Inferior pedicle breast reduction: A retrospective review of technical modifications influencing patient safety, operative efficiency, and postoperative outcomes

Department of Surgery, Division of Plastic, Aesthetic, Reconstructive Surgery, the DeWitt Daughtry Family, Department of Surgery, University of Miami Health System, 1120 NW 14th St, Miami, FL 33136, USA.
American journal of surgery (Impact Factor: 2.29). 11/2012; 204(5):e7-e14. DOI: 10.1016/j.amjsurg.2012.07.015
Source: PubMed


The inferior pedicle technique remains the most popular approach to breast reduction in the United States. Modifications to this procedure have enhanced versatility, patient safety, and outcome satisfaction in patients with all degrees of macromastia.
A 6-year retrospective review of 241 patients who underwent bilateral inferior pedicle breast reduction was conducted at our institution. Modifications analyzed included methylene blue tattooing to provide preoperative landmarks, preoperative hydrodissection to reduce intraoperative blood loss, incorporation of inframammary darting to reduce tension at the "T-junction," preservation of superomedial volume for enhanced medial fullness, and dermatome blade-guided tissue resection.
Inframammary darting reduced the incidence of wound dehiscence. Preoperative hydrodissection reduced intraoperative blood loss by a factor of 2. Dermatome blade use reduced operative times at no increased incidence of postoperative seromas or hematomas.
Outcomes resulting from these modifications appear to be at least comparable to, and perhaps better than, those previously reported.

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    • "Conservative measures include wearing a properly fitted brassiere, physical therapy, and weight reduction.3 These measures have failed to demonstrate a significant improvement in relief of pain, quality of life, or patient satisfaction indices.4,5 Reduction mammoplasty, or surgical resection of breast parenchyma, is one of the most commonly performed plastic surgery procedures performed in the United States, with more than 130,000 cases reported in 2010.5-7 "
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    ABSTRACT: Objective: Gigantomastia, or excessive breast hypertrophy, which is broadly defined as macromastia requiring a surgical reduction of more than 1500 g of breast tissue per breast, poses a unique problem to the reconstructive surgeon. Various procedures have been described for reduction mammoplasty with specific skin incisions, patterns of breast parenchymal resection, and blood supply to the nipple-areolar complex; however, not all of these techniques can be directly applied in the setting of gigantomastia. We outline a simplified method for preoperative evaluation and operative technique, which has been optimized for the management of gigantomastia. Methods: A retrospective chart review of patients who have undergone reduction mammoplasty from 2006 to 2011 by a single surgeon at the University of Virginia was performed. Patients were subdivided based on weight of breast tissue resection into 2 groups: macromastia (<1500 g resection per breast) and gigantomastia (>1500 g resection per breast). Endpoints including patient demographics, operative techniques, and complication rates were recorded. Results: The mean resection weights in the macromastia and gigantomastia groups, respectively, were 681 g ± 283 g and 2554 g ± 421 g. There were no differences in major complications between the 2 groups. The rate of free nipple graft utilization was not significantly different between the 2 groups. Conclusions: Our surgical approach to gigantomastia has advantages when applied to extremely large-volume breast reduction and provides both esthetic and reproducible results. The preoperative assessment and operative techniques described herein have been adapted to the management of gigantomastia to reduce the rates of surgical complications.
    Full-text · Article · Oct 2013 · Eplasty

  • No preview · Article · Oct 2013 · Journal of Plastic Reconstructive & Aesthetic Surgery