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Refinement in Reduction Mammaplasty: The “Tubulized” Inferior Pedicle for Moderate Breast Hypertrophy

Pascone, Michele M.D.; Di Candia, Michele M.D.; Pascone, Christian M.D.

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Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 147e-148e
doi: 10.1097/PRS.0b013e3181e3b678
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Sir:

Reduction mammaplasty is an established procedure performed mainly for the relief of physical pain and discomfort associated with heavy pendulous breasts. A number of breast reduction techniques have been developed over the years with several refinements to obtain a harmonious and pleasant contour of the breast shape, hiding as much of possible significant skin scars as possible. However, the multitude of studies and modifications present in the literature highlight that the ideal technique has yet to be found.1

The tubulized pedicle is a versatile and practical approach for moderate breast hypertrophy: it is performed using a mosque dome skin marking pattern, the transposition of the nipple-areola complex is based on dermoglandular bipedicle,2 and its inferior portion is tubulized (Fig. 1). The excision of the medial and lateral breast tissue is carried out en bloc down to the chest wall, leaving a layer of breast tissue over the pectoralis fascia to prevent bleeding. The edges of the inferior pedicle are folded and joined using a monofilament resorbable suture, burying the knot. The skin breast envelope is then closed, anchoring the T junction to the perichondrium.

Fig. 1.
Fig. 1.:
A dermoglandular bipedicle in an inverted-T reduction mammaplasty.

The technique has been used for the past 15 years on 78 patients, providing satisfactory functional and aesthetic outcomes (Fig. 2). The average weight of tissue excised per breast was 410 g (range, 210 to 580 g). Patients' ages ranged from 37 to 63 years (mean, 49 years) and the average body mass index was 26.1 kg/m2 (range, 22 to 28 kg/m2). The complication rate was 8 percent, including fat necrosis and wound breakdown; no partial or complete loss of the nipple-areola complex was observed.

Fig. 2.
Fig. 2.:
The inferior pedicle is tubulized, allowing full projection of the breast, replenishing the superior quadrant.

This refinement in inverted scar reduction mammaplasty produces good breast shape, reduces the distance between the nipple-areola complex and the inframammary fold, correcting the ptosis, and gives a satisfactory replenishment of the superior quadrant, guaranteeing full projection of the breast that is stable over time. In our series, it offered a safe, effective, and predictable help for treating moderate mammary hypertrophy associated with moderate ptosis.

Michele Pascone, M.D.

Michele Di Candia, M.D.

Christian Pascone, M.D.

Department of Plastic and Reconstructive Surgery

Policlinico University Hospital

Bari, Italy

DISCLOSURE

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

REFERENCES

1.Ribeiro L, Accorsi A Jr, Buss A, Marcal-Pessoa M. Creation and evolution of 30 years of the inferior pedicle in reduction mammaplasties. Plast Reconstr Surg. 2002;110:960–970.
2.Wise RJ. A preliminary report on a method of planning the mammaplasty. Plast Reconstr Surg. 1956;17:367–375.

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