Superomedial Pedicle Research Articles

A Matched Cohort Study of Superomedial Pedicle Vertical Scar Breast Reduction (100 Breasts) and Traditional Inferior Pedicle Wise-Pattern Reduction (100 Breasts)

The superomedial pedicle vertical scar breast reduction is gaining popularity for its round, projecting breast and shorter incision when compared with the traditional Wise-pattern reduction using an inferior pedicle. However, there is a paucity of large-volume institutional outcomes studies identifying how this technique fares against more traditional methods of reduction. A retrospective review of a prospectively maintained database of bilateral breast reductions over a 3-year period was performed. One hundred superomedial breast reductions (50 patients) were matched to 100 inferior pedicle breast reductions (50 patients). Matching was implemented based on age (±3 years) and size of reduction (±200 g). Patient demographics, size of reduction, nipple-areola complex sensitivity, minor and major postoperative complications, and symptomatic relief were assessed. Statistical analysis was performed with SAS Version 9.2. Two hundred twelve patients underwent 424 bilateral breast reductions between January of 2009 and June of 2012 at a single institution. Mean volume of tissue reduced was 815 g per breast (range, 200 to 2068 g) and 840 g per breast (range, 250 to 2014 g), respectively. All patients achieved symptomatic relief. No statistical difference in major or minor complications was seen between the two cohorts. No statistical difference in major or minor complications was seen between the two cohorts. No significant difference in complications was seen between small- and large-volume reductions. Superomedial pedicle vertical scar breast reduction is a novel, alternative mammaplasty technique with excellent functional and aesthetic outcomes which can be used for a wide range of macromastia without a significant difference in complication rates when compared with traditional Wise pattern inferior pedicle reduction mammaplasty. Therapeutic, III.

Surgical Outcomes of Gigantomastia Breast Reduction Superomedial Pedicle Technique

Reduction mammoplasty in patients with gigantomastia can prove a challenge for the plastic surgeon. Although several techniques have been described to reduce these very large breasts, they can often result in compromise of the nipple-areola complex (NAC), including necrosis, decreased sensation, and inability to breastfeed. The superomedial pedicle (SMP) reduction mammoplasty technique has been demonstrated as a safe and effective method of reduction in cases of mild to moderate hypertrophy. The aim of this study was to determine the risks of SMP in patients with gigantomastia (resection weight >1000 g/breast) at our institution. A retrospective study of all patients who underwent reduction mammoplasty with SMP technique by 8 surgeons at a single institution between 1999 and 2011 was performed. Patient demographics, preoperative breast measurements, and perioperative data were analyzed. Exclusion criteria were a reduction mammoplasty specimen weight of less than 1000 g. Our results show that 200 of 1750 patients who underwent SMP during the study period met the criteria. The average age at the time of the reduction was 39 years. The average body mass index was 36 kg/m. The average sternal notch to nipple distance was 35.5 cm for the right breast and 35.6 cm for the left breast. Average breast resection weight was 1277 g for the right and 1283 g for the left. Average NAC transposition was 11.25 cm for the right breast and 11.40 cm for the left breast. Twenty-one (10.5%) patients experienced partial necrosis of the NAC and 98% of the patients subjectively reported normal NAC sensation postoperatively. All patients exhibited good breast shape and projection postoperatively. Our study shows that SMP reduction mammoplasty in patients with gigantomastia is a safe and effective reduction mammoplasty technique and is associated with low risk for NAC necrosis with good breast shape.

