Breast Reduction Using the Superomedial Pedicle- and Septal Perforator-Based Technique: Our Clinical Experience

  • A. Uslu
  • M. A. Korkmaz
  • A. Surucu
  • A. Karaveli
  • C. Sahin
  • M. G. Ataman
Original Article Breast Surgery

Abstract

Background

Adequate tissue removal must be performed for symptom relief following reduction mammoplasty. However, this is not always possible in patients with gigantomastia because the pedicle is planned wider and the breast cannot be sufficiently reduced to prevent compromising the blood supply to the pedicle. To maximize blood circulation to the nipple–areola complex in our patients, the pedicle was planned to include the internal thoracic artery branches coming from both the second and third interspaces and the intercostal artery branches coming from the fourth and fifth intercostal spaces.

Methods

A total of 185 patients underwent reduction mammoplasty with the superomedial pedicle- and septal perforator-based technique. The mean weight of excised tissue was 928.77 g from the right breast and 899.92 g from the left, whereas the mean distance of nipple–areola transfer was 11.52 cm on the right breast and 11.27 cm on the left.

Results

Complications developed in 11 patients (5.94%): hematoma occurred in three patients, partial loss of areola and fat necrosis in five patients, and wound dehiscence in three patients.

Conclusions

The pedicle included vessels of both superomedial and septum origin without any disruption in circulation. Consequently, the blood supply of the nipple–areola complex was preserved. Furthermore, in cases where the pedicle was long, intercostal perforators were identified and the pedicle was narrowed thoroughly; thus, the breast was reduced to the desired volume while minimizing the risk of complications.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Reduction mammoplasty Breast reduction Superomedial pedicle technique Septal perforator technique Gigantomastia 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical Standards

All procedures performed in studies involving human participants were undertaken in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study formal consent is not required.

