Abstract
Background
Although the free-nipple breast-reduction technique is essentially an amputation, achieving aesthetic results still is important. The authors present their technique for free nipple–areola complex (NAC) transfer over the superomedial or superior pedicle full-thickness flaps in patients for whom a free-nipple technique is inevitable due to certain risk factors.
Methods
The study included 25 patients who underwent surgery with the aforementioned method for addressing severe gigantomastia. The patients had a mean age of 43 years (range 34–59 years) and a mean body mass index (BMI) of 35.8 kg/m2 (range 28–42 kg/m2). During the operation, the NAC was elevated as a full-thickness skin graft, then transposed to the superior or superomedial pedicles, which had been planned previously. The subsequent stages of the operation thus became a Wise-pattern breast reduction.
Results
The mean resection per breast was 1,815 g (range 1,620–2,410 g). Breast projection, shape, and areolar pigmentation were assessed during the follow-up visit. One patient experienced a partial loss of the NAC graft, which healed secondarily, and three patients experienced a patchy hypopigmentation of the NAC. Breast projection and conical structure were observed to be preserved during the follow-up period.
Conclusions
The modified free-nipple technique aimed to convert the reduction procedure to a technique similar to pedicle methods, yielding successful results during the early phases. The full-thickness flap constructed in this way provides more fullness and a maximum contribution to projection in patients who will inevitably undergo breast reduction with the free-nipple method.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Robbins TH (1977) A reduction mammaplasty with the areola nipple based on an inferior dermal pedicle. Plast Reconstr Surg 59:64–67
Skoog T (1963) A technique of breast reduction; transposition of the nipple on a cutaneous vascular pedicle. Acta Chir Scand 126:453–465
Cárdenas-Camarena L (2009) Reduction mammoplasty with superolateral dermoglandular pedicle: details of 15 years of experience. Ann Plast Surg 63:255–261
Lejour M (1994) Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg 94:100–114
Balch CR (1981) The central mound technique for reduction mammaplasty. Plast Reconstr Surg 67:305–311
McKissock PK (1976) Reduction mammaplasty by the vertical bipedicle flap technique. Rationale and results. Clin Plast Surg 3:309–320
Güven E, Aydin H, Başaran K, Aydin U, Kuvat SV (2010) Reduction mammaplasty using bipedicled dermoglandular flaps and free-nipple transplantation. Aesthet Plast Surg 34:738–744
Lacerna M, Spears J, Mitra A, Medina C, McCampbell E, Kiran R, Mitra A (2005) Avoiding free nipple grafts during reduction mammaplasty in patients with gigantomastia. Ann Plast Surg 55:21–24
Özerdem OR, Anlatici R, Maral T, Demiralay A (2002) Modified free-nipple graft reduction mammaplasty to increase breast projection with superior and inferior dermoglandular flaps. Ann Plast Surg 49:506–510
Nahabedian MY, McGibbon BM, Manson PN (2000) Medial pedicle reduction mammaplasty for severe mammary hypertrophy. Plast Reconstr Surg 105:896–904
Wettstein R, Christofides E, Pittet B, Psaras G, Harder Y (2011) Superior pedicle breast reduction for hypertrophy with massive ptosis. J Plast Reconstr Aesthet Surg 64:500–507
Gerzenshtein J, Oswald T, McCluskey P, Caplan J, Angel MF (2005) Avoiding free-nipple grafting with the inferior pedicle technique. Ann Plast Surg 55:245–249
Başaran K, Ucar A, Guven E, Arinci A, Yazar M, Kuvat SV (2011) Ultrasonographically determined pedicled breast reduction in severe gigantomastia. Plast Reconstr Surg 128:252e–259e
Gorgu M, Ayhan M, Aytug Z, Aksungur E, Demirdover C (2007) Maximizing breast projection with combined free nipple graft reduction mammaplasty and back-folded dermoglandular inferior pedicle. Breast J 13:226–232
Koger KE, Sunde D, Press BH, Hovey LM (1994) Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free-nipple transplantation. Ann Plast Surg 33:561–564
Misirlioglu A, Akoz T (2005) Familial severe gigantomastia and reduction with the free-nipple graft vertical mammoplasty technique: report of two cases. Aesthet Plast Surg 29:205–209
Karsidag S, Akcal A, Karsidag T, Yesiloglu N, Yesilada AK, Ugurlu K (2011) Reduction mammaplasty using the free-nipple-graft vertical technique for severe breast hypertrophy: improved outcomes with the superior dermoglandular flap. Aesthet Plast Surg 35:254–261
Hall-Findlay EJ (1999) A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 104:748–759
Mandrekas AD, Zambacos GJ, Anastasopoulos A, Hapsas DA (1996) Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients. Br J Plast Surg 49:442–446
Hawtof DB, Levine M, Kapetansky DI, Pieper D (1989) Complications of reduction mammaplasty: comparison of nipple-areolar graft and pedicle. Ann Plast Surg 23:3–10
Chen CL, Shore AD, Johns R, Clark JM, Manahan M, Makary MA (2011) The impact of obesity on breast surgery complications. Plast Reconstr Surg 128:395e–402e
Aydin H, Bilgin-Karabulut A, Tümerdem B (2002) Free-nipple reduction mammaplasty with a horizontal scar in high-risk patients. Aesthetic Plast Surg 26:457–460
Casas LA, Byun MY, Depoli PA (2001) Maximizing breast projection after free-nipple-graft reduction mammaplasty. Plast Reconstr Surg 107:955–960
Romano JJ, Francel TJ, Hoopes JE (1992) Free-nipple graft reduction mammoplasty. Ann Plast Surg 28:271–276
Abramson DL (1999) Increasing projection in patients undergoing free-nipple graft reduction mammoplasty. Aesthet Plast Surg 23:282–284
Serra MP, Longhi P, Sinha M (2010) Breast reduction with a superomedial pedicle and a vertical scar (Hall-Findlay’s technique) experience with 210 consecutive patients. Ann Plast Surg 64:275–278
Chestak KC (2013) Revision surgery following breast reduction and mastopexy. In: Neligan PC (ed) Plastic Surgery, vol 5 (Breast), 3rd edn. Elsevier, Saunders, Philadelphia, p. 247
Acknowledgments
None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Free-nipple breast-reduction technique performed with transfer of the nipple–areola complex over the superior pedicle. (MP4 12132 kb)
Rights and permissions
About this article
Cite this article
Basaran, K., Saydam, F.A., Ersin, I. et al. The Free-Nipple Breast-Reduction Technique Performed with Transfer of the Nipple–Areola Complex Over the Superior or Superomedial Pedicles. Aesth Plast Surg 38, 718–726 (2014). https://doi.org/10.1007/s00266-014-0343-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-014-0343-1