摘要

Objectives: I describe my experience with breast reshaping with composite mammaplasty with differrent skin resection patterns(J mammaplasty, wise pattern or circumvertical) and autologous intramuscular and subcutaneous fat grafting. Introduction: The aim of mastopexy is to remodel the breast but in most of the cases breast volume should be also reduced. Combing mastopexy with superior pedicle for nipple vascularization and inferior pedicle for autoaugmentation also with lipofilling offer to patient’s stable results without the use of an implant. Materials / method: I describe the surgical technique for composite mammaplasty. Photographic documentation was done for every patient. Preoperative bleeding protocol included 1g of tranexamic acid. Postoperative all patients were discharged with kynesiotape to promote wound healing without tension. In selected cases negative wound pressure dressings or hyperbaric chamber were advised. Lipofilling was performed under direct vision subcutaneous and intramuscular. Postoperative all patients had followed ups at 1,3, respectively 6 months and one year after the surgery with ultrasound control. Results: Fifty patients were included with one year follow up. Mean age of 38 years. All patients had followed up one year after surgery with ultrasound to evaluate fat grafting and gland position after autoaugmentation. Mean skin resection per breast was 15g. Mean autologous fat grafting was 95cc per breast. Superior and medial pedicle was performed in every case. Mean liposuction of the bra roll with radiofrequency assisted liposuction volume was 200cc(100-400cc) with 30 KiloJoules. Two patients had minimal superficial areola necrosis treated conservatively. Conclusion: Combining glandular reshaping, lipofilling and radiofrequency assisted liposuction stable results may be obtained with high grade of satisfaction among patients and minimal complications.