Superomedial Technique Research Articles

Sensibility Comparison in Reduction Mammoplasties: Is Superomedial or Inferior Pedicle Better?

Background Breast reduction (BR) techniques have evolved tremendously since their introduction. However, a comparison of these techniques has yet to clarify the best choice or whether there is only one choice. This study aims to contribute to this research by retrospectively comparing the missing points of superomedial (SM) and inferior (INF) pedicle techniques. Methodology A total of 93 patients underwent surgery for gigantomastia with SM or INF. Demographic data, surgery details, and postoperative course data were obtained using the sixth-month two-point static discrimination test (TPD) of breasts. Patients were divided into SM and INF groups and statistically analyzed for differences in TPD and breast attributes, including suprasternal notch-to-nipple distance, ptosis grade, age, smoking history, parity, and body mass index. Results Intergroup analysis revealed significant differences between the SM and INF groups in TPD, with mean values of 21.03 ± 4.28 and 33.39 ± 6.91, respectively. The correlations between TPD results were tested, and only ptosis grades 2-4 and right suprasternal notch-nipple-areolar complex (NAC) distance were related. Conclusions The SM technique has better sensibility because the distance for transposition of the NAC to the newly designated position is shorter.

Superomedial Reduction Mammoplasty Affects Patients' Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients.

Breast reduction by the superomedial technique can relieve symptoms related to breast hypertrophy; however, as the lateral and inferior portion of the breast parenchyma is removed and displaced, reduction mammoplasty may lead to an impaired ability to breastfeed. The aim of this study was to assess patients' ability to breastfeed after superomedial reduction mammoplasty. This was a cross-sectional study including patients treated with superomedial reduction mammoplasty between January 2009 and December 2018 at 2 tertiary hospitals in Denmark. Patients were stratified into 2 cohorts, depending on whether they had experienced childbirth before or after their reduction mammoplasty. Patients were sent specific questionnaires regarding maternity, breastfeeding before and after reduction mammoplasty, nipple sensitivity, and current demographic information. Operative details were retrieved from electronic medical records. In total, 303 patients were identified as eligible for this study (37 patients giving birth after and 266 before reduction mammoplasty). Fewer patients were able to breastfeed exclusively for the recommended 6 months after reduction mammoplasty (2/37, 5.41%) compared with before (92/266, 34.59%; P < 0.05). In addition, fewer patients were able to breastfeed at all after reduction mammoplasty (18/37, 48.64%) compared with before mammoplasty (241/266, 90.60%; P < 0.001). Patients unable to breastfeed after reduction mammoplasty had lower nipple sensitivity and more breast tissue excised (P < 0.05). Superomedial reduction mammoplasty seems to impair the patient's ability to breastfeed exclusively for the recommended 6 months. Patients of childbearing age considering reduction mammoplasty should be made aware that reduction mammoplasty reduces their breastfeeding capacity.

Age and Body Mass Index Affect Patient Satisfaction Following Reduction Mammoplasty: A Multicenter Study Using BREAST-Q.

Reduction mammoplasty effectively improves quality of life for women with macromastia. However, little is known whether surgical- or patient-related factors affect satisfaction. The authors sought to investigate factors associated with altered patient satisfaction following reduction mammoplasty. A cross-section study was performed by sending the BREAST-Q Reduction module to all patients who had undergone reduction mammoplasty between January 2009 and December 2018 at 2 tertiary Danish hospitals. Demographics and pre-, peri-, and postoperative details were gathered from electronic medical records. A total of 393 patients returned the questionnaire and were eligible for the study. Increasing age at the time of surgery was associated with higher satisfaction with breasts nipples, headache, psychosocial well-being, and outcome. Increased body mass index at the time of surgery negatively affected satisfaction with breasts and psychosocial well-being. Increase in body mass index after surgery was further associated with lower satisfaction with breasts, nipples, sexual well-being, and more pain in the breast area. Postoperative scar revision and wound infection was more common following inferior pedicle technique than superomedial technique and negatively affected satisfaction with outcome and pain in the breast area. Patients should be motivated to optimize their weight prior to reduction mammoplasty to achieve optimal satisfaction. Age was associated with improved patient satisfaction, which should considered when operating on younger patients. Postoperative complications affect patient satisfaction, and the superomedial technique seems to be a better choice than the inferior pedicle technique in medium-large breasts.

A New Septum in the Female Breast.

