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Oct. 17, 2008 -- Breast implants aren't the only remedy -- and perhaps not the best remedy -- for women whose breasts are sagging and very misshapen after massive weight loss, multiple pregnancies, or aging.
An alternative to breast implants, using a technique called spiral flap reshaping of the breast, may offer more satisfactory results, says Dennis Hurwitz, MD, clinical professor of plastic surgery at the University of Pittsburgh and a Pittsburgh plastic surgeon. Hurwitz, who pioneered the technique, will offer an update of his results Nov. 2 at the annual meeting of the American Society of Plastic Surgeons in Chicago.
When implants are used in patients with extremely sagging breasts, the results are often disappointing, he says. "In patients with loose skin, implants sag a lot," says Hurwitz. If the sagging is extreme, he says, the breast implants end up looking "like a rock in a sock."
As more patients lost massive amounts of weight -- 100 pounds or more -- after diet and exercise or bariatric surgery, Hurwitz encountered more patients unhappy with their extremely sagging breasts that flatten out to somewhat of a pancake shape. Others have the so-called pancake breasts as the aftereffect of multiple pregnancies or simply aging.
Over the last five years, he has published the results of his spiral flap technique, which is technically known as a spiral flap with an upper body lift. He describes it as a "two-fer," giving the patients some body contouring along with improved breasts.
In the technique, excess tissue and fat is taken from the patient's upper abdomen, along the bra line, or from beneath the upper arms, and that flap of tissue and fat is rotated into place to augment the breasts. The breasts are usually lifted as well.
Hurwitz has now performed the technique on more than 100 patients, he tells WebMD, and many other surgeons have learned his technique or variations. "Several hundred plastic surgeons are now doing this," he says.
None of the patients had significant infections, he says, and there have been no deaths or serious complications such as blood clots in the lung.
About one-fifth had tissue death in an area that was transferred, he says, but in most cases it resolved on its own.
Overall, Hurwitz says, he has had good results with the flap technique. In all, 15 patients of the 100 asked for further enlargement with breast implants later.
One downside, he says, is that "it's hard to tell [in advance] how big the breast will be."
In a report of 18 patients who had the spiral flap technique, published in the Annals of Plastic Surgery in 2006, Hurwitz says that 14 of the 18 were pleased with results, although three of the 18 got breast implants later because they wanted more augmentation.