A versatile modification of dermoglandular hammock flap for mastopexy: Extended hammock

Abstract

Breast ptosis commonly develops in response to ageing and breastfeeding. Clinical studies now focus on both filling the upper pole of the breast with parenchymal flaps and long-term maintenance of the breast projection without recurrence of upper pole concavity and a significant change in breast shape over time. This study presents a modification for a well-known mastopexy technique, the dermoglandular hammock flap, which provides not only autoaugmentation for the breast but also suspension for the breast parenchyma. This technical modification involving a hammock flap extended in both width and length dimensions, was performed in 17 patients aged 28-43 years with an average age of 31 years. They had minimal, moderate, and severe ptosis. Of these, eight patients had mastopexy only without needing any resection of the breast tissue. In four patients, there was significant asymmetry, needing excision of the breast tissue. In five patients, it was necessary to resect less than 290 g of glandular tissue from both breasts to provide enough reduction of the breast volume. There were no severe complications either in the early or late postoperative period, such as nipple-areolar necrosis, haematoma, infection, or dehiscence of the suture line. However, in one patient, skin depression developed at the end of the vertical scar line in one breast. In the follow-up, medial and upper pole fullness of the breast maintained without recurrence of the ptosis, providing satisfactory shape and projection. With this modification, dermoglandular suspension flap turns to be a more effective procedure and suitable for all types of ptosis. As the sagged lower pole of the breast is used as a flap behind the nipple-areola complex and upper pole, it makes not only parenchymal reposition, but also autoaugmentation in the breast, leading to successful breast fullness.