Eur J Plast Surg (2001) 24:296 DOI 10.1007/s002380100288 INVITED COMMENTAR Y Foad Nahai Published online: 19 September 2001 © Springer-Verlag 2001 The three flap mammaplasty is essentially a variation on resection is essential to avoid under or over resection. a theme. It is a variation on the vertical reduction The traction device helps make this possible. described by Lassus in the late 1960s, which was modified The authors advocate the de-epithelialization and and popularized by Lejour in the mid-1980s. The principle formation of the septum as a method to reduce the post- is the same: a superiorly based pedicle for the nipple operative “bottoming out or recurrence of ptosis”. As areola, resection of central and lower breast tissue, and supported by their case in Fig. 9, this certainly is not then the approximation of lateral and medial pillars. always the case. As Lassus has pointed out, bringing There is a current trend in breast reduction and masto- together the medial and lateral pillars forms a so-called pexy toward improving the shape and reducing the scar. dam that holds up the breast tissue and reduces the recur- The authors here attempt to do both. Although they rence of ptosis or bottoming out. However, the problem emphasize shape and longevity of results, they also is complex and a solution is not that simple. I personally demonstrate scar reduction. They point out that some of believe that resecting the central and lower breast tissue the extremely large reductions may require a small and suturing the medial and lateral pillars contribute to a “horizontal extraction” at the base of the vertical scar. better result with the vertical technique and reduces the While I concur with this opinion, it has been my experience possibility of bottoming out and a recurrence of ptosis. that these patients are very few and far between. We Moreover, in my experience the wider the resection – have always been able to complete a vertical reduction that is, the further lateral and the further medial that we without a horizontal scar component, as was advocated resect the lateral and medial pillars and the more unusual originally by Marchac. and constricted the lower part of the breast is on the There are essentially two modifications or variations operating table – the better the quality of the eventual on the classic vertical reduction theme here: the traction result in terms of shape and longevity. It is difficult to device and the so-called septum, the de-epithelialized place sutures through the fatty tissue in a very fatty part of the upper portions of the medial and lateral breast to hold the medial and lateral pillars together. It pillars. may be that the authors’ de-epithelialized septum would I commend the authors on their ingenious traction be beneficial and would allow a better approximation of device that definitely assists in resecting the breast tissue the medial and lateral pillars in fatty breasts. and in all likelihood takes several minutes off the length I congratulate the authors on this modification and of the operation. I tend to use various retractors and their thoughtfulness in concentrating on the traction clamps to hold the breast in that position to facilitate device to ease resection and the de-epithelialized flap to the resection. Proper positioning of the breast during approximate the medial and lateral pillars. I believe that Fig. 10 represents their best result in this paper with excellent conical shape and upper pole fullness. I would, This commentary refers to the article at http://dx.doi.org/ 10.1007/s002380100287 however, differ with them when they refer to the patient in Fig. 11b as having almost perfect symmetry. Although F. Nahai ( ) the mounds approximate each other rather closely Paces Plastic Surgery and Recovery Center, in size, the nipple areola complex on the right side is 3200 Downwood Circle, Suite 640, Atlanta, GA 30327 e-mail: NAHAIMD@aol.com too high!
European Journal of Plastic Surgery – Springer Journals
Published: Nov 1, 2001
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