A Comparison of Superomedial versus Inferior Pedicle Reduction Mammaplasty Using Three-Dimensional Analysis

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We read the article “A Comparison of Superomedial versus Inferior Pedicle Reduction Mammaplasty Using Three-Dimensional Analysis” by Zhu et al.1 with great interest. We would like to congratulate the authors for their quantification and comparison of postoperative volumetric and morphologic outcomes between inferior pedicle and superomedial pedicle breast reductions with the use of three-dimensional breast imaging (Geomagic software; 3D Systems, Rock Hill, S.C.). In their study, patients in each cohort were matched based on total postoperative breast size, body mass index, and age. They describe a significant difference in medial pole fullness between the two techniques (superomedial pedicle, 38.1 percent; inferior pedicle, 45.8 percent; p < 0.01) at 6 to 12 months. There were changes in volumetric distribution over time in both cohorts, with decreased medial volume in the superomedial pedicle cohort, and increased medial volume in the inferior pedicle cohort (p < 0.01).
However, we may note that in their article, the average weight resected was 417 cc in the superomedial pedicle cohort and 846 cc in the inferior pedicle cohort (p < 0.01). Furthermore, patients were not matched based on preoperative breast size.
We can easily suppose that there was no randomization and that the inferior pedicle technique was used for major breast reduction and the superomedial technique was used for minor breast reduction. We can also presume that breasts in the inferior pedicle cohort required more significant reduction than the breasts in the superomedial pedicle cohort, probably with a longer sternal notch–to-nipple distance, and stretched skin with less elasticity that is habitually noticed in gigantomastia.2
The inferior pedicle technique increases the lengthening of the sternal notch–to-nipple distance and the nipple-to–inframammary fold distance compared with the superomedial pedicle cohort, which may be attributable to a loss of skin elasticity caused by the gigantomastia and not necessarily by the pedicle technique.
With the medial pedicle Wise pattern breast reduction, Abramson et al.3 demonstrated that the nipple-to–inframammary fold distance increased 11 percent in patients whose reductions were between 500 and 1200 g per side and 34 percent in patients whose reductions were greater than 1200 g per breast.
Reus and Mathes4 showed that there was a 48 percent increase in the length of the vertical limb after inferior pedicle reduction mammaplasty when the resected volume was between 500 and 1200 g, and a 72 percent increase when the amount of resected tissue was greater than 1200 g. Therefore, when comparing the inferior pedicle and superomedial pedicle breast reduction techniques, it may be better if the initial preoperative breast volume and the weight resection were similar, to avoid an important confusion factor. Still, we congratulate the authors on their three-dimensional analysis of breast reduction outcomes over time and the comparison of these two techniques with the use of three-dimensional breast imaging.
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