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

Zhu, Victor M.D.; Kwei, Stephanie M.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1018e
doi: 10.1097/PRS.0000000000003194

Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn.

Correspondence to Dr. Kwei, Department of Surgery, Yale University School of Medicine, P.O. Box 208041, New Haven, Conn. 06520,

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We would like to thank the authors for their comments regarding our study,1 which compared superomedial versus inferior pedicle reduction mammaplasty using three-dimensional analysis. We agree that randomization with similar preoperative volume and resection weight between the cohorts would provide useful analysis of these techniques. In our data collection, we could not obtain accurate volumetric measurements of the preoperative breasts because the pendulous posterior breast surface frequently merged with the abdominal wall in the imaging software. Furthermore, it was difficult to identify the inframammary fold with an overlying large ptotic breast. Therefore, we decided to compare breasts with similar postoperative volumes and more accurate landmarks, to track mammometric changes over time between the two cohorts.

To verify our study outcomes, we performed a separate analysis where the cohorts were matched based on the volume of tissue resected (superomedial pedicle, 495 cc; inferior pedicle, 555 cc; p = 0.08). This analysis contained nine patients in each cohort, and revealed similar results, including increased sternal notch–to-nipple distance (superomedial pedicle, 21.4 cm; inferior pedicle, 23.3 cm; p = 0.01) and increased medial pole fullness (superomedial pedicle, 36.3 percent; inferior pedicle, 47.0 percent; p < 0.01) in the inferior pedicle cohort at the late postoperative period. In addition, no difference was found in superior pole volume at the late postoperative period (superomedial pedicle, 59.6 percent; inferior pedicle, 58.6 percent; p = 0.61). As such, it appears the main study outcomes are similar regardless of whether the cohorts are matched based on postoperative breast size or weight of tissue resected.

We are aware of the many contributions of other authors who have compared these techniques using traditional mammometrics and two-dimensional photography; however, we could not discuss these articles in the Letter format. We hope our observations may offer some insights when considering various pedicle techniques for reduction mammaplasty.

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The authors have no financial disclosures.

Victor Zhu, M.D.

Stephanie Kwei, M.D.

Department of Surgery

Section of Plastic and Reconstructive Surgery

Yale University School of Medicine

New Haven, Conn.

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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.
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