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Durability of Shape with a Combined Technique
The correct execution of modern techniques in reduction mammoplasty produces excellent and immediate results.
The surgeon who operates respecting anatomical and physiological precepts of the breast, and with a proper knowledge of an affirmed technique, can adjust the skin with precision, modelling it to the reduced glandular contents, in conformity with the various patterns that have been proposed.
However, the ultimate evaluation of the operative result is does not depend on the immediate outcome: the prognosis must be deferred for at least one year, by which time the new shape of the breast will reveal eventual merits or defects of the technique employed.
The crucial point of reductive breast surgery is neither the volumetric reshaping nor the glandular modelling, which should conform to specific aesthetic canons, but the guarantee of the durability of the result.
Thus it is necessary that the technique utilised exploit valid devices in order to offset the force of gravity which, in the course of the months following the operation, may again cause the breast to sag.
The goal to be achieved – to limit the gradual drooping of the gland – pays no consideration to the pathogenesis of mammary sagging and must therefore be predetermined both when reducing hypertrophic breasts, in which sagging is the result of increased weight and volume, as well as in breasts that droop due to parenchymal hypotrophy and tissue lassitude.
In either case it is simply a question of fashioning the breast to regular proportions, providing resistance to the forces of gravity.
Pursuing this aim, and with a knowledge of the principles of embryology, anatomy and physiology of the breast, we have ascertained that in order to achieve a good substantial result in reductive mammoplasty, at least three conditions are necessary:
A – Maximum conservation of the dermis.
B- Vertical direction of the flaps.
C- Maximum mobility of the pedicle bearing the nipple.