The simplified Regnault B technique The simplified Regnault B technique

for breast reduction and mastopexy :for breast reduction and mastopexy :

a single surgeon experience of 56 consecutive casesa single surgeon experience of 56 consecutive cases

S Tadiparthi, A Edwin, R DeBono

University Hospital North Durham, Durham, UK

IntroductionIntroduction

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

Original markings resulted in a ‘B’ shape

Uncommonly used technique – markings and procedure perceived to be difficult

We describe a simplification of these markings

Simplified Regnault B - Breast MarkingsSimplified Regnault B - Breast Markings

3 markings with

patient standingstanding :

1. Midline

2. Breast meridian

3. Inframammary fold - IMF

Breast markings Breast markings

Sitting position Supine position

Breast markingsBreast markings

Final breast markings…….Final breast markings…….

Pre-operative ImagesPre-operative Images

35 year old female, 36G bra size

Sternal notch to nipple distance 36cm

Appearance following breast markingsAppearance following breast markings

• 5 cm nipple marked5 cm nipple marked

• Breast tourniquet applied (optional)Breast tourniquet applied (optional)

• Superior shaded area (pedicle) de-epithelialisedSuperior shaded area (pedicle) de-epithelialised

Superior pedicle de-epithelialised

Superior pedicle raised with a

thickness of approximately 2cm

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

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

• Nipple sutured in new

position – level of IMF

• Lateral flap moved medially

& inferiorly

• Medial flap moved laterally

Immediate Immediate postoperative postoperative appearanceappearance

ResultsResults

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

ResultsResults

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

ResultsResults

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

MethodsMethods 56 consecutive patients

Performed by the senior surgeon between 2005 and 2007

Data collected retrospectively from notes

Subjective patient evaluation questionnaires

Patients invited to clinic for review by independent assessors

ResultsResults

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

BMI : range 20-34 (mean 26)

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

Sternal notch to nipple distance : range 23.5 – 37.5 cms

ProceduresProcedures

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 stayRisk factors and length of stay

Smoking 18% Hypertension 15% Hypercholesterolaemia 6% Diabetes, IHD, CVA 0%

Length of stay : mean 3 days

ComplicationsComplications

Wound breakdown 12% (mostly minor)

Wound infection 5 % (antibiotics only)

Haematoma 3.5% (1 evacuated in theatre & 1 aspirated using ultrasound)

Seroma 1.7% (1 patient)

Nipple necrosis 1.7% (1 partial necrosis)

Fat necrosis 0 %

No patients required revisional surgery

ResultsResults

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

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

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

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

Patient questionnairesPatient questionnaires

Nipple sensation :

Normal 64%

Reduced 30%Absent 6%

Breast feeding : None of our patients had tried to breast feed postoperatively

Patient satisfactionPatient satisfaction

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

91% satisfied or very satisfied with the operative results

97% would recommend the operation to others

ConclusionsConclusions

Versatile technique

Resection up to 1000g

Omits medial inframammary scar

Broad superior pedicle: complete nipple necrosis rare

No pseudoptosis or dog ears

High patient satisfaction

Thank youThank you