References

  1. 1.
    Strombeck JO (1960) Mammaplasty: report of a new technique based on the two-pedicle procedure. Br J Plast Surg 13:79–90CrossRefPubMedGoogle Scholar
  2. 2.
    Weiner DL, Aiache AE, Silver L, Tittiranonda T (1973) A single dermal pedicle for nipple transposition in subcutaneous mastectomy, reduction mammaplasty, or mastopexy. Plast Reconstr Surg 51:115–120CrossRefPubMedGoogle Scholar
  3. 3.
    Orlando JC, Guthrie RH (1975) The superomedial dermal pedicle for nipple transposition. Br J Plast Surg 28:42–45CrossRefPubMedGoogle Scholar
  4. 4.
    Hauben DJ (1984) Experience and refinements with the supero-medial dermal pedicle for nipple–areola transposition in reduction mammaplasty. Aesthetic Plast Surg 8:189–194CrossRefPubMedGoogle Scholar
  5. 5.
    Finger RE, Vasques B, Drew GS, Given KS (1989) Superomedial pedicle technique of reduction mammaplasty. Plast Reconstr Surg 83:471–480CrossRefPubMedGoogle Scholar
  6. 6.
    Hall-Findlay EJ (1999) A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 104:748–759CrossRefPubMedGoogle Scholar
  7. 7.
    Würinger E, Mader N, Posch E, Holle J (1998) Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg 101:1486–1493CrossRefPubMedGoogle Scholar
  8. 8.
    Hamdi M, Van Landuyt K, Tonnard P, Verpaele A, Monstrey S (2009) Septum-based mammaplasty: a surgical technique based on Würinger’s septum for breast reduction. Plast Reconstr Surg 123:443–454CrossRefPubMedGoogle Scholar
  9. 9.
    Dm O’Dey, Prescher A, Pallua N (2007) Vascular reliability of nipple–areola complex-bearing pedicles: an anatomical microdissection study. Plast Reconstr Surg 119:1167–1177CrossRefGoogle Scholar
  10. 10.
    Shapiro MA (1986) The nipple–areola and mammary blood supply. Plast Reconstr Surg 78:129CrossRefPubMedGoogle Scholar
  11. 11.
    Nakajima H, Imanishi N, Aiso S (1995) Arterial anatomy of the nipple–areolar complex. Plast Reconstr Surg 96:843–845CrossRefPubMedGoogle Scholar
  12. 12.
    van Deventer PV (2004) The blood supply to the nipple–areolar complex of the human mammary gland. Aesthetic Plast Surg 28:393–398CrossRefPubMedGoogle Scholar
  13. 13.
    van Deventer PV, Graewe FR (2016) The blood supply of the breast revisited. Plast Reconstr Surg 137(5):1388–1397CrossRefPubMedGoogle Scholar
  14. 14.
    Mojallal A, Moutran M, Shipkov C, Saint-Cyr M, Rohrich RJ, Braye F (2010) Breast reduction in gigantomastia using the posterosuperior pedicle: an alternative technique, based on preservation of the anterior intercostal artery perforators. Plast Reconstr Surg 125:32–43CrossRefPubMedGoogle Scholar
  15. 15.
    Hall-Findlay EJ (2013) Discussion: a matched cohort study of superomedial pedicle vertical scar breast reduction (100 breasts) and traditional inferior pedicle wise-pattern reduction (100 breasts): an outcomes study over 3 years. Plast Reconstr Surg 132:1077–1079CrossRefPubMedGoogle Scholar
  16. 16.
    Michelle le Roux C, Kiil BJ, Pan WR, Rozen WM, Ashton MW (2009) Preserving the neurovascular supply in the Hall-Findlay superomedial pedicle breast reduction: an anatomical study. J Plast Reconstr Aesthet Surg 63:655–662CrossRefPubMedGoogle Scholar
  17. 17.
    Amini P, Stasch T, Theodorou P, Altintas AA, Phan V, Spilker G (2010) Vertical reduction mammaplasty combined with a superomedial pedicle in gigantomastia. Ann Plast Surg 64:279–285CrossRefPubMedGoogle Scholar
  18. 18.
    Lugo LM, Prada M, Kohanzadeh S, Mesa JM, Long JN, de la Torre J (2013) Surgical outcomes of gigantomastia breast reduction superomedial pedicle technique: a 12-year retrospective study. Ann Plast Surg 70:533–537CrossRefPubMedGoogle Scholar
  19. 19.
    Landau AG, Hudson DA (2008) Choosing the superomedial pedicle for reduction mammaplaty in gigantomastia. Plast Reconstr Surg 121:735–739CrossRefPubMedGoogle Scholar
  20. 20.
    McCulley SJ, Schaverian MV (2009) Superior and superomedial pedicle wise-pattern reduction mammaplasty: maximizing cosmesis and minimizing complications. Ann Plast Surg 63:128–134CrossRefPubMedGoogle Scholar
  21. 21.
    Davison SP, Mesbahi AN, Ducic I, Sarcia M, Dayan J, Spear SL (2007) The versality of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg 120:1466–1476CrossRefPubMedGoogle Scholar
  22. 22.
    Portincasa A, Ciancio F, Cagiano L, Innocenti A, Parisi D (2017) Septum-enhanced mammaplasty in inferocentral pedicled breast reduction for macromastia and gigantomastia patients. Aesthetic Plast Surg 41(5):1037–1044CrossRefPubMedGoogle Scholar
  23. 23.
    Heine N, Eisenmann-Klein M, Prantl L (2008) Gigantomasty: treatment with a short vertical scar. Aesthetic Plast Surg 32:41–47CrossRefPubMedGoogle Scholar
  24. 24.
    Nahabedian MY, McGibbon BM, Manson PN (2000) Medial pedicle reduction mammaplasty for severe mammary hypertrophy. Plast Reconstr Surg 105:896–904CrossRefPubMedGoogle Scholar
  25. 25.
    Hawtof DB, Levine M, Kapetansky DI, Pieper D (1989) Complications of reduction mammaplasty: comparison of nipple–areolar graft and pedicle. Ann Plast Surg 23:3–10CrossRefPubMedGoogle Scholar
  26. 26.
    Schnur PL, Schnur DP, Petty PM, Hanson TJ, Weaver AL (1997) Reduction mammaplasty: an outcome study. Plast Reconstr Surg 100:875–883CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryAntalya Training and Research HospitalAntalyaTurkey
  2. 2.Department of Anesthesiology and ReanimationAntalya Training and Research HospitalAntalyaTurkey
  3. 3.Departman of Plastic and Reconstructive SurgeryHaydarpasa Sultan Abdulhamid Training and Research HospitalIstanbulTurkey
  4. 4.Departman of Plastic and Reconstructive SurgeryCankırı State HospitalCankırıTurkey

Personalised recommendations