Split Mammary Gland Retromuscular Technique Mammoplasty: Solution to Avoid Waterfall and Improve Breast Reduction Outcome Longevity.

Maintaining optimal mammoplasty outcomes remains a significant challenge for surgeons. Complaints such as early ptosis, waterfall, and double-bubble deformities can compromise the longevity of aesthetic outcomes. This surgical report describes the split mammary gland retromuscular technique (SMART) mammoplasty, a novel approach aimed at preventing early glandular descent and waterfall deformity and ensuring long-term aesthetic results. This technique involves splitting the mammary gland pillars into deep and superficial layers along the coronal plane in a superior pedicle mammoplasty, transposing the deep layer of the gland into a submuscular pectoralis major strip, and using the superficial layers for breast closure.