Differences in wound healing between ultrasound-assisted lipoplasty and suction-assisted lipoplasty in inverted T-pattern breast reduction surgery and chest wall contouring.

Abstract

Inverted T-pattern breast reduction does not directly address axillary or lateral chest wall fullness. Lipoplasty of this tissue has been advocated by some surgeons to reduce additional scarring. A prospective study was designed to examine the differences in wound healing of the breast reduction skin flaps when ultrasound-assisted lipoplasty (UAL) and suction-assisted lipoplasty (SAL) were each used as an adjunct to inverted T-pattern breast reduction surgery. The prospective study involved 15 consecutive nonsmoking female patients undergoing a standard inferior pedicle, central mound breast reduction and contouring of the lateral chest wall. Contouring of the left lateral chest wall and axilla was done with UAL and contouring of the right lateral chest wall with SAL. Lipoplasty was not used elsewhere in the breast tissue. The height and length of skin ischemia or necrosis at the inverted T incision was measured at postoperative day 2 or 3. Patients were placed on dressing changes and followed frequently until fully healed. The amount of breast tissue removed and the amount of UAL/SAL axillary aspirate were not significantly different from side to side (for the mean UAL side, tissue 828 +/- 190 g and aspirate 195 +/- 102 mL; for the mean SAL side, tissue 780 +/- 187 g and aspirate 194 +/- 94 mL; P > .05). The mean area of lateral skin flap ischemia at the inverted T incision was significantly less on the UAL side than on the SAL side (UAL, 47 +/- 128 mm(2); SAL, 361 +/- 500 mm(2); P = 0.02). The time to complete skin wound healing of the lateral flap was significantly less in the UAL-treated flaps than in the SAL-treated flaps (UAL, 9.6 +/- 8.6 days; SAL, 22.1 +/- 22 days; P = .02). The study was terminated once these resounding differences in lateral skin flap necrosis and time of wound healing became obvious. UAL offers significant benefits in comparison with SAL as an adjunct to standard breast reduction surgery for contouring of lateral chest wall fullness.