Lowering Revision Rates in Medial Pedicle Breast Reduction by the Selective Addition of “Inverted-T” Technique

The superomedial pedicle vertical-scar breast reduction is an effective technique, but high revision rates have been reported. The purpose of this study is to determine if revision rates can be lowered by the rational use of an inverted-T technique in a subset of patients who undergo superomedial pedicle reduction. Records were reviewed of 127 breast reductions performed between 2002 and 2011. Group 1 (2002-2007) consisted of 51 patients who underwent a superomedial pedicle vertical-scar reduction. Four of these patients (8%) required a subsequent revision. Based on this, indications were adopted where vertical-scar reductions were performed in patients with proposed nipple position to inframammary fold (PNP-IMF) distances of less than 22 cm, with the remainder undergoing reduction with a superomedial pedicle and inverted-T skin resection pattern. In Group 2 (2008-2011), there were 41 vertical reductions and 35 "hybrid" reductions. Age, BMI, preoperative medical conditions, and reduction size did not differ significantly between the two groups. Nine patients in Group 1 (18%) experienced one or more minor complications, as did 12 patients in Group 2 (16%), (p=0.62). There were four revisions in Group 1 (8%) and none in Group 2 (p<0.001). Mean operative time was 177 min in Group 1 compared to 136 min in Group 2 (p<0.001). Breast reduction employing a superomedial pedicle can be used effectively in a wide range of patients. Revision rates can be reduced by employing an inverted-T skin resection in patients with a long PNP-IMF distance, while not significantly increasing complication rates or operative time. 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 .

Reduction Mammaplasty as a Treatment Option for Early Breast Cancer

Background: Although reduction mammaplasty is a well-known technique for cosmetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. Mammaplasty combined with breast conservation surgery is an effective treatment of early breast cancer, and leads to better overall results and superior quality of life in patients with previous macromastia or ptosis. Our aim is to analyze both the aesthetic and oncologic outcome of reduction mammaplasty combined with conservative breast surgery reconstruction. Patient and Methods: 25 patients with stage 1 or 2 breast cancer, with a tumor size not more than 3 cmin its greatest dimension, were operated upon by quadrantectomy, and bilateral reduction mammaplasty. Oncologic data on tumor size, location, and axillary lymph node, were assessed, and accordingly the design of the pedicle was chosen. Reconstructed breast and opposite breast reduction were evaluated. Results: Of the total 50 breast reductions techniques, 35 (70 percent) were superomedial pedicle, 4 (8 percent) were superior, 3 (6 percent) were superolateral, and 8 (16 percent) were inferior. The cosmetic result was considered to be good or very good in 18 cases, satisfactory in 6 cases, and poor in 1 case. There were no other complications as regard nipple areola ischemia, heamatoma, seroma, wound problems, fat necrosis, or recurrence in any of the cases. Conclusion: By adding breast reduction and other plastic surgery techniques to breast conservation, patients have the opportunity for an improved cosmetic outcome and overall improved quality of life. Although the combined approach between the oncologic surgeon and the plastic surgeon requires more preoperative planning and intraoperative care, the concept can reduce deformities, favor the oncologic treatment, and optimize the aesthetic outcome in most early-stage cancer patients.

The Extended Superomedial Pedicle: Advancing Mammaplasty Techniques

Many variations can be applied to traditional mammoplasty techniques to improve outcomes in certain situations. The purpose of this report was to demonstrate the indications and benefits of mammoplasty autoaugmentation using an extended superomedial pedicle. All patients who underwent transfer of an extended superopedicleto other parts of the breast for autoaugmentation were included. Indications were determined and outcomes were assessed. Forty-eight patients were included in the series. The average follow-up was 2.1 years. Indications were categorized into reconstruction of a partial mastectomy defect (oncoplastic group, n = 18), upper pole volume in the contralateral mastopexy (implant reconstruction group, n = 9), and volume improvement and suspension (massive weight loss group, n = 21). The overall complication rate was 15% (n = 7/48), with a revision rate of 10% (5/48). The extended superomedial pedicle is a reliable and versatile adjunct to regular mastopexy techniques for various indications. It gives us the ability to transfer vascularized tissue from the lower pole to areas that require autoaugmentation.

