preoperatively, as well as (C) upon immediate follow up and at 2 months (D). The patient is reportedly very satisfied and pleased with the scars as well as the shape of her breasts.

Figure 8 A and B. Circumvertical - “Matryoshka” pattern for mastopexy. Periareolar line drawn with wise vertical limbs of 2.5cm; C. Superior pedicle de-epithelialization and excision (or de-epithelialization) of the lower pole skin; D, E and F. Stages of areolar suturing maintaining adequate diameter with no tension. Note circular areola without teardrop deformity and absence of pleating; G. Scar quality at 4 weeks.

Figure 9 A. Circumvertical “Matryoshka” pattern for mastopexy; B and C. Periareolar and vertical scars 2 years postoperative.

Figure 10 A. Patient with ptosis and previous breast augmentation; B. Simultaneous augmentation mastopexy with the circumvertical “Matryoshka” pattern early result; C, D and E. Result at 4 months.

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E-mail: rbcp@cirurgiaplastica.org.br

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Simplified planning and marking of mastopexy and reduction mammoplasty: the circumvertical "Matryoshka" pattern

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[1] Conflicts of interest: none.