Superior Pedicle Reduction Mammoplasty: A Safe and Reliable Tecnique in Breast Hypertrophy

Document Type : Original Article

Authors

1 The Department of General Surgery, Plastic and Reconstructive Surgery Unit, Faculty of Medicine & Health Sciences, Sana'a University; Yemen

2 Department of General Surgery, Al-Kuwait Hospital

Abstract

Objectives: The aim of this study is to evaluate the
superior pedicle technique in reduction mammoplasty of
breast hypertrophy.
Background: Breast reduction is a common aesthetic
surgical procedure. It aims not only at bringing the size of
the breast proportionate to the build of the individual, but
also to decrease the discomfort caused by massive, ill-shaped
and hanging breasts. The operative procedure reduces the
breast tissue mass and enhances aesthetic appearance No
technique has been shown to be superior. The superior pedicle
technique preserves superior and medial breast fullness while
providing appropriate resection of the breast parenchyma to
reduce symptoms and produce a smaller, lifted breast with
more youthful appearance.
Patients and Methods: We performed a retrospective chart
review of eighty (80) consecutive patients between September
2015 and October 2019. All the patients underwent bilateral
breast reductions. Preoperative assessment including history,
physical examination, breast ultrasound and mammography.
Also preoperative breast measurements, mainly mid-clavicle
point to NAC distance were taken. Standard breast photography
was also carried out preoperative and 4 weeks postoperative.
All patients were followed 1, 3 and 6 months postoperative
for complications and patient satisfaction.
Results: Patient's age ranged from 20 to 55 years old.
About 71.3% of the patients complained of preoperative
physical problems. The mean distance from mid-clavicle to
nipple in our cases was 33.2 (19-39) cm. The mean length of
nipple transposition was 13.2cm, ranging from 3 to 18cm.
The mean weight of breast tissue resection was 924g, ranging
from 190 to 1800g. The overall postoperative complications
were 20%, in the form of T-junction wound dehiscence (10%),
mild soft tissue infection (3.8%), asymmetry (2.5%), unilateral
partial NAC necrosis (2.5%) and unilateral complete NAC
necrosis (1.3%). 91.3% of the cases were satisfied, 5% acceptable
and 3,8% dissatisfied regarding improvement of
symptoms and size, shape and symmetry of the breasts.
Conclusion: The superior pedicle technique is simple,
safe and reliable technique in reduction mammoplasty with
maintaining upper and medial fullness and giving good aesthetic
results.

