Breast Reduction And Mastopexy - Regnault B Baps Presentation

The simplified Regnault B technique for breast reduction and mastopexy : a single surgeon experience of 56 consecutive cases

S Tadiparthi, A Edwin, R DeBono University Hospital North Durham, Durham, UK

Introduction 

Described by Paule Regnault in 1974 for breast reduction and mastopexy +/- prosthesis

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Original markings resulted in a ‘B’ shape

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Uncommonly used technique – markings and procedure perceived to be difficult

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We describe a simplification of these markings

Simplified Regnault B - Breast Markings

3 markings with patient standing : 4. Midline 5. Breast meridian 6. Inframammary fold - IMF

Breast markings Sitting position

Supine position

Breast markings

Final breast markings…….

Pre-operative Images

35 year old female, 36G bra size Sternal notch to nipple distance 36cm

Appearance following breast markings

• 5 cm nipple marked • Breast tourniquet applied (optional) • Superior shaded area (pedicle) de-epithelialised

Superior pedicle de-epithelialised

Superior pedicle raised with a thickness of approximately 2cm

Dissection vertically down to chest wall beneath the pedicle (at level of base of the 16 cm arc)

Triangular wedge of tissue below and lateral to the nipple is excised

Inferolateral wedge of tissue excised

665 grams of tissue removed from the right breast

Pedicle trimmed to remove excess breast tissue

Dermis of the 16cm arc divided so the pedicle fits better on closure

Resulting medial and lateral flaps after excision of breast tissue

• Drain sited

• Lateral flap moved medially

• Nipple sutured in new position – level of IMF

& inferiorly • Medial flap moved laterally

Immediate postoperative appearance

Results

32 year female : grade III ptosis & 38F breasts 375 g from right breast and 350 g from left breast removed 24 month follow up : scars healed well, good symmetry, normal nipple sensation

Results

48 yrs old wears 32G bra, sternal notch to nipple distance of 29 cm 300g removed each breast 28 month F/U : good symmetry of breast size, shape and nipple position

Results

39 years old, 34F bra, sternum to nipple distance of 27 cms 375 g removed from each breast 9 month F/U : good symmetry, slight hypertrophic scarring around nipple

Methods 

56 consecutive patients

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Performed by the senior surgeon between 2005 and 2007

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Data collected retrospectively from notes

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Subjective patient evaluation questionnaires

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Patients invited to clinic for review by independent assessors

Results 

Age : range 17 – 60 years (mean 39 years)

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BMI : range 20-34 (mean 26)

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Breast tissue excised : range 208 - 937 gram (mean 620g)

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Sternal notch to nipple distance : range 23.5 – 37.5 cms

Procedures  Breast

Reductions : 87% (n=49) Bilateral 66 % Unilateral 21%

 Mastopexies

: 11% (n=6)

Bilateral 4% Unilateral 7%

 Reduction

and mastopexy : 2 % (n=1)

Risk factors and length of stay

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Smoking Hypertension Hypercholesterolaemia Diabetes, IHD, CVA

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Length of stay : mean 3 days

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18% 15% 6% 0%

Complications 12% 5%

(mostly minor)

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Wound breakdown Wound infection

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Haematoma

3.5%

(1 evacuated in theatre & 1 aspirated using

1.7% 1.7% 0 %

(1 patient)



ultrasound)

(antibiotics only)

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Seroma Nipple necrosis Fat necrosis

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No patients required revisional surgery

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(1 partial necrosis)

Results 

61% (n=34) returned to clinic for review by independent assessors

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Follow-up time : 4 – 32 months (mean 17)

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Assessed with scale 1 (poor) to 5 (excellent) on : - breast shape/size/symmetry - nipple position

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All patients scored 5 or 4 (excellent or good) for symmetry of breast size and shape and nipple position

Patient questionnaires  Nipple

sensation :

Normal Reduced Absent

 Breast

64% 30% 6%

feeding :

None of our patients had tried to breast feed postoperatively

Patient satisfaction 

92% rated their scars 4 or 5 (scale 1 poor – 5 excellent)

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91% satisfied or very satisfied with the operative results

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97% would recommend the operation to others

Conclusions 

Versatile technique

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Resection up to 1000g

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Omits medial inframammary scar

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Broad superior pedicle: complete nipple necrosis rare

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No pseudoptosis or dog ears

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High patient satisfaction

Thank you