Tratamento da ptose mamária e hipomastia utilizando técnica de mamoplastia com pedículo súpero-medial e implante mamário

INTRODUCAO: O tratamento da ptose mamaria com hipomastia utilizando tecnica de mastopexia associada a implante mamario em um tempo cirurgico e frequentemente associado a potenciais complicacoes mais graves do que quando se utilizam os metodos separadamente. Na literatura, a incidencia relatada de complicacoes e semelhante a de procedimentos realizados em dois tempos cirurgicos. Varios autores descrevem padronizacoes e cuidados especificos que possibilitam a utilizacao dessa combinacao de tecnicas com seguranca. O objetivo deste trabalho e relatar tecnica operatoria para aumento mamario em pacientes com ptoses mamarias, analisando a incidencia de complicacoes e revisoes cirurgicas. METODO: Foi avaliada a incidencia de complicacoes e revisoes cirurgicas de 27 pacientes submetidas a mastopexia com implante mamario em um tempo cirurgico utilizando tecnica de pediculo supero-medial, operadas entre 2005 e 2010. RESULTADOS: Nao foram observadas complicacoes imediatas que levassem a reoperacoes precoces. Tres (11,1%) pacientes apresentaram pequenas deiscencias de sutura na juncao do T invertido, com resolucao espontânea. Uma (3,7%) paciente apresentou contratura capsular, 1 ano apos a operacao. Quatro (14,8%) pacientes foram submetidas a revisoes cirurgicas de cicatrizes. Historia previa de tabagismo aumentou em 4 vezes a incidencia de deiscencias de suturas e, em 2 vezes, o indice de revisoes cirurgicas de cicatrizes, porem sem diferenca estatisticamente significante. CONCLUSOES: A tecnica de mastopexia associada a implante mamario utilizando tecnica de pediculo supero-medial foi eficaz e segura para o tratamento da ptose mamaria com hipomastia.

Three Dimensional Analysis of Early Post-Operative Volumetric and Morphologic Changes Following Vertical Reduction Mammoplasty Using a Superomedial Pedicle

Three Dimensional Analysis of Early Post-Operative Volumetric and Morphologic Changes Following Vertical Reduction Mammoplasty Using a Superomedial Pedicle

Experience with Vertical Mammaplasty: Advantages and Drawbacks of Hall-Findlay’s Superomedial Pedicle Technique and Improving the Results by Adding Modifications to the Technique

Vertical techniques have become a growing area in reduction mammaplasty. Although it has many advantages such as a smaller scar and durable results, some problems still persist. The Hall-Findlay superomedial pedicle technique is one approach to obtain better results but is not without drawbacks. Some modifications are suggested to overcome its problems. Superior pedicle vertical mammaplasty was performed for mastopexy, and superior, superomedial, and modified superomedial techniques were used for the reduction cases. Patients were followed up for at least 2years and the complications were determined. Mastopexy cases had almost no complications. In reduction cases, the most common problems involved circulation and scar widening with the superior pedicle technique and bottoming-out deformity with the superomedial Hall-Findlay technique. These were negligible in its modified form. The tightness in the infra-areolar site is very important for a durable breast shape. Although the Hall-Findlay superomedial pedicle technique offers a versatile composite block nipple-areola complex with its sensation maintained, the inferior part of the pedicle that makes the medial pillar is in excess and the same amount of tissue must be removed from the lateral pillar to ensure tightness. 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 .

Therapeutic reduction mammoplasty in large-breasted women with cancer using superior and superomedial pedicles

Surgical management of breast cancer in large-breasted women presents a real challenge. This study aims to evaluate the outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superior and superomedial pedicles, situated at any breast quadrant except for the central and upper medial quadrants. Fifty women with breast cancer and large breasts underwent simultaneous bilateral reduction mammoplasty. The weight of the tissue removed ranged from 550 g to 1050 g and the tumor-free safety margins by frozen section were in the range of 4 cm to 12 cm. The age of the patients ranged from 36 to 58 (median 43) years and tumor size ranged from 1 cm to 4 cm. The cosmetic outcomes were excellent in 32 patients (64%), good in 15 (30%) patients, and fair in three patients (6%). The follow-up period was 8-36 (mean 20) months, with no local recurrence or systemic metastasis. Therapeutic reduction mammoplasty using superior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery. This oncoplastic procedure yields a satisfactory esthetic outcome with lower morbidity in large-breasted women with breast cancer.