Keywords

Main Subjects

References

1- Chopra K., Tadisina K.K. and Singh D.P.: Breast reduction
mammoplasty, 13: ic 59. eCollection, 2013.
2- Zidan A.A., Azzm E.Z. and El-Kafrawy H.Y.: Key hole
pattern with superior-medial pedicle in large breast reduction.
Egypt, J. Plast. Reconstr. Surg., Vol. 43, No. 3,
October: 463-468, 2019.
3- Dancey A., Khan M., Dawson J. and Peart F.: Gigantomastia
- A classification and review of the literature. J.
Plast. Reconstr. Aesth. Surg.,, 61: 493-502, 2008.
4- Dafyd D.H., Roehl K.R., Phillips L.G., Dancey A., Peart
F. and Shokrollahi K.: Redefining Gigantomastia. J. Plast.
Reconstr. Aesth. Surg., 64: 160-163, 2011.
5- Cho M.J., Yang J.H., Choi H.G., Kim W.S., Yu Y.B. and
Park K.S.: An idiopathic Gigantomastia. Ann. Surg. Treat.
Res., 88: 166-169, 2015.
6- Gradinger G.P.: Is there virtue in versatility in reduction
mammoplasty? Aesth. Surg. J., 17 (5): 308-315, 1997.
7- Stevens W.G., Cohen R., Schantz S.A., et al.: Laser assisted
breast reduction: A safe and effective alternative. A study
of 367 patients. Aesth. Surg. J., 6 (4): 432-439, 2006.
8- Aufricht G.: Mammoplasty for pendulous breasts. Plast.
Reconstr. Surg. J., 4: 13. [PubMed] [Google Scholar],
1949.
9- Arie G.: Una nueva tecnica de mastoplastia. Rev. Iber
Latino Am. Cir. Plast., 3: 28, 1957.
10- Pitanguy I.: Surgical correction of breast hypertrophy. Br.
J. Plast. Surg., 20: 78, 1967.
11- Weiner D.L. , Aiache A.E., Silver L. and Tittiranonda T.:
A single dermal pedicle for nipple transposition in subcutaneous
mastectomy, reduction mammoplasty, or mastopexy.
Plast. Reconstr. Surg., 51 (2): 115-20, 1973.
12- Nadeau M.H., Gould D.J., Macias L.H., Spring M.A. and
Grant Stevens W.: Superior pedicle technique of reduction
mammoplasty: A stepwise approach. Aesth. Surg. J., 35
(1): 94-104, 2015.
13- Nuzzi L.C., Firriolo J.M., Pike C.M., Cerrato F.E., et al.:
The effect of reduction mammoplasty on quality of life
in adolescents with macromastia. Pediatrics, 140 (5) e
20171103; Dol : //doi.org/10.1542/peds, 2017.
14- Fahmy K., Salama T., Aly A., Youssef T. and Jamal A.:
Superomedial pedicle VS. Inferior pedicle techniques in
reduction mammoplasty. Surgery Curr. Res., 8: 3, 2019.
15- Miller A.P., Zacher J.B., Berggren F.B., Falcone R.E. and
Monk J.: Breast reduction for symptomatic macromastia:
can objective predictors for operative success be identified?
Plast. Reconstr. Surg., 95: 77-83, 1995.
16- Gonzalez F., Walton R.L., Shafer B., Matory W.E. Jr. and
Borah G.L.: Reduction mammoplasty improves symptoms
of macromastia. Plast. Reconstr. Surg., 91: 1270-1276,
1993.
17- Thoma A., Spraque S., Veltri K., Duk E. and Furlong W.:
Aprocpective study of patients undergoing breast reduction
surgery: Health-related quality of life and clinical outcomes.
Plast. Reconstr. Surg., 120: 13-26, 2007.
18- Spector J.A. and Karp N.S.: Reduction mammoplasty a
significant improvement at any size. Plast. Reconstr.
Surg., 120: 845 -850, 2007.
19- Wagner D.S. and Alfonso D.R.: The influence of obesity
and volume of resection on success in reduction mammoplasty:
An outcomes study. Plast Reconstr Surg., 115:
1034-1038, 2005.
20- Fox J.W.: Superior pedicle reduction mammoplasty. Aesth.
Surg. J., 25 (4): 406-412, 2005. https://doi.org/10.1011
j.asi2005.05.010
21- Wettestein R., Christofides E., Psaras G. and Hander Y.:
Superior pedicle breast reduction for hypertrophy with
massive ptosis, J. Plast. Reconstr. Aesth. Surg., Apr., 64
(4), 500-7, 2011. doi: 10, 1016/j.bjps. 2010.05.018. Epub
2010 Jun 26.
22- Fino P., Di Taranto G.M. and Scuderi N.T.: Surgical
therapy of breast hypertrophy : a comparison of complications
and satisfaction rate in large and small superior
pedicle custom-made reduction mammoplasty. European
review for medical and pharmacological sciences, 20:
4411-4415, 2016.
23- Al-Shaham A.A.: Pedicle viability as the determinant
factor for conversion to free nipple graft. Can. J. Plast.
Surg., 18 (1) : e1-e4, 2010. doi: 10.4172/plastic-surgery.
1000643.
24- Brown R.H., Siy R., Khan K. and Izaddoost S.: The
Superomedial pedicle wise-pattern breast reduction:
Reproducible, reliable and resilient. Semin Plast. Surg.,
29 (2): 94-101, 2015. doi: 10.1055/s-0035-1549052.
25- Ulusal G.B. and Alber: In pursuit of effective volume
reduction and enhanced aesthetics for treatment of Gigantomastia
using superior dermoglandular pedicle, Aesthetic
Plastic Surgery, 42: 412-421, 2018.
26- Manrekas A.D., Zambacos G.J., Anastasopoulous A. and
Hapsas D.A.: Reduction mammoplasty with inferior
pedicle technique: Early and late complications in 371
patients. British J. Plast. Surg., 49: 442-446, 1996.
27- Davis G.M., Ringler S.L., Short K., Sherrick D. and
Bengston B.P.: Reduction mammoplasty: Long efficacy,
morbidity,and patient satisfaction. Plast. Reconstr. Surg.,
96: 1106-10, 1995.
28- Dabbah A., Lehman J.A., Parker M.G., Tantria D. and
Wagner D.S.: Reduction mammoplasty: An outcome
analysis. Ann. Plast. Surg., 35: 337-41, 1955.
29- Cunningham B.L., Grear A.J., Kerrigan C.L., et al.:
Analysis of breast reduction comlications derived from
the BRAVO study. Plast. Reconstr. Surg., 115-1604.
[PubMed] [Google Scholar], 2005.
30- Schatt J., Binter A. and Rab M.: Reduction mammoplasty
with superior pedicle - a retrospective 10 year follow-up
analysis of 33 patients. Handchir Mikrochir Plast. Chir.
Dec., 46 (6): 325-9, 2014. doi: 10.105s/s-0034-1385934.
Epub 2014 Nov 20.
31- Baslaim M.M., Al Amoudi S.A., Hafiz M., Al Hazmi
W.M., Salman B.A. and Al-Amoudi M.K.: The safety,
cosmetic outcome and patient satisfaction after inferior
pedicle reduction mammoplasty for significant macromastia.
Plast. Reconstr. Surg. Glob Open., 6 (6): e 1798.
Published Online 2018 Jun. 19, 2018.
32- Saleem L. and John J.R.: Unfavorable results following
reduction mammoplasty. Indian J. Plast. Surg., May -
Aug., 46 (2): 401-407, 2013

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