Pectoral Muscle-Strap Flap Surgery, What Is It?

Hello.

I’m Shin Seung-han, director of Mams Plastic Surgery Clinic.

Today, I’d like to talk about a surgical method that uses a muscle strap to support breast tissue and fill in the upper breast volume.

Tissue rearrangement?

Its official name is the “Leviero flap.”

Some people seem to present it as a method devised to fill the upper breast.

By calling it tissue rearrangement, they talk about it as if it were a new surgical technique.

Today, I’ll take some time to look into the meaning and history of the Leviero flap, and why it is not used.

In fact, it is hard to say this is a completely new method.

It was a method presented by Dr. Leviero in 1975, so it is already a 50-year-old technique.

Of course, the background for its development was to fill the upper breast.

The surgical concept of the Leviero flap

It is based on the idea of cutting tissue from the lower part of a sagging breast and filling the upper breast with it to improve volume.

But contrary to expectations, this tissue could not simply be cut off and filled into the upper breast like an implant.

Tissue needs blood vessels to survive; if it is simply transplanted, it will become necrotic.

So the idea was to create a flap using the lower blood vessels, move it upward, and fix it in place.

At first, the moved tissue was to be sutured to the fascia for fixation, but fixing heavy tissue with sutures can be said to be impossible.

So another method was needed.

The idea then became to create part of the pectoralis major as a long band to support the tissue.

To use a metaphor, it was like using the pectoral muscle strap like a clothesline, hanging the tissue on it as if drying laundry.

When it was first introduced 50 years ago, this method was praised as a groundbreaking idea.

But the reason new things always become popular is that the advantages are seen first, while the drawbacks only become apparent later.

Disadvantages of the Leviero flap

As time passed and long-term follow-up results became available, many drawbacks of the Leviero flap began to emerge.

1. Limited distance for moving the lower flap

The goal was to fix the lower tissue as high up as possible, but that was not easy.

If you simply detach the lower tissue and move it upward, you could fill any desired area in the upper breast.

However, the problem is that for this tissue to survive after transfer, the lower blood vessels must be included.

In other words, because there is a limit to the length of the blood vessels, there is also a limit to how far the tissue can be moved.

If the tissue is moved too far upward, the blood vessels are damaged and the transferred tissue shrinks or becomes necrotic.

In conclusion, it was impossible to move the lower tissue high enough to create a new upper breast as if filling it with an implant.

2. The problem with the muscle strap that must support the tissue

The second problem is the muscle strap, in other words, the clothesline.

The line that was supposed to support the tissue was not a sturdy nylon cord, but soft muscle.

Because this soft line could not support heavy tissue, it would stretch over time and the breast would sag again.

3. The background behind the creation of the Leviero flap

The third problem is related to the background behind this technique.

Basically, this method was developed mainly for lifting rather than reduction, and it was designed with the intention of moving tissue that would otherwise be wasted as much as possible upward.

However, while it was useful for smaller volumes, it was not sufficient for moving larger volumes.

Also, if there is a limit to the flap’s movement distance anyway, then in a large breast it would simply be better to leave more upper tissue in place.

There was no need to forcefully pull up lower tissue whose survival was uncertain just to fill the area.

For these reasons, the Leviero flap was useful in some lifting procedures, but in today’s reduction surgeries it has been pushed out of the mainstream.

One thing I would like to add is the name of the procedure.

In fact, many places attach their own names to existing surgical methods and present them as if they developed a new technique.

Naming the Leviero flap as tissue rearrangement is actually not appropriate when considering its original meaning and its prior usage.

“Medicine is a discipline, not a technique.”

Even though there is an official name, I do not think it is right to arbitrarily change the name of a surgical method.

I hope that those who undergo surgery will also be aware of this.

I ask for your caution and attention.

This has been Shin Seung-han, director of Mams Plastic Surgery Clinic.

Thank you.