Reduction Mammaplasty Using the Free-Nipple-Graft Vertical Technique for Severe Breast Hypertrophy: Improved Outcomes with the Superior Dermaglandular Flap

Abstract

Management of severe mammary hypertrophy is a challenge. The limitations of most dermal pedicle techniques include insufficient breast projection with severe hypertrophy. The authors have designed a free-nipple-graft vertical technique with a superior demaglandular flap to provide acceptable breast projection and an attractive, smooth breast contour for patients with severe hypertrophy and gigantomastia who are not suitable for pedicle breast reduction techniques. Reduction was performed for 24 patients with severe mammary hypertrophy between 2003 and 2009. This study evaluated patient age, cup size, mean distances from sternal notch to nipple and from nipple to inframammary fold, amount of resection, complications, and postoperative breast shape. All 24 patients were followed regularly to 1 year postoperatively. The inclusion criteria for the reported technique specified gigantomastia larger than 1,000 g per side, grade 4 breast ptosis, and increased sternal notch-to-nipple distance. The mean distance from the sternal notch to the nipple was 48.5 cm, and the mean distance from the nipple to the inframammary fold was 19.5 cm. The new nipple was positioned at a mean of 23.5 cm. The tissue excised per breast was 1,670 g. All the patients had long-lasting, pronounced nipple and adequate breast mound projection with attractive, smooth breast contours. A free-nipple graft with a superior dermaglandular flap yields a conical breast with adequate projection and fullness. Parenchyma sutures to the pectoral fascia provide long lasting results. Plastic surgeons experienced in superior pedicle breast reduction can adopt this technique easily.