Combined wide excision and mastopexy/reduction mammoplasty for inframammary hidradenitis: a novel and effective approach.
Hidradenitis suppurativa is a rare chronic skin condition involving the apocrine glandular zones, which are found predominantly in the axilla and inguinoperineal regions, but have been described at other sites, including the inframammary fold. Treatment requires complex surgical intervention with wide excision of involved tissue. Inframammary hidradenitis tends to affect young women and can prove resistant even to this radical form of surgery, which often results in marked scarring and breast deformity. We therefore decided to adopt a novel approach by incorporating the wide excision of inframammary skin currently necessary in a reduction mastopexy procedure. This enables primary closure with ptosis correction and should improve cosmesis. The reduction in the depth of the inframammary fold also makes hygiene easier in the long term. During a 6-year period, five patients (mean age 27 years) have been treated by this method. All patients had long-standing hidradenitis (mean 12 years), and had been treated with several courses of antibiotics. A modified Wise pattern reduction incision was used with a minimum amount of breast tissue being removed. In each case histology was consistent with hidradenitis. All wounds healed well and to date there have been no inframammary recurrences. The success of this operation in curing inframammary hidradenitis has had a dramatic affect on the lives of these young women and underlines the need for this rare condition to be treated in a specialist centre.