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Principles of Breast Re-Reduction: A Reappraisal

Mistry, Raakhi M. M.B.Ch.B.; MacLennan, Susan E. M.D.; Hall-Findlay, Elizabeth J. M.D.

Plastic & Reconstructive Surgery: June 2017 - Volume 139 - Issue 6 - p 1313–1322
doi: 10.1097/PRS.0000000000003383
Breast: Original Articles
Coding Perspective
Discussion

Background: This article examines outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction.

Methods: A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Patient demographics, surgical technique, and outcomes were analyzed.

Results: Ninety patients underwent breast re-reduction surgery. The average interval between primary and secondary surgery was 14 years (range, 0 to 42 years). The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 percent)]. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 percent)]. The nipple-areola complex was repositioned in 60 percent of patients (n = 54). The mean volume of tissue resected was 250 g (range, 22 to 758 g) from the right breast and 244 g (range, 15 to 705 g) from the left breast. Liposuction was also used adjunctively in all cases (average, 455 cc; range, 50 to 1750 cc). Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 percent).

Conclusions: Breast re-reduction can be performed safely and predictably, even when the previous technique is not known. Four key principles were developed: (1) the nipple-areola complex can be elevated by deepithelialization rather than recreating or developing a new pedicle; (2) breast tissue is removed where it is in excess, usually inferiorly and laterally; (3) the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and (4) skin should not be excised horizontally below the inframammary fold.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for this Article is on Page 1321.

Christchurch, New Zealand; and Banff, Alberta, Canada

From Christchurch Hospital and Banff Plastic Surgery.

Received for publication September 2, 2016; accepted December 12, 2016.

Disclosure: The authors have no financial disclosures to report.

Elizabeth J. Hall-Findlay, M.D., Banff Plastic Surgery, P.O. Box 2009, 317 Banff Avenue, Suite 340, Banff, Alberta T1L 1B7, Canada, ehallfindlay@banffplasticsurgery.ca

©2017American Society of Plastic Surgeons