Downloaded from http://journals.lww.com/plasreconsurg by BhDMf5ePHKbH4TTImqenVAHxkFJp/XpPk1L/H3vMGwqMxG9jwOd8eJPG+b4DlKuAX44qu/vwzmc= on 07/29/2018 PLASTIC SURGERY 2013, Abstract Supplement 128 D) Scar length and T-junction tension are minimized by resecting skin excess via tailor-tacking method. Patients were selected for BMI, grade of hypertrophy and mastopexies were not included. Morphometric analysis was performed collecting mammary base width, nipple projection, NAC and IMF positions, nipple- IMF distance. Photographic documentation with overlapping images was taken before and at patient follow up at 2 weeks, 3, 6 months, and 1 year. RESULTS: Similar complication rates and nipple sensation findings were detected between the two analyzed techniques. Analysis of the morphometric changes showed statistical significance for both base width (p value<0.001) and projection (p<0.01). CONCLUSION: The ideal breast reduction technique should aim to correct the breast hypertrophy features, such as widened base and lateral slope. 3 Tessier 4 and Escoffier 5 introduced the concept of “gland suspension” with dermoglandular flaps to sustain the mammary cone. The Yin-Yang technique represents a new method of gland suspension and uses 2 dermoglandular flaps (SMP and IPLB) that embrace each other to reconstitute the Yin-Yang symbol. The statistical significance in mammary base width (p<0.001) and projection (p<0.01) shows the Yin-Yang technique to be most effective in achieving the “ideal breast shape” while also decreasing scar length and tension. REFERENCES: 1. Robbins TH. A reduction mammaplasty with the areola- nipple based on an inferior dermal pedicle. Plast Reconstr Surg. 1977;59(1):64-67. 2. Gargano F, Tessier P, Wolfe SA. Breast reduction with dermoglandular flaps: Tessier’s “total dermo- mastopexy” and the “Yin-Yang technique.” Ann Plast Surg. 2011;67(6):S42-54. 3. Brown, et al. A method of assessing female breast morphometry and its clinical applications, Br. J. Plas. Surg. 1997;100:468–479. 4. Tessier P. Total dermal mastopexy associated with the Biesenberger breast reduction—a 35 year experience. Presented at: The Congress of the Swiss Society of Breast Diseases; Lausanne, Switzerland, 1984. 5. Escoffier JB. A propos d’une technique personnelle de mammoplastie modelante. Methode de support fibro-bidermique ou de lambeaux superposes. Oral communication, IV International Congress in Plastic Surgery, Rome, Italy, 1967. Impact and Role of Subdermal Plexus in DIEP Flap Perfusion: A CT and Micro-CT Vascular Analysis Alexis Laungani, MD; Jodie A. Christner, PhD; Nirusha Lachman, PhD; Erik L. Ritman, MD, PhD; Wojciech Pawlina, MD; Michel Saint-Cyr, MD INTRODUCTION: Single stage procedures in breast reconstruction following skin sparing or nipple sparing mastectomy with free DIEP flap usually do not require a large skin paddle. The majority of the flap is thus de-epithelialized and placed under the native conserved skin. We hypothesized that the conservation of an intact dermis and it subdermal plexus plays a critical role in the overall flap perfusion, through the recruitment of indirect linking vessels. The goal of the study was to investigate and compare the vascularity of DIEP flaps harvested with intact dermis versus de-epithelialized DIEP flaps. METHODS: Twelve hemi-DIEP flaps were harvested on six fresh adult cadavers acquired through the Department of Anatomy at Mayo Clinic, Rochester MN. After flap dissection, the perforator was canulated using a 24-gauge butterfly catheter (0.7-mm diameter) (BD Insyte; Becton Dickinson S.A., Madrid, Spain). The flaps were de-epithelialized using face-lift scissors (ASSI Face Lift Supercut scissors; New York, NY). 10 flaps were flushed with warm heparinized saline. The flaps were then scanned through a 64-slices CT-Scanner (Siemens) after injection of 5cc of contrast agent (Omnipaque 180). The contrast agent was flushed out with heparinized saline and the dermis was removed from the flap with the same face-lift scissors. The flaps were then rescanned after injection of 5cc of contrast agent (Omnipaque 180). The second phase consisted in scanning the flaps through a micro-CT scanner, with a resolution allowing the visualization of subdermal plexus. 1 flap was injected with 15cc of Microfil ((Flow Tech Inc., Carver, MA), stored at 4°C during 48 hours and subsequently scanned with a micro computed tomography (micro-CT) scanner, which generates three-dimensional (3-D) images. 1 flap was processed in the same way after the dermis was removed. The three-dimensional reconstructions were then compared. RESULTS: CT-Scanner injections studies showed a significant decrease in flap perfusion after removal of the dermis. Micro- CT Scanner images showed the importance of the subdermal plexuses CONCLUSION: The dermis plays a significant role in enhancing the overall DIEP flap perfusion through the preservation of indirect linking vessels. Preservation of the DIEP flap dermis and its subdermal plexus should be considered after skin sparing mastectomy and nipple sparing mastectomy in order to potentially decrease the partial flap necrosis and flap ischemia.