Breast contouring in postbariatric patients: a technique selection algorithm.

Background: Breast deformities in postbariatric surgery (post-BS) patients are different and more challenging than those from non-BS patients. The histological alterations confer the highest clinical consequences to this area: highest degrees of true ptosis, deflated and flattened glands, and totally inelastic covering tissues. Plastic surgeons need an easy-to-use algorithm for technical choices.

Methods: Ptosis and volume loss are the main problems to be corrected on massive-weight-loss (M.W.L.) breasts. Both problems need specific resolutions due to their specific characteristics. Depending on the degree of ptosis and the amount of volume loss, a decisional algorithm has been developed: suitable and advisable techniques are pointed out, minimizing the risk/benefit ratio. "Pros and cons" with the use of mammary implants are emphasized.

Results: A group of 195 postbariatric surgery patients underwent breast contouring since 2001 following the herein presented decisional algorithm. Results have been tested with Body Uneasiness Test: encouraging data pushed to continue this method and to refine it.

Conclusions: Referring to this strategy algorithm, choices 2 and 3 appear to be the more frequently applied and better fitted to cover the majority of M.W.L. breast defects. In the future, the birth and the rise of new mammary implant concepts and technologies could completely change this algorithm.