Vertical Reduction Mammaplasty Utilizing the Superomedial Pedicle: Is It Really for Everyone?

Classically, the vertical-style reduction mammaplasty utilizing a superomedial pedicle has been limited to smaller reductions secondary to concerns for poor wound healing and nipple necrosis. The authors reviewed a large cohort of patients who underwent a vertical-style superomedial pedicle reduction mammaplasty in an attempt to demonstrate its safety and efficacy in treating symptomatic macromastia. A retrospective review was performed of 290 patients (558 breasts) who underwent a vertical-style superomedial pedicle reduction mammaplasty. All procedures were conducted by one of 4 plastic surgeons over 6 years (JDR, MAA, DLV, DRA). The average resection weight was 551.7 g (range, 176-1827 g), with 4.6% of resections greater than 1000 g. A majority of patients (55.2%) concomitantly underwent liposuction of the breast. The total complication rate was 22.7%, with superficial dehiscence (8.8%) and hypertrophic scarring (8.8%) comprising the majority. Nipple sensory changes occurred in 1.6% of breasts, with no episodes of nipple necrosis. The revision rate was 2.2%. Patients with complications had significantly higher resection volumes and nipple-to-fold distances (P = .014 and .010, respectively). The vertical-style superomedial pedicle reduction mammaplasty is safe and effective for a wide range of symptomatic macromastia. The nipple-areola complex can be safely transposed, even in patients with larger degrees of macromastia, with no episodes of nipple necrosis. The adjunctive use of liposuction should be considered safe. Last, revision rates were low, correlating with a high level of patient satisfaction.

Commentary on: Vertical Reduction Mammaplasty Utilizing the Superomedial Pedicle: Is It Really for Everyone?

In “Vertical Reduction Mammaplasty Utilizing the Supero-medial Pedicle: Is It Really for Everyone?,” Dr Neaman and his coauthors review a cohort of 290 patients (558 breasts) who underwent a vertical-style superomedial pedicle reduction mammaplasty and try to show that it is safe and effective for a wide range of patients with symptomatic macromastia. I appreciate the opportunity to comment on this article to give my perspective, gained after almost 30 years in practice. For the first 10 years of my practice, I used mainly an inferior pedicle, inverted-T-type breast reduction and, although the results were acceptable, I agreed with Madeleine Lejour1 that we could be striving for improvement. I have learned a lot by analyzing my experience since then, with over 2000 “vertical” breast reductions performed using superior, lateral, and medial pedicles. The word “vertical” is often used to describe a particular procedure, but I believe we should instead be separating out how we design the pedicle, the nature of the parenchymal resection, and the skin resection pattern. The “Wise pattern” is a term often used to describe an inverted-T, inferior pedicle breast reduction, but Robert Wise2 originally described only a skin resection design adapted from a brassiere pattern. I still occasionally apply a Wise pattern for the skin redraping when I use a superomedial pedicle in large breast reductions or in massive weight-loss patients. I always, on the other hand, apply a Wise pattern for the parenchymal design—not for what is removed, but for what is left behind (Figure 1). Figure 1. (A) The pattern as originally described by Robert Wise was not just the keyhole opening but was a skin pattern design adapted from a brassiere pattern. (B) The use of the Wise pattern for the parenchyma instead of the skin is an excellent way to remove …

Inferiorly Based Parenchymal Flap Mammaplasty

Breast reduction and mastopexy are among the most frequent procedures in aesthetic breast surgery. Many approaches have been described, and various types of dermaglandular pedicles for the nipple-areola complex have been used. The authors present a technique suitable for either mastopexy or breast reduction whereby the superior or superomedial pedicle supplying the nipple-areola complex is combined with an inferior dermaglandular flap to restore the upper pole fullness, thereby improving breast shape and projection. From January of 2008 to January of 2010, 83 patients underwent inferiorly based parenchymal flap mammaplasty. Patients' ages ranged from 23 to 65 years. The mean follow-up period was 27 months. The inferior breast tissue that is usually removed in a superior/superomedial pedicle technique is spared and shaped as a small implant and stitched to the pectoralis major muscle. The superior/superomedial pedicle is used for the nipple-areola complex. All the procedures were successful. No major complications were reported. All the patients were very satisfied with the shape, size, projection, and upper pole fullness of their breast postoperatively as reported by the questionnaire. Comparative evaluation test scores of a four-member jury were significantly higher regarding breast shape (p = 0.007), projection (p = 0.0041), and upper pole fullness (p = 0.0028). The inferiorly based parenchymal flap mammaplasty is a safe, versatile, and reproducible technique. It demonstrates ease of pedicle shaping and breast remodeling in patients undergoing mastopexy and breast reduction. Therapeutic, IV.

