Reliability of inferior pedicle reduction mammaplasty in burned oversized breasts

Heavy pendulous breasts cause physical and psychological trauma. Postburn deformity of breasts results in significant asymmetry, displacement of nipple-areola complex, due to burn scar contracture, and significant scarring; these factors add more psychological discomfort and subsequent behavioral changes. The use of the inferior pedicle procedure in burned breasts can solve many problems. The technique reduces the size of the large breast, eliminates the scar tissue by excising both medial and lateral flaps, and brings the mal-located nipple and areola to a normal position. This study stresses the possibility of harvesting the inferior dermal pedicle flap from within the postburn scar tissue without necrosis of the nipple and areola, because of the excellent flap circulation. Acceptable aesthetic appearance and retainment of nipple viability and sensitivity can be achieved with the inferior pedicle technique even with postburn deformity of the breast. The study was conducted on 11 women, all of whom had sustained deep thermal burns to the breasts and anterior torso and whose breasts were hypertrophied and pendulous.     

Reduction mammaplasty with a single superiorly-based pedicle.

We have reduced 68 breasts in 34 women, transposing the nipple-areolar complex on a single superiorly-based pedicle. The complication rate was 4.4 percent. The method appears to be safe, and it produces better shaped breasts than we obtained by operations using double pedicles.     

Reduction mammaplasty improves breast sensibility

The belief that breast hypesthesia is an expected consequence of reduction mammaplasty is based on past reports that failed to objectively quantify breast sensibility. Forty-five women undergoing reduction mammaplasty by one plastic surgeon using a single operative technique were followed prospectively for change in breast sensation. Pressure threshold measurements were taken preoperatively and at 2 and 6 weeks postoperatively, by using Semmes-Weinstein monofilaments. Areas tested included the nipple, four points on the areola, and four points 1 cm from the areola on the breast skin. The data were nonparametric and were analyzed by using the Wilcoxon signed rank test. For all areas tested, sensation significantly improved from preoperatively to 2 weeks (i.e., nipple: 33.1 versus 29.3, p<0.0004) and again from 2 to 6 weeks (i.e., nipple: 29.3 versus 19.3, p<0.002). Relief of chronic nerve traction injury is conjectured as the reason for sensibility improvement. Numb nipples persisted in 2 percent of breasts at 6 weeks.     

Reduction mammaplasty with a circular folded pedicle technique.

A personal technique for breast reduction utilizing a circular dermal-breast pedicle is presented. After a cutaneous glandular excision in the inferior pole and glandular excision in a discoid shape under the central area, the pedicle is folded on itself to produce a direct elevation of the nipple-areola complex into its new position, to enhance projection, and to act as a central support. A rational economy of scars is obtained by a central convergence of the breast tissue that stretches the breast periphery and by sutures finishing in the inferoareolar area. There the skin excess is removed to avoid scar lengthening in both the caudal and cranial directions. Evaluation of long-term results reveals maintenance of breast projection, preservation of the inframammary fold to inferior areola distance, and minimal residual scarring.     

Reduction mammaplasty following radiation therapy for breast cancer.

This report describes an unusual case in which reduction mammaplasty was performed following radiation therapy for breast cancer. While healing was significantly prolonged (compared with the nonirradiated contralateral breast), the final result was satisfactory from both the functional and the aesthetic standpoint. Women with prior radiation therapy may be considered candidates for reduction mammaplasty. Patients should be warned of the increased risks of wound complications, the likelihood of delayed healing, and the possibility of pigmentation changes in the grafted nipple-areola complex. We elected to transpose the nipple as a full-thickness graft, but consideration also might be given to use of an inferiorly based pedicle flap.     

Suction mammaplasty: the use of suction lipectomy to reduce large breasts

The use of suction lipectomy to reduce breast volume is described. The technique applies only to a very limited group of patients whose nipple-areola complexes are normally located and whose enlargement is primarily fibrofatty in nature. Suction mammaplasty can be used as a sole technique in congenital asymmetry or in post-reduction enlargement or asymmetry.     

Reduction mammaplasty with discovery of occult breast carcinoma in twins: case reports.

A pair of twins is presented in whom breast carcinomas were found. A reduction mammaplasty in the first twin uncovered an occult intraductal carcinoma. Subcutaneous mastectomies were then done in both twins for identical, mirror-image lesions, The first twin subsequently required a radical mastectomy on the involved side.     

Reduction mammaplasty with superior-lateral dermoglandular pedicle: another alternative

During a period of 7.5 years, reduction mammaplasty using a superior-lateral dermoglandular pedicle was performed in 213 mammary glands in 112 patients. This procedure is a modification of the original technique by Skoog that takes advantage of its benefits but adds two basic premises: (1) to preserve the integrity of the galactophorous ducts for future nursing and (2) to cause less innervation injury. Patients were followed for an average of 28 months (range, 3 months to 7.5 years). The quantity of extirpated tissue ranged from 310 to 1380 g, with a median of 520 g. The nipple-areola complex migrated 5 to 14.5 cm (median, 7.8 cm). The most severe complication was partial necrosis of the nipple-areola complex, which occurred in five cases (four patients). This complication occurred only during the first 2 years of the study, in breast resections larger than 800 g, and with migrations larger than 10 cm. This problem resulted in a modification of the technique, and the complication has not occurred for the past 5 years. There were no important alterations in the sensibility of the nipple-areola complex nor in the integrity of the galactophorous ducts. The long-term satisfaction of the patients was high. The authors present an easily designed and accomplishable technique that is applicable to patients with severe hypertrophy and gigantomastia. The technique has a high security index, and the integrity of the mammary gland is maintained to the maximum.