Reduction Mammaplasty Using Bipedicled Dermoglandular Flaps and Free-Nipple Transplantation

Abstract

Secondary revisions due to deflation, flattening, and ptosis have been the major concerns after free-nipple breast reduction procedures. This study used a new modification of the standard technique known as the "bipedicled dermoglandular flap method" to reduce reoperation rates. A total of 24 patients were treated with the bipedicled dermoglandular free-nipple method between the years 2004 and 2008. The mean patient age was 45.6 years, and the average body mass index (BMI) was calculated as 27.8 kg/m². In contrast to the standard technique, the superior dermoglandular flap was fixed as backfolded, whereas the inferior flap was fixed directly to the pectoralis fascia together with the superior flap with polydiaxanone sutures. An average breast tissue volume of 1,736 g was removed. One case of seroma and one case of partial nipple graft loss (8%) were observed in the follow-up period. The patients were followed for an average of 32.4 months. Complications such as deflation, flattening, and Regnault's mild (1st degree), moderate (2nd degree), and severe (3rd degree) ptosis were not observed. However minimal glandular ptosis was observed in four cases (16.6%). Central peripheral minimal hypopigmentation was observed in five cases. None of these complications required reoperation. Bipedicled dermaglandular flap modification of conventional free-nipple reduction mammaplasty is a new option for reducing the probable complications of the standard technique.