Inferior Pedicle Breast Reduction Research Articles

Feasibility and Safety of Superomedial Pedicle for Breast Reduction in Geriatric Patients

Introduction Historically, inferior breast reduction is more commonly performed overall and this applies to the elder population. No study to this date has compared whether there is any difference in complications and overall safety between when using superomedial pedicle and inferior pedicle in geriatric patients and furthermore whether the safety profile of superomedial pedicle differs when compared to general population.MethodsPatient files of women who had undergone breast reduction by a single surgeon over a 9 year period (2015–2023) was reviewed retrospectively. Patients over 65 years old at the time of surgery were selected as the main study group. Results were compared to a control group aged 65 years and younger consisting of 136 patients, who also had a breast reduction by the same surgeon.ResultsFifty-four women met the inclusion criteria for the study group and they were further broken down into two subgroups; inferior and superomedial pedicle groups with 25 and 29 patients into each group, respectively. The mean age at the time of the operation was 67.8 years. Geriatric group had more significant comorbidities (37% vs. 9%, p<0.05). Looking solely on patients undergone superomedial pedicle breast reduction, OR times were similar between two age groups and hospital stay was slightly longer in the geriatric population albeit statistically insignificant. The average weight of specimens resected from each breast was 592.4 gr in geriatric population and slightly higher in the younger population with an average weight of 624 grams (p=0.27). Two women in the geriatric group and six women in the non-geriatric group developed major complications where superomedial pedicle was utilized, no meaningful difference was seen when major complications were compared (p=0.24). On the other hand, minor complications were significantly higher in the geriatric population compared to the younger cohort regarding superomedial pedicle reductions (p=0.02). ‘Satisfaction with breasts’ scores of BreastQ from the superomedial breast reduction subgroup was slightly higher than inferior pedicle breast reduction subgroup in geriatric population and it was statistically significant (0.032).ConclusionSafety margins and satisfaction scores of superomedial pedicled breast reduction in geriatric patients seem similar to their younger counterparts. Furthermore, with similar complication rates and with its slightly higher ‘Satisfaction with breasts’ scores when compared to inferior pedicle, superomedial pedicled breast reduction technique can be utilized without reservation in geriatric candidates for breast reduction.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

D161. Prospective Morphometric Study between Yin-yang And Inferior Pedicle Breast Reduction Techniques

D161. Prospective Morphometric Study between Yin-yang And Inferior Pedicle Breast Reduction Techniques

Inferior pedicle breast reduction in Egyptian research: A meta-analysis study

Background: Macromastia or breast hypertrophy is a common problem in the general female population, leading to debilitating symptoms and poor quality of life. Breast reduction surgery relieves disabling symptoms with great satisfaction, even though postoperative complications regularly occur.

Effects of Comorbidities on the Inferior Pedicle Reduction Mammaplasty: A Statistical Analysis.

Multiple studies have analyzed the impact of comorbidities on breast reduction surgery with mixed results. The purpose of this investigation was to perform a statistical analysis of all complications by a single surgeon, using a single technique for breast reduction. Records of patients undergoing breast reduction from 1984 to 2019 with an inferior pedicle were reviewed. Comorbidities analyzed included hypertension, diabetes, nicotine use, weight of breast tissue resected, pedicle length, and basal metabolic index. The literature on the effects of comorbidities on outcomes for breast reconstruction was also reviewed. Although increasing body mass index significantly increased the rate of fat necrosis, it did not impact those patients requiring reoperation for this complication. Body mass index greater than 35 kg/m 2 , weight of tissue resection greater than 1000 g, and nipple-to-inframammary fold distance greater than 20 cm all increased the odds ratio of having a breast with some fat necrosis. Increasing body mass index increased the risk of wound healing problems (both major and minor), but not for patients requiring reoperation. Body mass index greater than 35 kg/m 2 , breast tissue resection greater than 1000 g, and nipple-to-inframammary fold distance greater than 20 cm only minimally increased the odds ratio for a major wound complication. Patients with increased body mass index are at greater risk for fat necrosis and wound healing complications. However, these usually can be managed conservatively in patients undergoing inferior pedicle breast reduction. Patients do not require free nipple grafting. The use of nicotine or the presence of diabetes or hypertension does not impact outcome. Risk, III.