Lateral Breast Flap With Superomedial Pedicle Breast Lift

Single-stage, durable aesthetic contouring of the volume-depleted and ptotic breast remains a challenge for plastic and reconstructive surgeons. These challenges are often even more difficult in the patient who has undergone massive weight loss (MWL). The authors describe their technique of reshaping the breasts of MWL patients with laterally-based breast flaps during a superomedial pedicle breast lift. A total of 20 patients were treated in a private clinic by one of the authors between April 2006 and January 2010 were included in this study. Each patient underwent breast reshaping with mastopexy, lateral breast autoaugmentation, and implant insertion. A laterally-based breast flap was developed to augment the involuted and ptotic breast and was dissected in conjunction with the superomedial pedicle breast lift to maintain the implant position, prevent bottoming out, and provide tissue coverage between the skin and breast implant in the advent of wound breakdown. Mean follow-up for this patient series was 19.5 months (range, two to 47). The average patient age was 41 years (range, 21 to 56), and the majority of patients had Grade 2 ptosis (14 out of 20). The average volume of the implants in this study was 350 cc (range, 275 to 600). There were no instances of seroma or wound infection. Five patients had minor instances of wound breakdown, but none required surgical revision. One patient developed early capsular contracture and required revision. That same patient developed a small hematoma. Patient self-evaluation revealed a high level of satisfaction; all 20 patients reported being happy with their results. The laterally-based breast flap, in combination with the superomedial pedicle mastopexy, is a powerful tool for use in the postbariatric or postpartum patient in whom the majority of the breast parenchyma is needed to fill the skin envelope. This flap serves to improve overall breast shape by providing added tissue along the deficient inferior pole, relieving some of the unaesthetic lateral chest wall excess and providing an additional layer of support inferiorly along the fold.

Short Scar Reduction Mammaplasty in the Bariatric Patient

Reduction mammaplasty may be necessary even after massive weight loss. Patients typically present with unfavorable breast features such as significant loss of upper pole volume, inelastic skin, and severe ptosis. The most common approach in the United States has been the Wise-pattern inferior pedicle technique, emphasizing skin excision. This report presents the short scar vertical reduction mammaplasty approach for the bariatric patient population. It aims to demonstrate improved outcomes with less scar burden. The study included 15 women (n = 29 breast reductions) with mean age of 41.8 years. All the patients had undergone gastric bypass surgery, with mean weight loss of 109 pounds and mean body mass index of 33.3 kg/m(2). A modified superomedial pedicle vertical mammaplasty technique was used. New nipple position was placed lower than the inframammary fold in accordance with vertical lack of upper pole fullness. Suction-assisted lipectomy was used to contour the inferior pole of the breast before glandular resection. A full-thickness superomedial pedicle and median incision of the upper pole maximized pedicle safety. The mean breast resection was 605 g on the right side (range, 352-945) and 592 g on the left side (range, 360-908). Patient satisfaction was high, with pleasing and stable breast shape at long-term, and a mean patient-related aesthetic ranking of 4.3 of 5.0. No major complications were noted. It is shown that superomedial pedicle vertical reduction mammaplasty can be an alternative approach in bariatric patients, achieving long-term pleasing and stable results with significantly decreased scar burden.

