Beyond the T-junction : Reinforce strategic sites in superomedial pedicle mammoplasties using a dual dermal flap technique

Article Article scientifique Article Beyond the T-junction : Reinforce strategic sites in superomedial pedicle mammoplasties using a dual dermal flap technique eng 2025-09-20 2025-12 author Dogny Clélia Laura Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 857335 author Scampa Matteo 0000-0003-0461-7596 Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 751050 author Membrez Tom Department Diagnostique, Pathologies Clinique, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 873598 author Frigerio Giulia Elena Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 403318 author Engels Patricia Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 401873 author Kalbermatten Daniel Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 948183 Département de chirurgie (CHIRU) Daniel Felix Kalbermatten author André-Lévigne Dominik Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland. 748833 551-558 10.1016/j.jpra.2025.09.008 41244356 2352-5878 PMC12617785 https://www.sciencedirect.com/science/article/pii/S2352587825001846 Introduction: Breast reduction using superior or superomedial pedicles provides favorable long-term aesthetic outcomes, particularly regarding breast shape and projection. However, wound dehiscence remains a concern at the T-junction and the vertical-areolar junction, with reported rates ranging from 4 % to 20 %, contributing to a higher postoperative burden, suboptimal aesthetic results, and increased healthcare costs. The development of preventive techniques is a key aspect as scar quality is considered one of the most important factors by patients. Only a few techniques in the literature describe using dermal flaps at high-tension sites to reduce tension and provide additional support and blood supply. Materials and methods: : A literature review was performed via PubMed using the terms "dermal flap," "dermo-glandular flaps," "de-epithelialized flaps," "breast reduction," "mammoplasty," "scar dehiscence," and "scar complication." We then present a modification of the superomedial pedicle technique that includes two small semi-circular de-epithelialized dermal flaps placed at the T-junction and the vertical-areolar junction. These aim to offload tension and reinforce vascular support at high-risk sites. Results: Three studies described dermal flap use at the T-junction, reporting a reduction in scar-related complications from 4.3 % to 1.4-2.9 %. However, none addressed the vertical-areolar junction. Our technique is, to our knowledge, the first to reinforce both areas simultaneously. Conclusion: We propose a simple modification to the standard technique using small dermal flaps at strategic points to reinforce T-inverted scars for superomedial and superior pedicles. Building on previous studies, This approach aims to enhance healing and reduce complications without increasing operative time. Breast reduction Dermal flap Reduction mammoplasty Superior pedicle Superomedial pedicle Wound dehiscence Dewey 616.07 Dewey 617 137 Département de pathologie et immunologie 21F 57 Département de chirurgie 222 false 1343 Reconstruction chirurgicale et régénération des tissus 1029 JPRAS open 46 1f7c92a9-30b9-4af6-9b98-649f0ab371d3 Article (Published version) Public Article_scientifique_from_europePmc.pdf 1595632 application/pdf CC BY-4.0 d895e3a79e7b76a2ea16c8ddf237b6c471a3fcb5adff44bfe8099862a5372f39 openAccess Faculté de médecine / Section de médecine fondamentale / Département de pathologie et immunologie Faculté de médecine / Section de médecine clinique / Département de chirurgie

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