Selective breast reduction: a personal approach with a central-superior pedicle

Breast reduction shows a greater risk of complications in peculiar cases such as those with gigantomastia, a high degree of ptosis, obesity, smoking, cardiovascular diseases, or metabolic disorders. The authors feel that a reduction in the complication rate can be achieved by safeguarding the vascular and nervous structures of the breast as much as possible.

The authors propose a breast reduction method based on a double central-superior pedicle that was used in 91 patients with a more or less elevated degree of obesity. This technique aims to remove excess tissue, preserving the noble structures of the breast. Beginning from preoperative drawings similar to the ones of Lejour, deepithelialization and wide medial and lateral skin undermining are performed. Next, the excess tissue is removed from the caudal, medial, and lateral portions of the breast and from the deep cranial portion, sparing the horizontal septum that supplies vessels and nerves to the nipple. A "handle" composed of the superior and central pedicles is obtained. After fixing the central pedicle to the thoracic wall, redundant skin is removed, and a vertical or J-shaped suture is made.

The authors obtained good breast shape, short scars, and optimal viability of the nipple-areola complex. The results are stable and durable, and the complication rate seems to be very low.

The authors believe that this technique may be a valid alternative to traditional methods, especially in vast tissue resections and in cases of considerable nipple-areola complex lift. It is mainly indicated in obese and partial weight loss patients.