Power-Assisted Liposuction of the Superomedial Pedicle in Primary Wise-Pattern Reduction Mammoplasties

Background: Superomedial pedicle breast reduction is a widely performed procedure in plastic surgery. However, in cases of massive ptosis and excessively large breasts, achieving adequate pedicle reduction can be challenging. Direct excision of the tissue bulk may compromise blood supply while insufficient reduction can hinder proper pedicle positioning or result in strangulation when forcefully placed in the keyhole area. This study investigates the application of power-assisted liposuction (PAL) to the superomedial pedicle, aiming to achieve volume reduction while preserving its vascular integrity. Methods: Patients who underwent reduction mammaplasty with concomitant PAL were retrospectively reviewed. Parenchymal resection was performed first, followed by PAL, which was selectively applied to the pedicle. Eligibility for liposuction was made intraoperatively based on breast morphology and the ease of pedicle insetting. Results: The mean lipoaspirate per breast was 243.0 mL (SD 131.3) following a mean resection weight of 1261.7 g (SD 356.9). In 76.7% of cases, more than 150 mL was aspirated. The smallest volume per breast was 50 mL, while the highest reached 500 mL. A strong correlation was observed between the aspirated volume and resection weight. The overall complication rate was 3.3%, with one patient requiring hematoma evacuation. No cases of NAC necrosis occurred. All patients reported satisfactory breast shape and size. Conclusions: Power-assisted liposuction of the superomedial pedicle is a reliable and efficient technique for reshaping and reducing the pedicle while maintaining a low risk of complications.