Reduction mammaplasty and mastopexy with superficial fascial system suspension

Classic descriptions of breast reduction and mastopexy techniques have relied on dermal suspension with or without glandular shaping to contour the breast. Dermal suspension is often an unreliable and inconsistent anchor for high-tension wound repairs, resulting in unpredictable or poor scarring along with inadequate long-term lifting of the soft tissues. Hypertrophic scarring commonly occurs after dermal suspension reduction mammaplasty, being noted in 50 to 55 percent of patients at 6 months. Current studies regarding the anatomy and function of the superficial fascial system (SFS) have led to multiple applications of suspension with permanent (nonabsorbable) sutures in high-tension wound repairs of the body. As in other areas of the body, this system can be used effectively for suspension of breast-contouring procedures. Suturing the anterior SFS layer with nonabsorbable sutures (separately from the breast tissue or dermis) provides minimal tension skin repair. This should result in more predictable scarring with reduced risk of scar widening and hypertrophy. In addition, using SFS suspension in mammaplasties may result in longer-lasting contour results. The keyhole pattern used for dermal suspension techniques must be modified for SFS suspension. Reduction mammaplasty or mastopexy using these suspension wound repair techniques was performed in 109 patients (218 breasts) with a 6- to 36-month follow-up. The incidence of hypertrophic scarring was 3 percent at 6 months in this series. Suspension in mammaplasty procedures improved scar quality and provided more predictable and stable breast contours over long-term follow-up.