eMedicine Specialties > Plastic Surgery > Breast
Breast Reduction, Superior Pedicle: Follow-up
Updated: Sep 25, 2009
Outcome and Prognosis
Results of breast reduction are satisfactory and among the most well accepted by patients regardless of the technique used. The advantages of the superior pedicle techniques are many for both surgeon and patient.
Breast reduction, superomedial pedicle. Preoperative view of a 55-year-old woman with macromastia.
Breast reduction, superomedial pedicle. Preoperative lateral view of a 55-year-old woman with macromastia.
Breast reduction, superomedial pedicle. 2 months postoperative view. Nipple-areolar complexes are sensate and viable. Note eliminated symmastia.
Breast reduction, superomedial pedicle. 2 months postoperative lateral view.
- Reduction of the width of the breast is achieved easily without compromising the viability or sensitivity of the nipple-areola complex (NAC), which receives its blood supply from internal mammary and lateral thoracic arteries; nerve supply is from the anterior and lateral intercostal contributions. Symmastia, which cannot be corrected using other techniques without creating scars across the midline, is corrected with the superomedial technique.
- The achievable breast projection is superior over other techniques (a cosmetic advantage that is appreciated by surgeons and patients).
- Distance from the inframammary fold (IMF) to the NAC does not increase significantly postoperatively with use of the superiorly based techniques. More, they resist change over time and do not develop pseudoptosis, which is a common late finding with the inferior pedicle technique.
- Operation times are shorter. These techniques do not employ skin undermining or tailored skin excisions for shaping. Further, dermoglandular resection is completed en-bloc, which is simple and fast.
- The superior pedicle technique tends to preserve projection but is limited by pedicle length. This technique is suggested for resections of no more than 1200 g and NAC transpositions of no more than 9 cm.
- The superomedial pedicle technique may better preserve sensation to the NAC than the superior pedicle technique. The author has found the superomedial pedicle technique useful for all breast types, not restricted to use on nonsmokers or patients with soft and mobile breasts. The superomedial pedicle technique can be safely used for resections of up to 2000 g and cephalic NAC transpositions of 5-15 cm with reliable preservation of viability and sensibility. Attainable pedicle lengths likely exceed the author's limit of 27 cm.
- Recently published articles corroborate the above assertions. Davison et al reported a statistically significant reduction in operation time of 41 min (P = 0.0001) in a matched consecutive cohort of 25 patients.13 Furthermore, out of 279 patients, all nipples were found to be viable, NAC hypesthesia was reported in only 2 patients, and the overall complication rate was 18% (74% of the patients with complications had BMIs >30).13 Landau and Hudson looked at the superomedial pedicle technique in 61 patients (122 breasts) over a 10-y period. Mean resection weight was >1300 g per breast. They found a partial areola necrosis rate of 6.5%. All nipples were viable. Minor complications (eg, wound breakdown) were reported in 18% of patients (Landau, Hudson, 2008).10 These figures attest to the safety and versatility of the superomedial pedicle technique for reduction mammaplasty regardless of breast size or patient BMI.
Future and Controversies
Elizabeth Hall-Findlay has shown good results using her combination of superomedial pedicle combined with vertical closure. The long-term results she has presented suggest that the late development of pseudoptosis is less problematic than with other techniques. The learning curve for this technique can be steep. No other technique appears to have the distinct advantages of this particular approach with benefits that include faster operative times, greater control over breast shaping, reduced risk of peri-incisional skin necrosis, reduced risk of NAC insensitivity or nonviability, reduced risk of fat necrosis, and durability of results. Some have cited the steep learning curve as a barrier to wide acceptance of the technique; in particular, the rate of postoperative pseudoptosis is a challenge. With proper application of the technique, pseudoptosis is avoided.
The authors and editors of eMedicine gratefully acknowledge the contributions of previous editor Saleh M Shenaq, MD†, to the development and writing of this article.
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References
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Further Reading
Keywords
breast reduction, breast surgery, superior pedicle, breast reduction superior pedicle, reduction mammoplasty superomedial pedicle, reduction mammoplasty superior pedicle, breast reduction, nipple-areolar complex, NAC, Lejour, Hall-Findlay, Lassus
