Keyhole Pattern with Superior-Medial Pedicle in Large Breast Reduction

Background: Breast surgery is one of the most difficult
fields of aesthetic surgery, because of the complexity of
surgical procedures and the relative guidelines defining the
aesthetically perfect breast.
The goal in reduction mammaplasty is to achieve a pleasing
balance among size, shape, and projection of the breast with
optimal sensation and appropriate blood supply for the nippleareola
and breast. These goals are challenged by the amount
of excess tissue and severely distorted breast landmarks in
massive breast hypertrophy and severe breast ptosis.
The traditional treatment for massive breast hypertrophy
or severe breast ptosis is breast amputation with free grafting
of the nipple-areola or inverted T, inferior pedicle used to
have a relatively high number of complications and the
disadvantage. On the other hand, relying on inverted T,
superior-medial pedicle can avoid the disadvantage of the
previse techniques and give reliable, stable and pleasant results
in large reduction mammoplasties.
Patients and Methods: This is a prospective randomized
study that included 20 healthy female patients suffering from
breast hypertrophy and they are candidate for reduction
mammoplasty by the proposed technique. Design of skin
marking for superior-medial pedicle breast reduction technique
was carried out with the standard Wise pattern. The amount
of removed tissue was recorded, the aesthetic result and patient
satisfaction was estimated for the results.
Results: This study includes 20 female patients of an age
ranged between 24-45 years old and a breast size (suprasternal
notch to nipple distance) ranging from 33 to 42cm. The weight
of removed tissues during surgery in our study was ranging
from 1210 to 1970. We found that 75% of our results are of
excellent aesthetic results, 15% good and 10% fair with 70%
of patients were satisfied, 20% of patients were somewhat
satisfied/somewhat dissatisfied and 10% of patients were
dissatisfied.
Conclusion: From this study we concluded that the keyhole
pattern with superior medial pedicle was an efficient technique
for excising more tissue in large breasts with pleasant aesthetic
results.