Bifurcated Inferior Pedicle with a Bucket-Handle Pectoralis Flap to Enhance Superior Pole Fullness in Breast-Reduction Surgery

Abstract

Introduction: Breast-reduction surgery utilizing the inferior pedicle technique is popular among breast surgeons because of its reliable areolar neurovascular preservation qualities. Although smaller, more elevated breast mounds are achieved, one shortcoming is persistent or recurrent glandular ptosis with loss of superior pole fullness (bottoming-out). A modification of the inferior pedicle technique is presented, which enhances and maintains the aesthetically desired bulk in the superior pole of the breast. Methods: After creating an inferior pedicle with a generous base width, a superior portion of the pedicle is incompletely bifurcated. The superior section of bifurcated inferior pedicle is secured superiorly high on the pectoralis fascia after passing it through a bipedicle (bucket-handle) flap of pectoralis major muscle. Result: The support afforded by the pectoralis flap to the superior section of this bifurcated inferior pedicle helps maintain the position of the superiorly placed breast parenchyma. This provides long-term superior pole fullness. Discussion: The modification is safe, and surgeons who are comfortable with the inferior pedicle technique should master it easily. The technique and surgical results are presented.