Value of Triplicated Inferior Pedicle Breast Reduction in Improving Cosmetic Outcome in Upper Outer Quadrant Breast Cancer Patients

Abstract Background: Breast is the true mirror of femininity. Breast cancer is one of the diseases that affect the psychological state of women, not only because of the complications it entails, but also because of the negative impact of treatment on women psychologically and physically. Aim of Study: The aim of this work is to assess the effect of triplicated inferior pedicle technique on improving cosmetic outcome in patients with breast cancer in upper outer quadrant. Patients and Methods: This study conducted at Ain Shams University hospitals, starting January 2020 till May 2020 with follow up 6 months.The study include 15 patients from 30- 50 year. This prospective study started with 15 Female patients with breast cancer in upper outer quadrant or upper pole lesion. During the period of the study at Ain-Shams University Hospitals. The data was collected and presented as followed in several tables and figures. Results: In our study the mean value of immediate post-operative SN-N was 21cm. After 6 months the mean value of postoperative SN-N was 21.5cm. In the current study the mean value of preoperative inframammary fold- nipple distance (IMF-N) was 17.27cm. In our study mean value of immediate postoperative IMF-N was 7.33cm, and After 6 months the mean value of postoperative IMF-N was 8cm. So, triplicated inferior pedicle is to obtain the benefits and avoid the most annoying complication and maintain the shape of breast after breast reduction without significant difference in postoperative complications. Conclusion: Breast reduction is a procedure, which has evolved tremendously over the years due to the continuous and ongoing quest to achieve the objective of reducing the breast size, improving breast shape and relocating the nipple areola complex, while minimizing scars and also preserving lactation and innervation to the nipple-areola complex.

The Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt

Background: The inferior pedicle wise pattern breastreduction is one of the most popular techniques used. However,a major criticism of inferior pedicle technique is bottomingout of the breast and lack of upper pole fullness. This is causedby gravitational pressure of the breast parenchyma/pedicleon the inferior pole with subsequent scaphoid appearance inthe upper pole and lengthening of the vertical scar. In thisstudy, a modification of the inferior pedicle technique will bedone by creation of two lateral dermal flaps alongside withthe inferior pedicle, and using these flaps to suspend thepedicle to the chest wall and prevent its descent to evaluateits effect on prevention of bottoming out of the breast.Patients and Methods: This is a prospective randomizedstudy that included 20 healthy female patients suffering frombreast hypertrophy and they are candidate for reductionmammoplasty by the proposed technique. Design of skinmarking for inferior pedicle breast reduction technique wascarried out with the standard wise pattern with the creationof two wings (medial and lateral) at the middle of the inferiorpedicle; composed of de-epithelialized dermal flaps. Buttressingthese two wings to the pectoral fascia at the suitabledistances would create a sort of an internal bra effect; whichsupports the inferior pedicle. During the follow up, the lengthof the vertical scar (as an indicator of bottoming out) wasmeasured immediately postoperative and every 3 months inthe follow-up period. Results: This study includes 20 female patients of an ageranged between 22-51 years old and a breast size (suprasternalnotch to nipple distance) ranging from 31 to 44cm. The followupfor 1-year post-operative shows change in the areola tofold distance by a ratio satisfaction reaching 60%.Conclusion: From this study we concluded that the inferiorpedicle suspension to pectoral fascia improve the result shapeof the breast and decrease the bottoming out of the breast.

Inferior pedicle breast reduction and long nipple-to-inframammary fold distance: How long is safe?

BackgroundFree nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle. MethodsA retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis. ResultsOverall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16–48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5–27). The mean resection weight was 699.6 g (SD:310.4; r:125–2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8–9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88–1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001–1.005), adjusting for N-IMF and SNN distances. ConclusionInferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.

Effect of Tumescent Lidocaine and Epinephrine Infiltration on Blood Loss in Inferior Pedicle Wise-Pattern Breast Reduction: A Prospective Randomized Study.

