The Short-Scar Periareolar Inferior Pedicle Reduction Technique in Severe Mammary Hypertrophy

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Abstract

Background:

Reduction mammaplasty in severe mammary hypertrophy is challenging to even the very experienced plastic surgeon. Extremely long pedicles threaten blood supply, and the severely stretched skin envelope is difficult to effectively shape and reduce. In this setting, free-nipple techniques and inverted-T pattern skin resections are often used.

Methods:

A retrospective review of 88 consecutive patients undergoing breast reduction with the removal of at least 1000 g of tissue in at least one breast over a 17-year period was performed. Patient demographics, comorbidities, and complications were noted during routine postoperative care.

Results:

One hundred forty breasts in 88 patients were noted to meet the study criteria. The mean body mass index of the patients was 37 kg/m2 (range, 24 to 57 kg/m2), and 89 percent of the patients were categorized as obese. The mean volume of resection was 1336 g (range, 1000 to 3144 g). Mean follow-up was 10 months (range, 1 to 96 months). There was a 16.4 percent incidence of minor delayed healing along with a 2.9 percent incidence of partial areolar necrosis, which was treated conservatively and allowed to heal by secondary intention. There was a 5.7 percent reoperation rate related to excisional biopsy of fat necrosis in 4.3 percent and revision of periareolar scar in 1.4 percent.

Conclusion:

Combining an inferior pedicle approach with a circumvertical skin pattern in the setting of severe mammary hypertrophy is a safe and effective technique for breast reduction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

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