Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

Abstract

Reduction mammoplasty using the inferior pedicle technique has been used for more than five decades. Without doubt, it has many advantages, especially in patients with moderate to severe macromastia. Although the esthetic outcome of reduction mammoplasty in the early postoperative period is usually satisfactory, typical esthetic drawbacks appear during the first year. These drawbacks include bottoming out, loss of superior fullness, box-shaped breasts, poor definition of the infra-mammary fold (IMF), elongation of the vertical scar, star gazing of the nipple-areola complex (NAC) and, of course, the scar burden. Parenchymal reshaping and suspension have been introduced as an additional step to eliminate the drawbacks of the inferior pedicle procedure. This is a prospective study done in a period from March 2016 to March 2018 in Kasr Al-Ainy Hospital (Cairo University hospitals) by the senior author and his team of co-authors. Reduction mammoplasty (Wise pattern) with the inferior pedicle and dermal wrap technique (using two dermal wings) was performed in 20 patients. The distance from the suprasternal notch (SSN) to the NAC was > 30 cm. The patients’ ages ranged from 28 to 55 years (average age, 39 years). Body mass index (BMI) ranged from 27 to 35 kg/m2 (average BMI, 33.3 kg/m2). The distance between the SSN and NAC ranged from 33 to 45 cm (average distance, 40 cm). The nipples were lifted by 11 to 19.5 cm. The distance from the nipple to the IMF ranged from 18 to 24 cm. This distance was reduced postoperatively to between 9 and 11.5 cm (p value < 0.001). Follow-up of the patients revealed that suspension of the breast parenchyma and plication of the dermal flap improved the esthetic results following inferior pedicle breast reduction. The addition of volumetric and geometric adjustment “preoperatively” may significantly improve the results and minimize the operative time of this relatively lengthy procedure (4–6 h for both breasts). Level of Evidence: Level IV, terapeutic study.