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Vertical Bipedicle Breast Reduction Workup

  • Author: Bhupesh Vasisht, MD, FACS; Chief Editor: James Neal Long, MD, FACS  more...
 
Updated: Nov 16, 2015
 

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.

 
 
Contributor Information and Disclosures
Author

Bhupesh Vasisht, MD, FACS Voluntary Clinical Instructor, Department of Plastic Surgery, Cosmetic and Reconstructive Surgery, Rutgers 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, New Jersey Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

James Neal Long, MD, FACS Founder of Magnolia Plastic Surgery; Former 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; Section 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, Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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

  2. STROMBECK JO. Mammaplasty: report of a new technique based on the two-pedicle procedure. Br J Plast Surg. 1960 Apr. 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. 2011 Jul 7. [Medline].

  6. Manahan MA, Buretta KJ, Chang D, Mithani SK, Mallalieu J, Shermak MA. An outcomes analysis of 2142 breast reduction procedures. Ann Plast Surg. 2015 Mar. 74 (3):289-92. [Medline].

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

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

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

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

  11. 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. 1998 Sep. 51(6):444-9. [Medline].

  12. 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. 2002 Dec. 110(7):1644-52; discussion 1653-4. [Medline].

  13. Scott GR, Carson CL, Borah GL. Maximizing outcomes in breast reduction surgery: a review of 518 consecutive patients. Plast Reconstr Surg. 2005 Nov. 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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