Reduction mammaplasty using the inferior glandular "pyramid" pedicle: experiences with 300 patients

A comprehensive review of 300 patients undergoing reduction mammaplasty (576 breasts) based on an inferior glandular pedicle is presented. The average age was 31.7 years, weight 146.6 lbs., and the amount of tissue removed 1313.6 gm. No deepithelialization of the skin was performed, and average operating time was 174 minutes. The average distance the nipple-areola complex was moved was 12 cm, with the longest being 22.5 cm. Fifty-seven percent had fibrocystic mastopathy on histologic analysis, and no malignancies were found, even in patients who had undergone a previous mastectomy for breast carcinoma. The most common complication (3.1 percent) was minor suture line necrosis along the infra-mammary crease. All healed without intervention. There was no necrosis or sensory loss to the nipple-areola complex in any patient, and cosmesis was excellent. The analysis also showed that the use of epinephrine, injected subcutaneously just prior to the operation, significantly decreased intraoperative blood loss (p less than 0.0005), regardless of the amount of tissue removed, and eliminated the need for transfusions.     

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 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.     

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: a comparison between the Robbins and Pontes techniques

The purpose of this paper is to propose a practical classification of mammary hypertrophy and compare perioperative factors in two types of reduction mammaplasty: the Pontes and Robbins techniques. In a series of 51 patients, the advantages and disadvantages of each method are compared and discussed. The Pontes method appears to be better for the low-volume and ptotic (type II and III) breast, whereas the Robbins technique has a more universal application.     

Reduction mammaplasty and correction of ptosis: dermal bra technique

A new technique for reduction mammaplasty or mastopexy techniques is presented, which the authors call the dermal bra. The surgical steps are described point by point. A series of 36 patients underwent reduction mammaplasty or mastopexy by means of this technique from January of 1998 to April of 2001. Thirty-two patients were followed; 28 presented satisfactory results, including a good mammary appearance, invisible scar, good and stable breast projection, and lasting results. Nipple-areola complex sensitivity was unchanged in all 32 patients. The overall complication rate was 12.5 percent (one patient suffered purse-string suture exposure, and three had a cutaneous rend). The advantages and disadvantages of this technique are discussed.