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The simplified Regnault B technique

for breast reduction and mastopexy :

a single surgeon experience of 56 consecutive cases

S Tadiparthi, A Edwin, R DeBono


University Hospital North Durham, Durham, UK
Introduction
 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 Markings

3 markings with
patient standing :

4. Midline
5. Breast meridian
6. Inframammary fold - IMF
Breast markings
Sitting position Supine position
Breast markings
Final breast markings…….
Pre-operative Images

35 year old female, 36G bra size


Sternal notch to nipple distance 36cm
Appearance following breast markings
• 5 cm nipple marked
• Breast tourniquet applied (optional)
• Superior shaded area (pedicle) de-epithelialised
Superior pedicle Superior pedicle raised with a
de-epithelialised thickness of approximately 2cm
Dissection
vertically down to
chest wall beneath
the pedicle (at
level of base of
the 16 cm arc)
Triangular wedge of tissue
below and lateral to the nipple
is excised
Inferolateral wedge
of tissue excised

665 grams of tissue


removed from the
right breast
Pedicle trimmed to remove Dermis of the 16cm arc divided
excess breast tissue so the pedicle fits better on
closure
Resulting
medial and
lateral flaps
after
excision of
breast
tissue
• Drain sited • Lateral flap moved medially
• Nipple sutured in new
position – level of IMF & inferiorly
• Medial flap moved laterally
Immediate
postoperative
appearance
Results

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
Results

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
Results

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
Methods
 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
Results
 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


Procedures
 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 stay

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

 Length of stay : mean 3 days


Complications
 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


Results
 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 questionnaires

 Nipple sensation :
Normal 64%
Reduced 30%
Absent 6%

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


Conclusions
 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 you