Contouring the Inferior Pole of the Breast in Vertical Mammaplasty: Suction-Assisted Lipectomy versus Direct Defatting

Precise contouring of the inframammary fold is essential in vertical mammaplasty to avoid persistent dog-ears and revision surgery. This report presents the adjunctive use of suction-assisted lipectomy to shape the inferior pole of the breast in vertical reduction mammaplasty. A total of 117 patients underwent a modified superomedial pedicle vertical breast reduction. In group I (n = 45), the lower pole shaping was achieved with direct defatting. Based on contour problems leading to revisions, group II (n = 72) comprised the later experience whereby the inferior pole and inferolateral aspect of the breast was approached with liposuction. The rest of the procedure was similar. Revisions and complications were analyzed retrospectively. The demographics were similar in terms of age (38 ± 13 years versus 37 ± 12 years; p > 0.05), body mass index (31.8 ± 5.2 versus 32.1 ± 4.8; p > 0.05), and the amount of breast reduction (713 ± 341 g versus 668 ± 455 g on the right side and 704 ± 347 g versus 649 ± 450 g on the left side; p > 0.05). Group II patients required revision surgery significantly less than group I patients (22.2 percent versus 5.5 percent; p < 0.05). However, the complication rates were similar (15.6 percent versus 12.5 percent; p > 0.05). In a practice setting with a broad spectrum of patient profiles, adjunctive use of liposuction in vertical breast reduction accomplishes effective contouring of the lower pole of the breast and reduces the revision rates significantly with a low complication rate. This is particularly helpful in large breasts with an ill-defined lateral border. It is emphasized that liposuction is used for contouring purposes and not for volume reduction.

Enhancing Pedicle Safety in Mastopexy and Breast Reduction Procedures: The Posteroinferomedial Pedicle, Retaining the Medial Vertical Ligament of Würinger

Nipple necrosis, a potential postoperative complication of breast surgery procedures, should be avoided. Because of the great variation in the blood supply to the nipple, it is advisable to include as many arteries in the pedicle as possible. According to the literature, the perforators of the internal thoracic artery are the most constant and reliable sources of blood to the nipple-areola complex. It is also supplied by the lateral thoracic artery and the anterior intercostal arteries. If two of the above-mentioned main vessel branches are included in the pedicle, the vascular supply to the breast will be more reliable. According to the anatomical studies of Würinger and van Deventer, we can safely include the dual blood supply to the nipple-areola complex. In the authors' technique, a pedicle is raised that includes the horizontal septum and the medial vertical ligament of the breast (i.e., inferior and superomedial pedicles), but with the breast tissue remaining attached to the pectoral fascia. The second, third, and fourth perforators of the internal thoracic artery are found in the medial vertical ligament, and the inferior mammary branches of the anterior intercostal arteries are in the horizontal septum. The authors have performed this technique in 106 consecutive patients (211 breasts) between 2001 and 2009. Good results regarding breast shape, nipple projection, and upper breast fullness were obtained. The posteroinferomedial pedicle technique is safe and versatile and can be used with a periareolar, vertical scar, or inverted-T skin approach. The technique is easy to perform and has a short learning curve.

Median Incision of the Upper Pole in Medial Pedicle Vertical Mammaplasty

The medial pedicle is commonly employed in vertical breast reduction. With this procedure, there is concern about pedicle compression, especially in large breast reductions when a relatively large medial pedicle is rotated into a smaller sized areolar opening. The author describes a technical refinement to the vertical mammaplasty, whereby a splitting incision is made into the upper pole parenchyma that allows safe pedicle inset without any constriction by the pillar closure, while upper pole fullness is still maintained. A total of 94 patients underwent mammaplasty with the author's technique, in which a superomedial pedicle was dissected as a full-thickness flap. The excision of breast tissue was beveled (especially laterally) to treat lateral fullness, while it was maintained perpendicular to the chest wall at the areola opening to preserve upper pole fullness. A straight incision was made into the upper pole, such that the pedicle was then easily rotated to the defect, obviating the need for upper pole debulking. Resection per breast ranged from 350 to 2505 g (average, 780 g). In this series, medial pedicle vertical mammaplasty was a safe and effective operation for a wide variety of breast sizes and shapes, without any nipple-areola complex necrosis. Follow-up at an average of one year demonstrated a stable and aesthetically pleasing shape in all patients. The median incision of the upper pole adds to the safety of vertical mammaplasty by preventing medial pedicle compression. Additionally, the aesthetic outcome is improved.

