Breast Reduction: The Superolateral Dermoglandular Pedicle Revisited
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Breast hypertrophy, generally found in association with ptosis, is a common problem in postadolescent women. Beyond the psychological burden of excessively heavy, droopy breasts, physical symptoms compound the condition, with neck, shoulder and back pain. Reduction mammaplasty is one of the most common cosmetic operations, especially to improve patient’s musculoskeletal symptoms, with proven benefits in patient satisfaction and self-esteem postoperatively. Multiple techniques exist for breast reduction, with no clear evidence of benefit of one over another.
We review the senior author’s experience in using a superolateral pedicle for breast reduction in 726 patients over the past 40 years. Over the past 10 years, the technique has also been adapted for simultaneous augmentation–mastopexy, especially in post-bariatric surgery patients. Benefits include recruitment of lateral breast tissue to fill the upper pole and correct axillary fullness. The technique has the advantages of ease of execution and a low complication rate.
Complete data were available for 397 patients. Resection weights varied from 380 to 1248 g, and mean sternal notch–nipple distance was 25.3 cm. Mean follow-up was 22 months. Complications were uncommon: four cases of partial nipple-areola complex loss, dehiscence in 14 patients, three hematomas and seven cases of superficial surgical site infection. Nipple sensitivity was decreased in eight patients, and three patients were unable to breastfeed following surgery. Revision surgery was requested by 14 patients.
Breast reduction using the superolateral dermoglandular flap is easy to execute, versatile, safe and effective, preserving physiological functions, and is an excellent option when treating patients with medium-to-large breasts.
Level of Evidence IV
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KeywordsBreast reduction Mammaplasty Pedicle Vascular Blood supply Breast surgery Nipple-areola complex Flap
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest, commercial associations or financial interests to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Supplementary material 1 (MP4 235475 kb)
- 1.International Society of Aesthetic Plastic Surgery (2016). https://www.isaps.org/wp-content/uploads/2017/10/GlobalStatistics.WorldWide.Summary2016s-1.pdf. Accessed June 8, 2018
- 2.Brazilian Society of Plastic Surgery (2017). http://www2.cirurgiaplastica.org.br/2017/10/27/estetica-procura-por-procedimentos-nao-cirurgicos-aumenta-390/. Accessed June 8, 2018
- 6.Pitanguy I (1962) Une nouvelle technique de plastie mamaire. Étude de 245 cas consecutifs et presentation dune technique personelle. Ann Chir Plast 7:199–208Google Scholar
- 17.Ariê G (1957) Una nueva técnica de mastoplastia. Rev Latinoam Cir Plast 3:23–31Google Scholar
- 18.Uebel CO (1978) Breast reduction with the lateral dermo-glandular rotation flap. In: Annals of the XVth Brazilian congress of plastic surgery, São Paulo, SPGoogle Scholar
- 19.Uebel CO (2011) Breast reduction using the supralateral dermoglandular flap. IPRAS J 3:16–17Google Scholar
- 20.Uebel CO (2013) Combined abdominal contouring and mastopexy. In: Rubin JP, Jewell ML, Richter DF, Uebel CO (eds) Body contouring and liposuction. Elsevier Saunders, PhiladelphiaGoogle Scholar
- 22.Silveira Netto E (1976) In: Ely JF (ed) 13 Congresso Bras Cir Plástica. Mastoplastia redutora sectorial com pediculo areolar interno, pp 13–15. Porto AlegreGoogle Scholar
- 23.Pitanguy I (1962) A new technic of plastic surgery of the breast. Study of 245 consecutive cases and presentation of a personal technic. Ann Chir Plast 7:199–208Google Scholar
- 34.Skoog T (1963) A technique of breast reduction; transposition of the nipple on a cutaneous vascular pedicle. Acta Chir Scand 126:453–465Google Scholar
- 39.Cooper AP (1840) On the anatomy of the breast. Longman, Orme, Green, Brown and Longmans, LondonGoogle Scholar
- 40.Marcus GH (1934) Untersuchungen uber die arterielle Blutversorgung der Mamilla. Arc Klin Chir 179:361–369Google Scholar
- 41.Strombeck JO (1964) Breast reconstruction. I. Reduction mammaplasty. Mod Trends Plast Surg 16:237–255Google Scholar
- 42.Skoog T (1974) Plastic surgery. New methods and refinements. Almqvist and Wiksell, StockholmGoogle Scholar
- 51.Schulz S, Zeiderman MR, Gunn S et al (2017) Safe plastic surgery of the breast II: saving nipple sensation. Eplasty 17:303–312Google Scholar