THOREK MODIFIED REDUCTION MAMMAPLASTY: LONG TERM EVALUATION OF AESTHETIC AND FUNCTIONAL RESULTS.

Text: INTRODUCTION AND AIMS Gigantomastia is an excessive breast enlargement, disabling for the patient. The treatment of choice is reduction mammaplasty. Thorek technique was developed to treat gigantomastia avoiding the main risk associated with the pedicle based techniques: Nac necrosis. The technique presented many advantages and some inconvenient, mainly concerning the aesthetical result and Nac sensitivity, so several authors modified it, but it is still frequently criticized. The authors describe a modification developed to prevent the main disadvantages of the original procedure. MATERIAL AND METHODS 15 patients were selected. The selection criteria were: age, preoperative jugular-nipple distance > 35 cm, comorbidities, no desire to breast-feeding. The modification of the technique is the creation of an inferiorly based dermal flap and its anchorage to pectoralis major muscle. The results were evaluated on three levels: aesthetic, functional, management of the patients. RESULTS The aesthetic results were satisfactory. The sensitivity of the NAC was preserved at least in 3 areolar quadrants in 90% of patients. The contractility of the nipple was preserved in more than 50% of cases. The mean operative time was 2,5 hours, the drains permanence and the recovery time were reduced. Postoperative complications were: a single case of partial necrosis of the nipple areola complex; a case of pathological scarring. CONCLUSION(S) Many surgical options can be used to treat gigantomastia. Thorek modified technique is still valid in selected patients and when the alternative techniques are relatively contraindicated: aged patients, jugular nipple distance greater than 35cm, comorbidities, no future breastfeeding desire.