Background: Several techniques have been developed to address cases of macromastia. The primary objective remains achieving optimal aesthetic outcomes and reducing breast volume, but concerns persist regarding the stability of results over time. In particular, as far as the superior pedicle inverted-T breast reduction with an inferiorly based dermal flap is concerned, long-term reported results stop at 5 years’ follow-up. This work investigates the outcome of this at greater than 10 years’ follow-up, considering intrinsic and extrinsic factors that may contribute to ptosis recurrence. Methods: A total of 70 patients were included and examined in a long-term consultation, more than 10 years postoperatively. Physical measures, including standard breast distances, skin distention test for elasticity assessment, and BREAST-Q scores, were collected at the time of consultation and compared with preoperative and intraoperative data. Results: The authors’ study sample shows a mean age of 42 years. Mean follow-up was 13 years, with 18 years as the longest follow-up registered. Mean amount breast tissue volume removed was 1134 g. A positive correlation between smoking habit and inferior pole elongation is shown (P = 0.031), and between smoking habit and inferior pole skin distention (P = 0.002). A significant positive correlation between age and almost all the BREAST-Q scales is reported. Smoking patients had a higher sternal notch–to-nipple distance distance variation over time and superior pole skin distention. Conclusions: Intrinsic and extrinsic factors may affect outcome and satisfaction irrespective of the age. This versatile procedure demonstrates reliability across time, offering enduring results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Summary: Breast reduction is one of the most required plastic surgery procedures worldwide, improving significantly the quality of life for patients with macromastia and gigantomachia. Despite various proposed approaches aiming to yield more stable results postreduction, no single technique has demonstrated unequivocal superiority. Recurrence ptosis at 6–12 months postoperative remains a challenging concern. To improve this issue, the authors propose a novel application of the poly-4-hydroxybutyrate (P4HB) scaffold on the anterior surface of the Ribeiro dermo-adipose flap. The primary aim was to establish a durable and resilient biological connection between the mammary gland and the flap, thereby promoting long-lasting outcomes in breast reduction procedures. The P4HB scaffold is a monofilament, single-layer, biologically derived, fully resorbable, rapidly integrating within breast tissue; this biological process stimulates the formation of freshly vascularized connective tissue up to a thickness of 2–3 mm. Within 18–24 months, the scaffold undergoes gradual resorption through hydrolysis-based mechanism, providing enhanced strength and resistance to the native tissue, as shown in animal model. A key innovation proposed by the authors involves the division of a 15 × 20 cm rectangular sheet of the P4HB scaffold along its diagonal, resulting in two right triangles. This modification ensures increased height of the device if compared with the traditional splitting technique of the scaffold. The strategic establishment of a biological bridge between the mammary gland and flap through the implementation of the P4HB scaffold could potentially enhance the longevity and aesthetics of breast reduction outcomes.

Background. Nontuberculous mycobacteria (NTM) periprosthetic infections after breast augmentation procedures are increasingly common worldwide and should raise suspicion after empirical antimicrobial therapy fails but clinical signs of infection persist. In this case experience, the authors suggest the use of negative pressure wound therapy (NPWT) for NTM-infected wounds to obtain a faster periprosthetic space closure, shorten healing time, and anticipate breast reimplantation. Case Report. This case report describes the successful application of NPWT to manage wound healing after breast removal in a 60-year-old female who underwent secondary breast augmentation 7 years before. The patient presented with an M. abscessus infection of the left breast after lung segmentectomy that persisted post-implant removal and targeted antibiotic therapy. Based on clinical and laboratory findings, the authors opted for a debridement of the periprosthetic space associated to a radical capsulectomy. Application of NPWT for wound drainage and closure allowed a faster recovery, reduced interval from implant removal to reimplantation, and led to a pleasant cosmetic result. Conclusion. The use of NPWT for wound management after NTM peri-implant infection may help to encourage faster periprosthetic space drainage and closure, thus expediting the timing of a negative culture and breast reimplantation.

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