Preservation Breast Reduction: A Dual Vector Technique Preserving NAC-Glandular Continuity Without Dermoglandular...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Aesthetic Surgery

Background:

• Reduction mammaplasty for significant breast hypertrophy and ptosis presents challenges in nipple-areola complex (NAC) elevation while maintaining perfusion and shape.
• Traditional techniques often require dermoglandular pedicles for NAC transposition when elevation exceeds 10-12 cm.
• The NAC-inframammary fold (IMF) distance is a more accurate determinant of ptosis than sternal notch-nipple distance, especially in bell-shaped breasts.

Purpose of the Study:

• To introduce the Preservation Breast Reduction (PBR) technique for reduction mammaplasty.
• PBR focuses on preserving NAC-glandular anatomical continuity without pedicle dissection.
• The technique utilizes orthogonal geometric vectors to shorten the NAC-IMF distance, addressing breast hypertrophy and ptosis.

Main Methods:

• Retrospective study of 45 patients with moderate-to-severe hypertrophy and Regnault grade II-III ptosis (2018-2023).
• Surgical approach involves vertical dermal plication for NAC elevation and en bloc resection of inferior glandular quadrants.
• Complications and patient satisfaction (Likert scale, ≥12-month follow-up) were recorded.

Main Results:

• Mean NAC-IMF distance reduced from 17.5 cm to 8-10 cm, with stable results at follow-up.
• Low complication rate: one hematoma (2.2%) and three cases (6.6%) of localized adiponecrosis.
• No NAC necrosis observed; 91% patient satisfaction reported.

Conclusions:

• PBR technique successfully preserves NAC-glandular unit through anatomical continuity, enabling significant NAC elevation without pedicle dissection.
• The method achieves consistent geometric rebalancing and eliminates the need for pedicle creation for NAC vascularity.
• Preliminary results suggest reliable vascular safety and stable morphological outcomes in selected patients.