Upper body lift and breast reshaping with lateral chest wall perforator propeller flap following massive weight loss

• Published in: Annales de chirurgie plastique et esthétique 2020-02, Vol.65 (1), p.44-53
• Main Authors: Isola, N., Herlin, C., Chaput, B., Aillet, S., Watier, E., Bertheuil, N.
• Format: Article
• Language: English
• Subjects: Adult; Augmentation mammaire autologue; Autologous breast augmention; Bariatric Surgery; Body Contouring - methods; Body Mass Index; Bodylift supérieur; Breast reshaping; Cancer; Chirurgie post-bariatrique; Female; Follow-Up Studies; Hematoma - surgery; Humans; Lambeau perforant; Life Sciences; Mammaplasty - methods; Massive weight loss; Mastopexie; Mastopexy; Middle Aged; Patient Satisfaction; Perforator flap; Perforator Flap - surgery; Perte de poids massive; Postoperative Complications - surgery; Reconstruction mammaire; Reoperation; Thoracic Wall - surgery; Tissue and Organ Harvesting; Upper body lift; Weight Loss
• ISSN: 0294-1260; 1768-319X
• DOI: 10.1016/j.anplas.2019.07.006

After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3±10.9kg/m2, with a mean preoperative pre-UBL BMI of 28.7±3.6kg/m2. The average weight loss before surgery was 67.7±22.4kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9±8.4months. The patients’ satisfaction with their improved breast shapes and chest wall contours was “good”, with an aesthetic outcome mean ranked 3.8±0.8 (out of 5). After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping. Après une perte de poids massive, les patientes présentent fréquemment des excédents cutanés séquellaires de la partie supérieure du corps associée à une sévère dystrophie mammaire. En général, plusieurs interventions sont nécessaires pour traiter ces différentes localisations anatomiques. Pour corriger ces séquelles cutanées d’amaigrissement, des seins et du haut du corps, une approche combinée associant des lambeaux perforants latéro-thoraciques en hélice avec un bodylift supérieur (BS) a été choisie. Entre septembre 2015 et mars 2017, après une chirurgie bariatrique, neuf patientes ont simultanément subi un bodylift supérieur et une reconstruction mammaire autologue par lambeaux perforants latéro-thoraciques en hélice. Les auteurs