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1 Sociedade Brasileira de Cirurgia Plástica, Curitiba, PR, Brazil 2 Universidade Federal do Paraná, Curitiba, PR, Brazil. 3 Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil. Introduction: Several breast augmentation techniques have been developed to avoid late ptosis. However, these techniques result in persistent pendulum and changed shape due to loss of filling in the upper pole. The combination of breast augmentation with a thoracic flap involving a bipedicled flap from the greater pectoral muscle has been used with good results that are maintained in late postoperative periods. Method: More than 4,000 procedures were performed using the author’s technique. The marking of traditional mammoplasty and construction of the inferior pedicle flap were performed as described by Ribeiro. A pectoral muscle strap was divulsed and the thoracic flap passed through and attached to the chest wall. The muscle and glandular flaps were wrapped by the upper pole tissue and sutured to the lateral breast pillars. Results: Use of the thoracic flap technique fixed by a pectoral muscle strap results in minimum pendulum, which provides better long-term aesthetic results. With this technique, the breast tissue is divided and repositioned in the desired location while maintaining the breast shape rather than depending on the dermal closure to provide the final shape. Conclusion: This technique provides long-term preservation of the upper breast pole and reduced scar tension with consequent aspect improvement; it also eliminates post-operative pendulum movement (ptosis) without significantly increasing surgical time. ■ ABSTRACT

Mammoplasty with bipedicled flap from the pectoral muscle: 30 years of experience