Advertisement

Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

  • Tarek Mahboub
  • Rama Ahmed Ali
  • Dina M. Badwai
  • Ahmed A. Taha
Original Paper
  • 14 Downloads

Abstract

Background

Reduction mammoplasty using the inferior pedicle technique has been used for more than five decades. Without doubt, it has many advantages, especially in patients with moderate to severe macromastia. Although the esthetic outcome of reduction mammoplasty in the early postoperative period is usually satisfactory, typical esthetic drawbacks appear during the first year. These drawbacks include bottoming out, loss of superior fullness, box-shaped breasts, poor definition of the infra-mammary fold (IMF), elongation of the vertical scar, star gazing of the nipple-areola complex (NAC) and, of course, the scar burden. Parenchymal reshaping and suspension have been introduced as an additional step to eliminate the drawbacks of the inferior pedicle procedure.

Methods

This is a prospective study done in a period from March 2016 to March 2018 in Kasr Al-Ainy Hospital (Cairo University hospitals) by the senior author and his team of co-authors. Reduction mammoplasty (Wise pattern) with the inferior pedicle and dermal wrap technique (using two dermal wings) was performed in 20 patients. The distance from the suprasternal notch (SSN) to the NAC was > 30 cm.

Results

The patients’ ages ranged from 28 to 55 years (average age, 39 years). Body mass index (BMI) ranged from 27 to 35 kg/m2 (average BMI, 33.3 kg/m2). The distance between the SSN and NAC ranged from 33 to 45 cm (average distance, 40 cm).

The nipples were lifted by 11 to 19.5 cm. The distance from the nipple to the IMF ranged from 18 to 24 cm. This distance was reduced postoperatively to between 9 and 11.5 cm (p value < 0.001).

Conclusions

Follow-up of the patients revealed that suspension of the breast parenchyma and plication of the dermal flap improved the esthetic results following inferior pedicle breast reduction.

The addition of volumetric and geometric adjustment “preoperatively” may significantly improve the results and minimize the operative time of this relatively lengthy procedure (4–6 h for both breasts).

Level of Evidence: Level IV, terapeutic study.

Keywords

Breast Reduction Mammoplasty Dermal Suspension Plication Inferior Pedicle 

Notes

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Compliance with ethical standards

Ethical approval

Ethical approval from a local ethics committee was obtained for this study.

Informed consent

Written and verbal consent was obtained from the patients.

Conflict of interests

Tarek Mahboub and Rama Ahmed declare that they have no conflict of interest.

References

  1. 1.
    Chan YH (2004) Biostatistics301: repeated measurement analysis. Singap Med J 45(8):354–369Google Scholar
  2. 2.
    Courtiss EH, Goldwyn RM (1977) Reduction mammaplasty by the inferior pedicle technique: an alternative to free nipple and areola grafting for severe macromastia or extreme ptosis. Plast Reconstr Surg 59:500–507CrossRefGoogle Scholar
  3. 3.
    Pennington DG (2006) Improving the results of inferior pedicle breast reduction using pedicle suspension and plication. Aesthetic Plast Surg 30:390–394Google Scholar
  4. 4.
    Ding H, Wang B, Gu Y, Zhao Y (2015) The combination of inferior pedicle method and dermal suspension sling technique : one new efficient method for breast reduction. Int J Clin Exp Med 8(4):6613–6620PubMedPubMedCentralGoogle Scholar
  5. 5.
    Echo A, Guerra G, Yuksel E (2011) The dermal suspension sling: shaping the inferior pedicle during breast reduction. Aesthetic Plast Surg 35:608–616Google Scholar
  6. 6.
    Kankaya Y, Oruc M, Sungur N, Aslan O, Gurosy K, Ozer K, Kocer U (2016) Four flap suspension technique for prevention of bottoming out after breast reduction. Ann Surg Treat Res 90(1):10–15CrossRefGoogle Scholar
  7. 7.
    Makboul M, Abdelhamid M, Al-Attar G (2017) Long term follow up and patient satisfaction after reduction mammoplasty: superomedial versus inferior pedicle. World J Plast Surg 6(1):82–87PubMedPubMedCentralGoogle Scholar
  8. 8.
    Nahabedian MY, Mofid MM (2002) Viability and sensation of the nipple-areolar complex after reduction mammaplasty. Ann Plast Surg 49:24–31CrossRefGoogle Scholar
  9. 9.
    Robbins TH (1984) Inferior pedicle breast reduction technique. Plast Reconstr Surg 73:325CrossRefGoogle Scholar
  10. 10.
    Temel M, Karakaş, Dokuyucu R, Türkmen A (2015) The dermal internal brassiere flap, a new modification of inferior pedicle breast reduction technic. Aesthetic Plast Surg 39:350–358CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Plastic Surgery, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.GizaEgypt

Personalised recommendations