BackgroundUnderstanding the female breast fascial system is of paramount importance in breast surgery. Little was written about breast ligaments. Most articles refer to Cooper's work without further anatomical studies. Lately, a horizontal septum has been described conveying nerves and vessels to the nipple areola complex.MethodsDuring the surgical dissection of the lower part of the breast, in supero-medial technique for breast reduction operations, a fascial septum between the lower two quadrants was detected. This fibrous septum was studied through anatomic dissection of breast tissues during routine breast reshaping procedures that was done on 30 female patients. Magnetic resonance imaging (MRI) was performed preoperatively in all cases and correlated with the intraoperative findings. In the other five cases, outside the clinical study, the imaging was done during routine investigation for breast swellings.ResultsA vertical septum was identified in the lower part of the breast, lying at the breast meridian between the two lower quadrants. It is a tough bi-laminated structure that extends from the middle of the infra-mammary crease caudally to nipple-areola complex cranially and from the pectoral fascia posteriorly to the overlying skin anteriorly. This was proved by MRI findings.ConclusionsThis study describes a new inferior vertical septum which separates the lower half of the breast into two definite anatomical compartments: medial and lateral.

Comparison of accuracy of anterior and superomedial approaches to shoulder injection: an experimental study.

Introduction: We aimed to compare the accuracy between the standard anterior technique of shoulder injection and the new superomedial technique modified from Neviaser arthroscopic portal placement. Intra-articular placement, especially at the long head of biceps (LHB) tendon, and needle depth were evaluated. Methods: Fifty-eight patients (ages 57 ± 10 years) requiring shoulder arthroscopy in the beach-chair position were recruited. Needle punctures for both techniques were performed by an experienced sports medicine orthopedist. Patients were anesthetized, and the shoulder placed in the neutral position. A single needle was passed through the skin, with only one redirection allowed per trial. The superomedial technique was performed, then the anterior technique. Posterior-portal arthroscopy determined whether needle placement was inside the joint. The percentage of intra-articular needle placements for each technique defined accuracy. When inside the joint, the needle’s precise location was determined and its depth measured. A marginal χ2 test compared results between techniques. Results: The superomedial technique was significantly more accurate than the anterior technique (84% vs. 55%, p < 0.05). For superomedial versus anterior attempts, the LHB tendon was penetrated in 4% vs. 28% of patients, respectively, and the superior labrum in 35% vs. 0% of patients, respectively; the needle depth was 42 ± 7 vs. 32 ± 7 mm, respectively (all p < 0.05). Conclusions: The superomedial technique was more accurate, penetrating the LHB tendon less frequently than the standard anterior technique. A small-diameter needle was needed to minimize superior labral injury. The superomedial technique required a longer needle to access the shoulder joint.

Choosing the Superomedial Pedicle for Reduction Mammaplasty in Gigantomastia

The optimal reduction technique for the treatment of macromastia greater than 1 kg remains controversial. Conventionally, breast amputation and free nipple grafting has been used, but this leaves a flat and insensate nipple. Anatomical studies have suggested the superomedial technique to be a safe choice in these patients. A retrospective study analyzing the outcome of reduction mammaplasty for macromastia greater than 1 kg using the superomedial pedicle technique was performed. Data were collected over a 10-year period from 1995 to 2005. All reduction mammaplasty patients with resection weights greater than 1 kg per breast were included in the study. Sixty-one patients were included (122 breasts). The mean age was 29 years. The mean suprasternal notch to nipple distance was 35 cm on the left and 35 cm on the right, and the mean nipple to inframammary crease distance was 19 cm on the left and 20 cm on the right. The Wise keyhole reduction pattern technique was used for all patients. Mean follow-up was 12 months. The mean resection weight per breast was 1360 g for the left breast and 1398 g for the right breast. Fifteen different surgeons performed the operations over this period. All patients had viable nipples postoperatively; there was partial areola necrosis in eight breasts (6.5 percent), with only minor other complications, including T-junction breakdown in 22 breasts (18 percent) and dog-ear excisions. This study has confirmed the superomedial pedicle technique to be safe and reliable for resections greater than 1 kg.

A comparison between two methods of reduction mammaplasty

The results of two methods of reduction mammaplasty commonly used in our department were analysed: the superomedial technique and the central cone (C.C.) technique recently described by Ramselaar [6]. Data were prospectively collected and measurements were focused on the position of the nipple-areolar complex. Information was obtained from 27 consecutive patients, who had a reduction on both sides. The follow-up period was 10–18 months. 19 patients participated in the follow-up study. The groups were comparable with regard to weight, height and age. Although the nipple areolar complex was differently positioned in both methods, this differance disappeared after operation and the amount of sagging of the breasts was identical. The number of postoperative complications was nearly the same. The C.C. technique resulted in more blood loss. The width of the inframammary scar was narrower in the C.C. group. The subjective sense in the nipples changed comparably in both techniques. Although both techniques differ substantially, the late results are similar according to the parameters used. Other factors should determine the choice of reduction mammaplasty technique.