The “Superior Ledge”: a Modification of the Standard Superomedial Pedicle Reduction Mammoplasty to Accentuate Nipple-Areola Complex Projection
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The superomedial pedicle parenchymal excision pattern for reduction mammaplasty has the benefits of a reproducible breast shape and improved superomedial fullness, but is limited by a susceptibility to nipple retraction. The senior author of this paper has formalized the “superior ledge” modification of the superomedial pedicle technique (SL-SMP) to address these limitations.
To describe the technical details of the SL-SMP breast reduction technique and to analyze patient outcomes.
The technique involves only partial-thickness parenchymal excision superolateral to the pedicle, thereby leaving a “superior ledge” of parenchyma on top of which the nipple-areola complex (NAC) rests in a tension-free manner. Postoperative photographs were recorded; and patient demographics, intraoperative details, complications, and outcomes were recorded and analyzed.
One hundred seven patients underwent SL-SMP reduction mammaplasty between 2007 and 2013. Complications included wound-healing complications (9.3 %), infection (2.8 %), seroma (1.9 %), and hematoma (1.9 %). Mean follow-up was 44.6 months (Range: 17–72), and during that period no incidence of clinically relevant NAC retraction was noted by either the patient or surgical team.
Maintenance of a distinct superior ledge underlying the final position of the NAC is an important modification to stress, to prevent nipple retraction. Importantly, the height of the ledge can be personalized for each patient. We feel it is a valuable addition to the plastic surgeon’s armamentarium to optimize outcomes for patients seeking relief from excessive breast tissue.
Level of Evidence V
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KeywordsMacromastia Breast reduction Mastopexy Superomedial pedicle
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Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
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- 2.DeGeorge BR, Colen DL, Mericli AF et al (2013) Reduction mammoplasty operative techniques for improved outcomes in the treatment of gigantomastia. ePlasty 13:466–476Google Scholar
- 3.ASPS 2012 Plastic surgery statistics Report. Published by American Society of Plastic Surgeons, 2012Google Scholar
- 13.Abdel-Khalek A (2008) Vertical breast reduction: superomedial pedicle. Egypt J Plast Reconstr Surg 32(1):111–117Google Scholar
- 23.Antony AK, Yegiyants SS, Kanielson KK et al (2013) A matched cohort study of superomedial pedicle vertical scar breast reduction (100 breasts) and traditional inferior pedicle Wise-pattern reduction (100 breasts): an outcomes study over 3 years. Plast Reconstr Surg 132:1068–1076CrossRefPubMedPubMedCentralGoogle Scholar