Median Incision of the Upper Pole in Medial Pedicle Vertical Mammaplasty

Abstract

The medial pedicle is commonly employed in vertical breast reduction. With this procedure, there is concern about pedicle compression, especially in large breast reductions when a relatively large medial pedicle is rotated into a smaller sized areolar opening. The author describes a technical refinement to the vertical mammaplasty, whereby a splitting incision is made into the upper pole parenchyma that allows safe pedicle inset without any constriction by the pillar closure, while upper pole fullness is still maintained. A total of 94 patients underwent mammaplasty with the author's technique, in which a superomedial pedicle was dissected as a full-thickness flap. The excision of breast tissue was beveled (especially laterally) to treat lateral fullness, while it was maintained perpendicular to the chest wall at the areola opening to preserve upper pole fullness. A straight incision was made into the upper pole, such that the pedicle was then easily rotated to the defect, obviating the need for upper pole debulking. Resection per breast ranged from 350 to 2505 g (average, 780 g). In this series, medial pedicle vertical mammaplasty was a safe and effective operation for a wide variety of breast sizes and shapes, without any nipple-areola complex necrosis. Follow-up at an average of one year demonstrated a stable and aesthetically pleasing shape in all patients. The median incision of the upper pole adds to the safety of vertical mammaplasty by preventing medial pedicle compression. Additionally, the aesthetic outcome is improved.