Female Breast Reshaping after Massive Weight Loss

Abstract

A knowledge of breast anatomy is critical for understanding the advantages and disadvantages of different techniques for breast reshaping, and it is therefore critical for selecting which techniques are best suited for certain patients, minimizing vascular compromise, healing problems, and sensory changes; and maximizing preservation of function and long-term stability of the post-operative shape. The female breast has a diverse physiology that makes accurate reproducible measurements of this organ very difficult. It is a three-dimensional soft tissue structure that is anchored to a bony and muscular framework but does not remain constant over time. Breast shape is affected by physiological changes associated with puberty, ovulation, gestation and lactation. The criteria for a perfectly shaped breast vary certain universal concepts of breast aesthetics seem to be accepted by artists and the general public. The aesthetically pleasing breast will be of a size and fullness proportional to the body with little or no ptosis, be conical to teardrop in shape, the nipple will be at the anterior most point of the breast mound. The best method to record the relative position of the breast on the anterior chest is by photographic documentation. If this is used, it is important to include other anatomic features in the photograph in order to orient the breast for size and spatial relationships shoulders, umbilicus. Massive weight loss (MWL) is defined as 50% or greater loss of the excess weight. The body contour deformities that develop in morbidly obese patients following massive weight loss involve almost all areas of the body although many articles focused on ways to improve shape, projection, and long-term results of breast management after massive weight loss, yet no consensus was reached upon the best technique for management. Autologous breast reshaping depends on increasing volume of the breast by utilizing excess axillary tissue (lateral thoracic/spiral/intercostal artery perforator flap), as well as modification of existing superomedial pedicle techniques to maximize breast volume, and increasing breast parenchymal support with suture fixation and dermal suspension. Regardless of which technique is chosen, most procedures will incorporate some of the mentioned principles to maximize aesthetic results and subsequently patient satisfaction. Different procedures will continue to evolve for maintenance of breast shape over time.