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

Reduction mammaplasty for hypertrophic and ptotic breasts becomes particularly challenging when significant nipple-areola complex (NAC) elevation is required while maintaining reliable perfusion and a natural breast shape. Traditional techniques rely on dermoglandular pedicles to safely transpose the NAC, particularly when elevation exceeds 10-12 cm. In our approach, the focus shifts from the sternal notch-nipple distance to the NAC-inframammary fold (IMF) distance, which-when exceeding 15 cm-more accurately defines the true degree of ptosis and secondarily determines the increased notch-nipple distance. In such cases, the breast assumes an ellipsoid "bell-shaped" morphology that no longer requires a pedicle-based NAC transposition. This procedure allows preservation of the NAC-glandular unit as a single anatomical block and restoration of a stable hemispheric contour.

To describe the preservation breast reduction (PBR), a reduction mammaplasty technique based on preservation of NAC-glandular anatomical continuity without dermoglandular pedicle dissection. The technique is based on two orthogonal geometric vectors that shorten the NAC-IMF distance, which represent the primary anatomical determinant of breast hypertrophy and ptosis. The controlled reduction of the vertical breast dimension induces a series of consequential morphological changes, including glandular volume reduction, redefinition of the breast base, restoration of projection, and reconstruction of stable hemispheric breast contour.

A retrospective study was conducted on 45 consecutive patients (2018-2023) presenting with moderate-to-severe hypertrophy and Regnault grade II-III ptosis. The surgical approach is based on two orthogonal vectors: 1. A progressive vertical dermal plication along the breast meridian, allowing NAC elevation to the Pitanguy point A, without pedicle transposition; 2. en bloc resection of the inferior glandular quadrants along a horizontal plane located 8-10 cm below the new NAC, redefining the IMF position and breast base. When required, additional glandular reshaping was achieved through selective triangular resection beneath the areola to reduce base width and enhance projection. Complications and patient satisfaction (4-point Likert scale, ≥12-month follow-up) were recorded.

The NAC-IMF distance was reduced from a mean of 17.5 cm to 8-10 cm and remained stable at follow-up. Complications included one hematoma (2.2%) and three cases (6.6%) of localized, self-limited nodular adiponecrosis (~ 2 cm) at the base of the breast along the vertical plication line, with no impact on final outcomes. No cases of NAC necrosis were observed. Patient satisfaction was 91%.

The PBR technique preserves the NAC-glandular unit through maintenance of anatomical continuity, allows significant NAC elevation without dermoglandular pedicle dissection, and achieves consistent geometric rebalancing of the breast. The technique eliminates the need to create a dermoglandular pedicle for preservation of nipple-areola complex (NAC) vascularity. In this preliminary series, it demonstrated reliable vascular safety inferred from clinical outcomes and stable morphological results in selected patients.

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