The idea of infiltrating epinephrine-containing solution in reduction mammoplasty with the aim of reducing blood loss dates back to 1985. Although its use is fairly common among surgeons, scientific evidence supporting such use has been feeble and inconsistent. Therefore, we aimed to investigate the effects of tumescent infiltration of lidocaine- and epinephrine-containing solution on blood loss in reduction mammoplasty. A prospective, randomized, double-blinded study is planned. Forty patients admitted to our clinic for mammary hypertrophy are randomly assigned to experiment and control groups, each of a size of 20 patients. Control group underwent conventional Wise-pattern, inferior pedicle breast reduction, whereas experiment group received tumescent fluid infiltration 20min prior to making of the incisions. Data including age, body mass index (BMI), comorbidities, operative time, length of hospitalization along with preoperative, postoperative 2nd and 12th hour complete blood counts are recorded for each patient and compared between groups. Data analysis showed no significant difference between groups in terms of age, BMI, comorbidities or preoperative hematocrit levels. Operative time and hospitalization were significantly shorter in experiment group (p < 0.05*). The drop in hematocrit level in both the 2nd (4.93 ± 2.44% to 15.53 ± 7.17%) and 12th hour (9.4 ± 6.79 compared to 21.28 ± 10.15) was lower in the experiment group (p < 0.01*). A multiple variate analysis incorporating preoperative, postoperative 2nd and 12th hour hematocrit levels demonstrated a significant reduction in blood loss with the use of tumescent infiltration (Wilks' lambda F = 12.84, p < 0.01*). Multiple regression analysis revealed age, BMI, comorbidities, preoperative hematocrit levels and hospitalization did not affect postoperative blood loss (p > 0.05). Duration of operation, however, seemed to affect amount of blood loss postoperatively (p < 0.05*). With outcomes obtained from this study, it is clearly shown that tumescent infiltration significantly reduces blood loss in Wise-pattern, inferior pedicle breast reduction. Furthermore, tumescent infiltration is also shown to decrease operative time and length of hospital stay. EBM LEVEL II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Transverse Scar Breast Reduction Technique with Suspended Dermal Slings for Correction of Severe Breast Ptosis and Macromastia

Introduction: Visible scarring over the breast mound isa disadvantage of the classic inverted-T breast reductiontechnique. The transverse scar breast reduction (TSBR) techniquewith suspended dermal slings limits the scar formationto the hidden inframammary crease.Patients and Methods: Sixteen female were included inthis study. We used the TSBR technique with suspendeddermal slings for correction of severe breast enlargement andbreast ptosis. Early postoperative complications were recorded.After 2 years, patients’ satisfaction about the surgery wasanalyzed.Results: All cases showed complete wound healing withintwo weeks except one case who showed partial ischemia ofthe nipple areola complex, which was managed successfullyby dressing changes. Regarding late complications, two casesshowed fat necrosis. However, overall patients’ satisfactionwas high.Discussion: Many surgeons use the technique of wisepattern inferior pedicle breast reduction for correction of hugebreasts with severe ptosis. Vertical scar breast reductiontechnique is not best indicated for correction of such condition.Transverse scar breast reduction limited the scars of thesurgery to the hidden inframammary fold and achieved stableand accepted results.Conclusion: Transverse scar breast reduction with suspendeddermal slings corrected huge breast enlargement andsever breast ptosis with a concealed scar restricted to theinframammary crease. Patients’ satisfaction about the outcomeof surgery was high after 2 years of follow-up.

Management of Recurrent Symptomatic Macromastia: A Single Surgeon’s Experience

Abstract Background Breast reduction for symptomatic macromastia can have excellent long-term results and relief of symptoms. However, patients may require a re-reduction for recurrent symptoms. Previous reports of re-reduction after a primary inferior pedicle reduction have called into question the safety of blood supply to the nipple-areola complex with re-reduction. Objectives To examine a single surgeon’s experience and management of recurrent symptomatic macromastia after inferior pedicle breast reduction. Methods A retrospective review was performed of a single surgeon’s breast reduction experience using billing data to identify cases of breast re-reduction from January 2003 and January 2018. Breast re-reduction was performed either with a Wise pattern, inferior pedicle or with a smile reduction with an inferior pedicle. Liposuction was used in re-reductions only. Results In 15 years, 3530 breast reductions were performed in 1758 patients. In 7 patients, 14 total re-reductions were performed, including 13 secondary breast re-reductions (12 bilateral, 1 unilateral) and 1 tertiary, unilateral breast re-reduction. Seven Wise pattern, inferior pedicle and 7 smile reductions with inferior pedicle procedures were done at the breast level. This translates to a re-reduction incidence of 1 in 250 or 0.4% rate of re-reduction at the patient level in our practice. The minor complication rate was 14% (1 seroma), and the major complication rate was 0%. There were no instances of partial or complete nipple areola necrosis. Conclusions Recurrent symptomatic macromastia can be managed with re-reduction with re-creation of the inferior pedicle or a smile breast reduction as we describe without increased risk to nipple-areolar complex viability. Level of Evidence: 4

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

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.

