Vertical Bipedicle Breast Reduction Workup

  • Author: Bhupesh Vasisht, MD, FACS; Chief Editor: James Neal Long, MD, FACS   more...
 
Updated: Mar 29, 2012
 

Laboratory Studies

Routine blood work is not necessary in most patients. Patients who require large volume breast reduction may need routine laboratory tests in the rare event that a blood transfusion is needed. Mammogram is indicated in patients aged 35 years or older. A younger patient may require a mammogram if she has a history of breast cancer in the family.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Bhupesh Vasisht, MD, FACS  Voluntary Clinical Instructor, Department of Plastic Surgery, Cosmetic and Reconstructive Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Private Practice, South Shore Plastic Surgery

Bhupesh Vasisht, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Surgery of the Hand, American Society of Plastic Surgeons, and New Jersey Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Patricia K Gomuwka, MD, FACS  Consulting Staff, Department of Plastic Surgery, Riverside Regional Medical Center

Patricia K Gomuwka, MD, FACS is a member of the following medical societies: American Cleft Palate/Craniofacial Association, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Canadian Society of Plastic Surgeons, Medical Society of Virginia, and Royal College of Physicians and Surgeons of Canada

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

Saleh M Shenaq, MD†  Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston

Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law, Medicine & Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

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

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.

References

  1. McKissock PK. Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg. Mar 1972;49(3):245-52. [Medline].

  2. STROMBECK JO. Mammaplasty: report of a new technique based on the two-pedicle procedure. Br J Plast Surg. Apr 1960;13:79-90. [Medline].

  3. Cosmetic Surgery National Data Bank Statistics. American Society for Aesthetic Plastic Surgery. 2007;[Full Text].

  4. Rohrich RJ, Gosman AA, Brown SA, Tonadapu P, Foster B. Current Preferences for Breast Reduction Techniques: A Survey of Board-Certified Plastic Surgeons 2002. Plastic & Reconstructive Surgery. 2004;114(7):1724-1733. [Full Text].

  5. Abramo AC. A Superior Vertical Dermal Pedicle for the Nipple-Areola: An Alternative for Severe Breast Hypertrophy and Ptosis. Aesthetic Plast Surg. Jul 7 2011;[Medline].

  6. Slezak S, Dellon AL. Quantitation of sensibility in gigantomastia and alteration following reduction mammaplasty. Plast Reconstr Surg. Jun 1993;91(7):1265-9. [Medline].

  7. Schnur PL, Schnur DP, Petty PM, et al. Reduction mammaplasty: an outcome study. Plast Reconstr Surg. Sep 1997;100(4):875-83. [Medline].

  8. Cunningham BL, Gear AJ, Kerrigan CL, et al. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg. May 2005;115(6):1597-604. [Medline].

  9. Shermak MA, Chang D, Buretta K, Mithani S, Mallalieu J, Manahan M. Increasing age impairs outcomes in breast reduction surgery. Plast Reconstr Surg. Dec 2011;128(6):1182-7. [Medline].

  10. Godwin Y, Wood SH, O'Neill TJ. A comparison of the patient and surgeon opinion on the long-term aesthetic outcome of reduction mammaplasty. Br J Plast Surg. Sep 1998;51(6):444-9. [Medline].

  11. Chao JD, Memmel HC, Redding JF, et al. Reduction mammaplasty is a functional operation, improving quality of life in symptomatic women: a prospective, single-center breast reduction outcome study. Plast Reconstr Surg. Dec 2002;110(7):1644-52; discussion 1653-4. [Medline].

  12. Glatt BS, Sarwer DB, O'Hara DE, et al. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Plast Reconstr Surg. Jan 1999;103(1):76-82; discussion 83-5. [Medline].

  13. Jaspars JJ, Posma AN, van Immerseel AA, et al. The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. Br J Plast Surg. Jun 1997;50(4):249-59. [Medline].

  14. Schnur PL, Schnur DP, Petty PM, et al. Reduction mammaplasty: an outcome study. Plast Reconstr Surg. Sep 1997;100(4):875-83. [Medline].

  15. Scott GR, Carson CL, Borah GL. Maximizing outcomes in breast reduction surgery: a review of 518 consecutive patients. Plast Reconstr Surg. Nov 2005;116(6):1633-9; discussion 1640-1. [Medline].

 
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Macromastia with marked notching of the shoulders from bra straps and striking intertrigo of the medial aspect of the breasts.
Preoperative surgical diagram of the classic Wise pattern or inferior pedicle reduction technique. The typical measurements are shown.
The markings for the vertical bipedicle reduction is essentially the same as for the inferior pedicle reduction. The shaded area depicts the tissue that will be preserved. This will be the vascular supply to the new nipple areolar complex once it is transposed to its new location.
Intraoperative schematic demonstrating the bipedicle flap. The medial and lateral flaps are brought into the midline and sutured at the inframammary fold. The letter M represents the meridian or the axis for the breast on which the reduction is maintained.
Preoperative and postoperative images. Preoperative measurement of nipple to sternal notch was 32 cm bilaterally. Over 1300 g of tissue were removed from each breast during the vertical bipedicle reduction mammaplasty procedure on this patient.
Preoperative and postoperative images. Preoperative measurement of nipple to sternal notch was 44 cm bilaterally. Over 3000 g of tissue were removed from each breast during the vertical bipedicle reduction mammaplasty procedure on this patient.
Anatomy of the breast.
 
 
 
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