Superior Pedicle Breast Reduction Workup

  • Author: James Neal Long, MD, FACS; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: Mar 29, 2012
 

Laboratory Studies

  • Preoperative CBC and PT/aPTT are screening exams routinely used by the authors to establish preoperative adequacy of hematocrit and coagulation.
Next

Imaging Studies

  • Mammograms should be ordered according to guidelines established by the National Cancer Institute, the American Cancer Society, and the American College of Radiology. Each of these organizations recommends annual mammograms for women over 40.
Previous
Next

Other Tests

  • In women who have undergone gastric bypass surgery, investigations should be directed towards malnutritive states, which can impact protein synthetic function and, therefore, healing. In addition to CBC and PT/aPTT, prealbumin and albumin levels can be helpful (though not definitive) in establishing the absence of these problems. Other useful lab data include serum B12 and folate levels.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

James Neal Long, MD, FACS  Associate Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, Children's Hospital and Kirklin Clinics, University of Alabama at Birmingham School of Medicine; Chief of Plastic, Reconstructive, Hand, and Microsurgery, Birmingham Veterans Affairs Medical Center

James Neal Long, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Coauthor(s)

Dean R Cerio, MD  Staff Physician, Department of Plastic Surgery, University of Alabama, Birmingham

Disclosure: Nothing to disclose.

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Specialty Editor Board

Pankaj Tiwari, MD  Assistant Professor, Division of Plastic Surgery, Ohio State University College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous editor Saleh M Shenaq, MD†, to the development and writing of this article.

References

  1. Lassus C. Breast reduction: evolution of a technique--a single vertical scar. Aesthetic Plast Surg. 1987;11(2):107-12. [Medline].

  2. Arie G. Una nueva tecnica de mastoplastia. Rev Iber Latino Am Cir Plast. 1957;3:28.

  3. Pitanguy I. Surgical correction of breast hypertrophy. British Journal of Plastic Surgery. 1967;20:78.

  4. Weiner DL, Aiache AE, Silver L, Tittiranonda T. A single dermal pedicle for nipple transposition in subcutaneous mastectomy, reduction mammaplasty, or mastopexy. Plast Reconstr Surg. Feb 1973;51(2):115-20. [Medline].

  5. Orlando JC, Guthrie RH Jr. The superomedial dermal pedicle for nipple transposition. Br J Plast Surg. Jan 1975;28(1):42-5. [Medline].

  6. Hugo NE, McClellan RM. Reduction mammaplasty with a single superiorly-based pedicle. Plast Reconstr Surg. Feb 1979;63(2):230-4. [Medline].

  7. Arufe HN, Erenfryd A, Saubidet M. Mammaplasty with a single, vertical, superiorly-based pedicle to support the nipple-areola. Plast Reconstr Surg. Aug 1977;60(2):221-7. [Medline].

  8. Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg. Sep 1999;104(3):748-59; discussion 760-3. [Medline].

  9. Schlenz I, Kuzbari R, Gruber H, Holle J. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. Mar 2000;105(3):905-9. [Medline].

  10. Landau AG, Hudson DA. Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia. Plast Reconstr Surg. Mar 2008;121(3):735-9. [Medline].

  11. Hauben DJ. Experience and refinements with the supero-medial dermal pedicle for nipple-areola transposition in reduction mammoplasty. Aesthetic Plast Surg. 1984;8(3):189-94. [Medline].

  12. Finger RE, Vasquez B, Drew GS, Given KS. Superomedial pedicle technique of reduction mammaplasty. Plast Reconstr Surg. Mar 1989;83(3):471-80. [Medline].

  13. Kim P, Kim KK, Casas LA. Superior pedicle autoaugmentation mastopexy: a review of 34 consecutive patients. Aesthet Surg J. Mar 2010;30(2):201-10. [Medline].

  14. Davison SP, Mesbahi AN, Ducic I, Sarcia M, Dayan J, Spear SL. The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg. Nov 2007;120(6):1466-76. [Medline].

  15. Choi M, Unger J, Small K, Tepper O, Kumar N, Feldman D, et al. Defining the kinetics of breast pseudoptosis after reduction mammaplasty. Ann Plast Surg. May 2009;62(5):518-22. [Medline].

  16. Conroy WC. Reduction mammaplasty with maximum superior subdermal vascular pedicle. Ann Plast Surg. Mar 1979;2(3):189-94. [Medline].

  17. Cruz-Korchin N, Korchin L. Breast-feeding after vertical mammaplasty with medial pedicle. Plast Reconstr Surg. Sep 15 2004;114(4):890-4. [Medline].

  18. de Araujo Cerqueira A. Mammoplasty: breast fixation with dermoglandular mono upper pedicle flap under the pectoralis muscle. Aesthetic Plast Surg. Jul-Aug 1998;22(4):276-83. [Medline].

  19. Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg. Sep 1999;104(3):748-59; discussion 760-3. [Medline].

  20. Hall-Findlay EJ. Pedicles in vertical breast reduction and mastopexy. Clin Plast Surg. Jul 2002;29(3):379-91. [Medline].

  21. Hauben D. Reduction mammoplasty using a superomedial dermal pedicle. In: Reduction Mammaplasty. Lippincott William & Wilkins; 1990:239-54.

  22. Lassus C. A 30-year experience with vertical mammaplasty. Plast Reconstr Surg. Feb 1996;97(2):373-80. [Medline].

  23. Malata CM, Bostwick II J. Breast reduction with the superior parenchymal pedicle: T-scar approach. Operative Techniques in Plastic and Reconstructive Surgery. 1999;6(2):126-135.

  24. Ohlsen L, Skoog V. Skoog's technique of reduction mammaplasty. In: Reduction Mammaplasty. Lippincott William & Wilkins; 1990:193-232.

  25. Reus WF, Mathes SJ. Preservation of projection after reduction mammaplasty: long-term follow-up of the inferior pedicle technique. Plast Reconstr Surg. Oct 1988;82(4):644-52. [Medline].

  26. Robbins LB, Hoffman DK. The superior dermoglandular pedicle approach to breast reduction. Ann Plast Surg. Sep 1992;29(3):211-6. [Medline].

  27. Rodier-Bruant C, Wilk A, Rosenstiel M, Nisand G, Meyer C. [Does the choice of mammoplasty pedicle influence the shape of reduced the reduced-sized breast?]. Ann Chir Plast Esthet. Aug 1995;40(4):404-11. [Medline].

  28. Thorek M. Possibilities in the reconstruction of the human form. N Y Med J. 1922;116:572.

  29. van der Meulen JC. Superomedial pedicle technique of reduction mammaplasty. Plast Reconstr Surg. Dec 1989;84(6):1005. [Medline].

  30. Weiner D. Breast reduction: The superior pedicle technique (dermal and composite). In: Reduction Mammaplasty. Lippincott William & Wilkins; 1990:233-8.

 
Previous
Next
 
Preoperative markings of a superomedial pedicle reduction. Notice that the base of the pedicle is made wider for longer nipple transpositions.
Preoperative markings of a superior pedicle technique breast reduction.
Breast reduction, superior pedicle. The pedicle, now developed, is imbricated superiorly into the new NAC inset position.
Breast reduction, superior pedicle. The NAC is into the new position. Vertical closure, no inframammary incision line. The lateral dimpling is from intraparenchymal pillar suturing and typically settles out completely within 6 weeks.
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.
Anatomy of the breast.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.