U-Shaped Triple Lipodermal Flap: A Technical Refinement Aimed at Mitigating T-Junction Necrosis in Reduction Mammoplasty

TL;DR

This study introduces a new surgical technique to reduce T-junction necrosis in breast reduction surgery, showing promising results in a low-risk patient group.

Contribution

The U-shaped triple lipodermal flap technique is proposed as a novel method to mitigate T-junction necrosis in reduction mammoplasty.

Findings

The U-shaped triple lipodermal flap technique resulted in a 5% wound breakdown rate at the T junction in a low-risk patient group.

The technique is described as safe, versatile, and effective in distributing tension to reduce ischemia risks.

Abstract

T intersection breakdowns are a difficult problem encountered in Wise pattern breast reductions.

This preliminary study aimed to evaluate the efficacy of the U-shaped triple lipo-dermal flap technique in reducing T junction necrosis in superomedial pedicle reduction mammoplasty limited to a fairly low risk group of patients.

Our prospective cohort study comprised 20 women who underwent breast reduction surgery between May 2023 and May 2024. All the patients who underwent breast reduction surgery for benign breast enlargement met the inclusion criteria. We excluded patients who were smokers, had autoimmune diseases, had a body mass index (BMI) of greater than 30, had diabetes, hypertension, were scheduled for onco-reconstruction or had complication other than wound healing. Data on BMI, ptosis severity, weight of the removed breast tissue, healing rates and follow-up duration were gathered. All patients were operated by a single surgeon. These patients were followed up on postoperative days 7, 10, 14, 21, 28, 40, and monthly. During follow-up complications with regard to wound healing, the scar quality and patient satisfaction were considered.

One patient (5%) had experienced epidermolysis and subsequent full thickness dehiscence at the T zone.

The principle behind this strategy is that the incorporation of lipodermal flaps distributes the tension across the suture line, thereby reducing the risk of ischemia at the T junction. The technique is safe, versatile, and easy to execute. It provides a tension-free zone and acting as internal dermal sling. The use of the U-shaped triple lipo-dermal flaps in Wise pattern superior medial pedicle breast reduction demonstrated a 5% rate of wound breakdown at the T junction in a low-risk group of patients. Further studies need to be conducted on a broader breast reduction population is needed to more fully assess the efficacy of this technique.

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