Share this article on:

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

de Runz, Antoine M.D.; Carloni, Raphael M.D.; Boccara, David M.D.; Bekara, Farid M.D.; Bertheuil, Nicolas M.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1017e–1018e
doi: 10.1097/PRS.0000000000003193
Letters

Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France

Department of Plastic and Reconstructive Surgery, CHU Rouen, Rouen, France

Plastic, Reconstructive, and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France

Department of Plastic and Reconstructive Surgery, Lapeyronie Hospital, CHU Montpellier, Montpellier, France

Department of Plastic and Reconstructive Surgery, Hopital Sud, CHU Rennes, Rennes, France

Correspondence to Dr. de Runz, Service de Chirurgie Maxillo-Faciale, Plastique, Reconstructrice, et Esthétique, Hôpital Central, 29 Avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France, aderunz@gmail.com

Back to Top | Article Outline

Sir:

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.

Back to Top | Article Outline

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this communication.

Antoine de Runz, M.D.

Department of Maxillofacial, Plastic, Reconstructive, and

Cosmetic Surgery

Nancy University Hospital

Nancy, France

Raphael Carloni, M.D.

Department of Plastic and Reconstructive Surgery

CHU Rouen

Rouen, France

David Boccara, M.D.

Plastic, Reconstructive, and

Cosmetic and Burn Surgery Unit

Hôpital Saint Louis

Paris, France

Farid Bekara, M.D.

Department of Plastic and Reconstructive Surgery

Lapeyronie Hospital

CHU Montpellier

Montpellier, France

Nicolas Bertheuil, M.D.

Department of Plastic and Reconstructive Surgery

Hopital Sud

CHU Rennes

Rennes, France

Back to Top | Article Outline

REFERENCES

1. Zhu VZ, Shah A, Lentz R, Sturrock T, Au AF, Kwei SLA comparison of superomedial versus inferior pedicle reduction mammaplasty using three-dimensional analysis. Plast Reconstr Surg. 2016;138:781e–783e.
2. Hammond DC, O’Connor EA, Knoll GMThe short-scar periareolar inferior pedicle reduction technique in severe mammary hypertrophy. Plast Reconstr Surg. 2015;135:34–40.
3. Abramson DL, Pap S, Shifteh S, Glasberg SBImproving long-term breast shape with the medial pedicle wise pattern breast reduction. Plast Reconstr Surg. 2005;115:1937–1943.
4. Reus WF, Mathes SJPreservation of projection after reduction mammaplasty: Long-term follow-up of the inferior pedicle technique. Plast Reconstr Surg. 1988;82:644–652.
Back to Top | Article Outline

GUIDELINES

Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2017American Society of Plastic Surgeons