Periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle

The goals of reduction mammoplasty are to reduce the volume of a breast, to create an aesthetic shape that is stable over time, to maintain blood supply and innervation to the areolar complex, and to make fine limited scars. The present authors used periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle. To minimise the scar, periareolar incision was performed. To reduce the volume of breast and to preserve blood supply and innervation to the nipple-areolar complex, a central or an inferior pedicle technique was used. To prevent areolar widening, a purse-string suture was used. A total of 82 breasts in 41 patients with very large breasts were operated on between July 1998 and June 2004. The mean age was 39, and the mean resection amount was 389 g per breast (right 413 g, left 364 g) with an average follow up of 28 months. Most of the patients were satisfied with the fine periareolar scar, the size of the breasts and the sensation of the nipple-areolar complex. The present authors have applied this procedure to all kinds of macromastia. Although the advantages of the periareolar reduction mammoplasty are an inconspicuous limited scar, a preservation of sensation to the nipple-areolar complex and a short operation time, 24 breasts (29%) showed areolar widening. There were persistent periareolar wrinkles in eight breasts (10%) and poor sensation to the nipple-areolar complex in 12 breasts (15%), in which more than 500 g of breast tissue was removed per breast. In conclusion, the periareolar reduction mammoplasty is optimal for patients who require a reduction of less than 500 g per breast. In severe macromastia with or without ptosis, the inverted T-incision is more preferable to periareolar incision, and periareolar incision can be modified by adding a wedge resection of the outer excess in skin flap inferiorly, which results in periareolar and vertical scars below the nipple-areolar complex.