Short Scar Mammaplasty in Gigantomastia: Power-Assisted-Liposuction-Mammaplasty (P.A.LM.)

Report the authors experience performing power-assisted liposuction mammaplasty (PALM) with short scars, over a period of 5 years, while demonstrating its safety and reliability as a breast reduction surgical technique. The study included 200 women (400 breasts), of which 45 secondary reduction mammaplasties. The PALM surgical technique combines breast liposuction, minimal skin undermining, and glandular resection as well as preservation of the maximal blood supply to the breast by preserving the superior, lateral, and central pedicles. Conservation of the nipple areola complex (NAC) sensation is secured by way of the lateral pedicle. A large upper-inner quadrant pocket is created to contain the transposed gland. Glandular suspension dermal-chest wall sutures are used to fix the breast, inside the created pocket, to the inner upper chest wall and to the inferior pole of the breast to recreate the inframammary fold. The mean age was 37 (range, 21–67) and mean Body Mass Index (BMI) 32 (range, 25–43). The mean nipple-sternal notch distance was 36 cm (range, 29–47 cm), the mean NAC was 16 cm (range, 10–28 cm), the mean liposuction per breast was 700 mL (range, 300–3000 mL), and the mean glandular resection per breast was 230 g (range, 40–600 g). Breast projection was maintained at 12 and 24 months follow-up appointments. Complications included wound infection (6 breasts, 1.5%), wound dehiscence (3 breasts, 0.75%), and seroma (10 breasts, 2.5%). Total areolar necrosis was not recorded in any patients, although partial areolar necrosis occurred in 2 of 200 patients (1%) and 10 patients (5%) underwent revisional surgery. The PALM technique is a safe and reliable option in breast reduction and is indicated for patients with massive breast ptosis, gigantomastia or for post-bariatric breast reduction surgery.