A Novel Technique for Correction of Bottoming Out Following Inferior Pedicle Breast Reduction

Introduction: Bottoming out is a frequent pitfall of breastreduction following inferior pedicle technique. This is attributedto the lack of deep tissue suspension and skin enveloperelaxation. The condition is associated with lack of medialfullness and poor projection. The authors present a newtechnique that depends on redistribution and auto-augmentationrather than resection of tissues.Patients and Methods: The technique was performed in25 patients who had bottoming out following inferior pediclebreast reduction. The time elapsed from the primary surgeryto the corrective surgery ranged from 2 to 4.5 years with amean of 2.5 years. The used technique consists of deepithelializationand complete division of the lower segment at theinfra-mammary fold. The divided lower dermoglandularsegment is rolled in a retromammary pocket underneath thepedicle and fixed to the pectoral fascia. The idea is to use thislower segment of the inferior pedicle as an auto-prosthesis.Follow-up period is 12 months.Results: All patients achieved good breast shape withgood projection. There were no serious complications. Onlytwo patients developed partial wound disruption.Conclusion: A novel technique for correction of bottomingout following inferior pedicle breast reduction was used withgood surgical outcome

Comparison of Sensory Changes Following Superomedial and Inferior Pedicle Breast Reduction.

Comparison of Sensory Changes Following Superomedial and Inferior Pedicle Breast Reduction.

Reduction mammoplasty techniques in post-bariatric patients: our experience.

Background and aim of the work:Excessive body weight represents a huge problem affecting a wide part of world population, causing significant physical and psychological consequences. To solve their obesity-related problems, patients should begin a bariatric treatment to lose an adequate percentage of their body mass and therefore, they should be subjected to body contouring surgery. In this article we describe our experience in applying breast remodeling techniques to post-bariatric patients.Methods:We did a retrospective study on our post-bariatric patients subjected to breast reduction and/or mastopexy during a five-years period, considering breast features, kind of surgery performed, aesthetic and psychological outcomes and postoperative complications.Results:Thirty-six post-bariatric patients underwent breast surgery in our unit between 2010 and 2015; their average age was 43 years. The follow up period ranged from 6 months to 4 years and an half. The most frequent surgical techniques performed were Thorek and inferior pedicle breast reduction. The prevalent complications observed were surgical wound delayed healing and nipple-areolar complex (NAC) partial or complete necrosis as immediate ones and unfavorable scarring as delayed ones.Conclusions:Breast reshaping after a massive loss of weight should be forerun by an accurate analysis of breast volume, shape and ptosis degree, in order to obtain optimal results both for the surgeon and the patient. (www.actabiomedica.it)

Inferior Pedicle Breast Reduction for the Management of Gestational Gigantomastia: Literature Review and a Case Presentation

Background: The actual cause of Gestational gigantomastia (Gg) remains a dilemma. Its treatment has ideally been surgical, employing most commonly the different pedicle techniques in the last decade. Aim: This paper reviews the literature on the management of Gg using the inferior pedicle technique (IPT) and supports it with a successful case presentation using the IPT. Method: Using the PubMed search engine and Google scholar, literature search was done for Gg treated with the inferior pedicle reduction method. Published literature from other sources was also included. Data obtained was cleaned and analysed. The inferior pedicle breast reduction technique was employed without any modification in the normal procedure for the case presented. Results: Thirty-one literature addressing Gg and IPT were identified. Most surgeons use this technique with very good outcomes. Our patient confirmed reduced breast mould, firm and adolescent looking breast with no back, shoulder, neck and rib pains. She also experienced with time increased nipple areolar sensation, ability to undertake all tasks with ease and a new sense of confidence. Conclusion: The inferior pedicle breast reduction technique can be the standard treatment for gestational gigantomastia with the length from suprasternal notch to the nipple ≤ 50 cm that present without any anatomical complications.

Four flap suspension technique for prevention of bottoming out after breast reduction.

PurposeBottoming-out deformity is accepted as the most important disadvantage of inferior pedicle breast reduction. For prevention of this deformity, different techniques are used in combination with inferior pedicle. In this study, we aimed to prevent bottoming-out deformity by producing an internal bra effect through combination of inferior pedicle technique with 2 superior and 2 inferior dermal flaps that were raised from each side of the pedicle.MethodsThirteen patients whose medical records became available during the follow-up period at Ankara Training and Research Hospital from January 2010 to January 2015 were included in this study. We retrospectively obtained patient medical records including demographic characteristics and clinical data. Superior dermal flaps were planned on both sides of the pedicle 2 cm inferior to the lower border of areola and inferior dermal flaps were planned 6 cm inferior to the superior dermal flaps. The superior and inferior dermal flaps were secured to the periosteum of the 2nd and 4th ribs respectively with permanent sutures.ResultsPreoperatively, the average distance between the inframammary fold and areola was 13.9 cm (range, 11-18 cm). The average amount of breast parenchymal resection was 745 g (range, 612-1,496 g). The average distance between the inframammary fold and the lower border of the areola was 7.9 cm (range, 7.5-9 cm) on the postoperative first-year measurements.ConclusionIn conclusion, according to our study, suspension technique to prevent bottoming-out deformity is associated with an easier technique without the need for alloplastic or allogenic materials. Since fixation is performed to the ribs instead of soft tissues like the pectoral fascia or muscle, we believe that this fixation is more long lasting and can be an effective alternative to other suspension techniques.

