Superior pedicle reduction mammoplasty supported by central glandular pedicle

Abstract

Abstract Objectives: To evaluate effect of supporting superior pedicle by central glandular pedicle in reduction mammoplasty in improving aesthetic outcome and reducing the incidence of nipple areola necrosis and postoperative NAC loss of sensation.Background: Superior pedicle reduction mammoplasty provides good aesthetic outcome, but has high possibility of nipple areola complex loss of sensation, therefor keeping the central glandular portion as support to superior pedicle ensures good blood and sensory supply to NAC Methods: This study included 37 patients presented by breasts hypertrophy from March 2019 to March 2021. All patients’ breasts were examined for suprasternal notch to nipple distance, areolar diameter, nipple to infra mammary fold distance. Postoperative assessment included: Nipple areola complex vascularity, nipple areola complex sensitivity and patients’ satisfaction about breast contour, projection, symmetry, scars and overall aesthetic outcome using a score out of 4. Patients underwent marking using wise pattern for skin incision. Intraoperative; excision of skin, fat and glandular tissue inferior to NAC, starting from skin and went directly to chest wall keeping central breast mound with the superior pedicle. Finally closure was in vertical or inverted T pattern according to skin excess to be removed. Results: In this study we operated upon 37 patients who were asking for breast reduction aged between 20 and 57 years with mean age 39.6 years. The overall complication percentage 14.8% excluding poor scarring. We had no cases of total Nipple areola complex loss, low incidence of nipple areola complex persistent reduced sensation after 1 year of follow up (2.7%) and no complete loss of sensation in any patient. Aesthetic outcome accepted by 97.3% of patients. Conclusion: Superior pedicle reduction mammoplasty supported by central glandular pedicle helps in ensuring reliable blood perfusion and sensory nerve supply to nipple areola complex which reduces possibility of post-operative nipple areola complex necrosis and loss of sensation, while patient gets pleasant and long standing aesthetic outcome. Key words: superior pedicle - reduction- mammoplasty- supported by – central – glandular - pedicle