Narrow inferior-central septum–based pedicle: A safe technique to improve aesthetic outcomes in breast reduction

Abstract

Inferior-central pedicle has some aesthetic drawbacks, including hypertrophic scar along the inframammary fold (IMF), squaring of the breast contours, and propensity to develop long-term 'bottoming-out.' This study aimed to verify if the narrow inferior-central (NIC) septum-based pedicle can allow the surgeon to improve aesthetic outcomes compared with the traditional inferior-central pedicle approach. Forty breasts underwent NIC-based breast reduction (group A), and 37 underwent traditional inferior-central pedicles (group B). The NIC pedicle was drawn with a width of 3.5-4.5cm. The recorded measurements were sternal notch to nipple distance (S-N) and nipple to IMF distance (N-IMF) at the time of preoperative markings and follow-up 1, 6, and 18 months after the procedure. The two groups were homogeneous regarding demographics, operative data, and preoperative S-N and N-IMF distances. Both groups showed no total or partial nipple-areola necrosis. At the 18-month follow-up, S-N (p<0.00001) and N-IMF (p=0.00039) distances were statistically different between the two groups, in favour of NIC group A. Changes in N-IMF distances between the 1- and 18-month visits were statistically different among groups (p<0.0001), with a length variation of +17.51% and +28.46%, respectively. Patient satisfaction rate regarding "breast shape" (p=0.021), "lower pole appearance" (p=0.00017), and "scar" (p=0.047) were higher in group A. NIC-based pedicle proved to be a safe procedure and allowed us to overcome limitations that typically characterise the inferior pedicle, i.e., 'bottoming-out' deformity, hypertrophic scar of the lower pole, and squaring of the breast contours. II.