''The dermal internal brassiere flap,'' a new modification of inferior pedicle breast reduction technic.

The inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation. A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests. The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p < 0.0001). The preoperative mean nipple pressure threshold value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p < 0.0001) There were no patients determined as having bottoming-out deformity. No breast asymmetry was encountered at the late follow-up period. All patients, except the scarred ones, were satisfied with the results. In this study, we achieved an internal fascial reconstruction using a pair of triangular and quadrangular dermal flaps suspended to the rib periosteum. We believe that our modifications will contribute to decreasing the disadvantages of the inferior pedicle breast reduction technique. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The “Dermal Cage”: A Modification of the Inferior Pedicle Breast Reduction

In spite of more recent techniques for breast reduction, the inferior pedicle technique has proven to be enduring and still a very popular option in the plastic surgeon's armamentarium despite certain shortcomings. This technique is especially important for treating large breasts with a long sternal notch-to-nipple distance. The modifications we describe in this article overcome some of the main drawbacks of the standard inferior pedicle technique and make the procedure particularly effective when used on appropriately selected patients. This is achieved principally by the creation of a strong, durable, and internalized "dermal cage" that remains fixed to the chest wall in the upper part, as well as on both sides, to support the majority of the remaining breast tissue. This serves several purposes, including narrowing the breast thereby giving good projection and reduction of the N-IMF length of the inferior pedicle. Through suspension and fixation of the inferior pedicle to the chest wall, one can mitigate the effects of gravity on the inferior pedicle. The benefits of this include reduced tension on the T junction, thereby reducing the incidence of wound dehiscence in the immediate postoperative period, while reduction of tension on the nipple-areola complex reduces "bottoming" out over the long term. This process has been the main shortcoming of the inferior pedicle technique to date. The technique was used on 26 patients over a 7-year period with a mean long-term follow-up of 41months. The results demonstrate the short- and long-term effectiveness of our own particular combination of modifications to previously described techniques and modifications of the inferior pedicle breast reduction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Laser-evoked potentials as a novel tool for sensibility assessment following inferior pedicle breast reduction

Nipple-areola complex numbness is common following breast reduction with most techniques. The aim of our study was to objectively quantify specific sensory outcomes before and after inferior pedicle breast reduction with two combined neurophysiological methods: dermatomal somatosensory evoked potentials (D-SEPs) and laser-evocated potentials (LEPs). Patients’ subjective breast sensation was assessed preoperatively and postoperatively by accurate clinical examinations. Thirty patients underwent quantitative measurements preoperatively and at 3 and 6 months following inferior pedicle breast reduction to assess tactile and vibratory sensitivity (D-SEP recordings) and painful and thermic sensitivity (LEP recordings). The collected data did not reveal significant differences in D-SEP latencies or amplitudes between preoperative and postoperative evaluations following inferior pedicle breast reduction. However, LEP data showed significant alterations in latency and amplitude in accordance with clinical examinations. This study provides the basis for a new approach to selectively investigate painful and thermic sensitivity, which is necessary to find the best technique to preserve breast sensitivity. This study also provides the first objective neurophysiologic evidence of breast sensitivity modifications and introduces a new technique that provides a simple, inexpensive, and dependable investigative tool for breast sensitivity assessment in breast surgery. Level of Evidence: Level III, diagnostic study

Inferior pedicle breast reduction: a retrospective review of technical modifications influencing patient safety, operative efficiency, and postoperative outcomes

BackgroundThe inferior pedicle technique remains the most popular approach to breast reduction in the United States. Modifications to this procedure have enhanced versatility, patient safety, and outcome satisfaction in patients with all degrees of macromastia. MethodsA 6-year retrospective review of 241 patients who underwent bilateral inferior pedicle breast reduction was conducted at our institution. Modifications analyzed included methylene blue tattooing to provide preoperative landmarks, preoperative hydrodissection to reduce intraoperative blood loss, incorporation of inframammary darting to reduce tension at the “T-junction,” preservation of superomedial volume for enhanced medial fullness, and dermatome blade–guided tissue resection. ResultsInframammary darting reduced the incidence of wound dehiscence. Preoperative hydrodissection reduced intraoperative blood loss by a factor of 2. Dermatome blade use reduced operative times at no increased incidence of postoperative seromas or hematomas. ConclusionsOutcomes resulting from these modifications appear to be at least comparable to, and perhaps better than, those previously reported.