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

[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.