Dermafascial fixation suture: A technique for a more durable projection with short-scar (vertical) reduction mammaplasty

Background: Short-scar reduction mammaplasty has several advantages over the traditional technique, mainly reduced scarring and superior long-term breast shape. Multiple modifications of the short scar reduction mammaplasty technique have been made in an effort to decrease the learning curve while improving the results. The authors present another modification of the short-scar technique for a more durable projection without reliance on a skin envelope. Methods: The perimeters of the medial pedicle and the nipple-areola complex are marked, and the medial pedicle is deepithelialized. A 2 x 5-cm skin area at the inferior border of the pedicle is further deepithelialized, then pexied to the pectoralis fascia in a superomedial direction using a nonabsorbable monofilamanet suture with a horizontal mattress suturing technique. Results: Taking the suture bites from the dermis rather than the breast parenchyma for the pexy aims to spare the pedicle's circulation. This durable internal rearrangement of the breast parenchyma with dermafascial pexy further decreases the tension at the nipple-areola complex because the final breast shape no longer relies on the skin closure. Suture spitting at the nipple-areola complex also is prevented with elimination of the purse-string suture because there is no need for a further decrease in the tension with the purse-string suture after the dermafascial pexy. Conclusions: The authors believe that the dermafascial pexy is a concept more than a technique. It incorporates the two strongest structures, the dermis and the fascia, to achieve more durable results not only with reduction mammaplasty, but also with any aesthetic breast surgery that uses the pedicles.