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

Area of Science:

• Plastic Surgery
• Surgical Techniques
• Breast Reduction

Background:

• Reduction mammoplasty requires adequate tissue removal for symptom relief.
• Gigantomastia presents challenges in breast reduction due to wider pedicle planning, potentially compromising blood supply.
• Preserving nipple-areola complex vascularity is crucial in reduction mammoplasty.

Purpose of the Study:

• To describe a modified superomedial pedicle technique for reduction mammoplasty in gigantomastia.
• To maximize blood circulation to the nipple-areola complex during breast reduction.
• To achieve significant breast volume reduction while minimizing complications.

Main Methods:

• A total of 185 patients underwent reduction mammoplasty using a superomedial pedicle and septal perforator-based technique.
• The pedicle was designed to include branches from the internal thoracic artery (2nd and 3rd interspaces) and intercostal arteries (4th and 5th intercostal spaces).
• Mean excised tissue weight and nipple-areola transfer distance were recorded.

Main Results:

• The mean weight of excised tissue was 928.77g (right) and 899.92g (left).
• Mean nipple-areola transfer distance was 11.52cm (right) and 11.27cm (left).
• Complications occurred in 5.94% of patients (hematoma, partial areola loss, fat necrosis, wound dehiscence).

Conclusions:

• The described technique successfully preserved nipple-areola complex blood supply by incorporating superomedial and septum perforator vessels.
• This approach allows for significant breast reduction in gigantomastia cases while minimizing the risk of vascular compromise and other complications.
• Intercostal perforators were utilized to narrow the pedicle when necessary, ensuring desired volume reduction.