Breast Reduction With a Superomedial Pedicle and a Vertical Scar (Hall-Findlay's Technique)

Vertical scar breast reduction has not achieved widespread acceptance and many still view it as a technique with certain limitations. We present the results of a vertical scar pattern breast reduction with superomedial pedicle (Hall-Findlay's technique) in a series of 210 breast reductions. A superomedial pedicle was used with no pectoralis fascial suspension sutures, no or minimal use of liposuction or skin undermining. Glanduloplasty sutures were used to shape the breast parenchyma and the vertical incision closed with less gathering. Reductions of up to 1100 g per side were successfully achieved. Satisfactory healing was observed in 96.7% patients. All patients had a satisfactory final breast shape. 11 dog ears (5.2%) of which 9 had a revision (4.2%), 1 puckering on the inframammary fold on one side (0.47%), which did not require a revision, 7 wound problems in the vertical component of the scar (3.3%), which spontaneously healed in 4 weeks, and 2 re-reduction for further reducing the weight of the breasts (0.95%). The total rate of complications was 10% while the revision rate was 5.2%. We validate Hall-Findlay's technique with our independent results. The technique combines the safety of the superomedial pedicle with advantages of a vertical scar in a quick but safe manner ensuring adequate resection and sound healing with less scars and faster recovery for the patient.

Vertical Reduction Mammaplasty Combined With a Superomedial Pedicle in Gigantomastia

Vertical reduction mammaplasty using a superomedial pedicle is a well-accepted technique giving good results in mild to moderate breast hypertrophy. We describe modifications of the vertical reduction technique to achieve safe reductions even for very large breasts and minimize unsightly scarring, skin necrosis and poor shape. Over the past 4 years, 162 patients have undergone bilateral breast reduction using the vertical mammaplasty technique with a superomedial dermoglandular pedicle. We present a retrospective study of 23 cases of gigantomastia (reductions over 1100g) who underwent bilateral reduction mammaplasty, using our technique. The mean age was 49 years, BMIs ranged from 28 to 52 kg/m. The mean suprasternal notch-to-nipple distance was 40.5 cm on the right and 41.4 cm on the left. The average resection weight per breast was 1303 g on the right, and 1245 g on the left side. The suprasternal notch-to-nipple distance was reduced by between 13.2 and 36.0 cm (mean, 16.1 cm). Mean follow-up was 14 months. We observed a superficial infection in 2 patients, a deep hematoma in one patient, partial necrosis of the nipple-areola complex in 1, and 2 patients needed correction surgery due to dog-ear formation. By using the described modifications, the nipple and areola were safely transposed on a superomedial dermoglandular pedicle producing good breast shapes, while scarring and complications in vertical reduction mammaplasty for oversized breasts were effectively minimized.

Superior and Superomedial Pedicle Wise-Pattern Reduction Mammaplasty

Our center has refined a wise-pattern superior and superomedial pedicle breast reduction technique with predictable quality outcomes giving high patient satisfaction and a very low complication or revision rate. Fifty patients who underwent bilateral superior or superomedial pedicle wise-pattern breast reduction were included in the study. Demographic and perioperative data were collected, as were details of complications. A 21-item postal questionnaire was used to evaluate satisfaction with outcome parameters. The superomedial pedicle technique was used in 86% reductions, and the superior pedicle in 14%, and the mean weight removed from the breasts was 778 g (range, 244-1766 g). Mean patient satisfaction with outcome parameters, as well as maintenance of shape was excellent, as were mean improvements in symptoms of macromastia. No patient required a revision procedure. Superior and superomedial pedicle wise-pattern scar reduction mammaplasty with the technique presented predictably gives excellent results and patient satisfaction, with long-term preservation of shape.