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A Superior Vertical Dermal Pedicle for the Nipple–Areola: An Alternative for Severe Breast Hypertrophy and Ptosis

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Abstract

Background

Nipple–areola nourishment and sensation have been the main concern in reduction mammaplasty for severe breast hypertrophy and ptosis. Free grafting for the nipple–areola can cause flatness and loss of sensation. These complications can be improved by pedicle techniques for the nipple–areola, no matter the pedicle orientation. The aesthetic outcomes and complications are similar for the inferior and superior pedicle techniques. The pedicle length has been crucial to nipple–areola viability and sensation.

Methods

Using a keyhole pattern, a vertical flap with a superior pedicle was outlined for nipple–areola transposition. The mammary tissue under the flap was removed, creating a vertical dermal flap 7–14 cm long, and the superior pedicle was located on the new site of the areola marked by the pattern. Sensation was evaluated monthly by subjective contact testing of the four quadrants of the nipple–areola.

Results

The Pearson product–moment correlation coefficient was used to correlate the return of sensation with the length of the dermal flap and the amount of breast tissue removed. Sensation was achieved for the four quadrants 6 months after the breast reduction for all the patients of this series. Recovery of sensation was significantly greater for the superior quadrants than for the inferior quadrants in the first 3 months.

Conclusions

The vertical dermal flap with the superior pedicle preserves nipple–areola nourishment and sensation. It is an alternative option for pedicle techniques in surgical correction of severe breast hypertrophy and ptosis.

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References

  1. Schwarzmann E (1930) Die technic der mamoplastik. Chirurgentagung 2:932

    Google Scholar 

  2. Skoog T (1963) A technique of the breast redution. Acta Chir Scand 126:453

    PubMed  CAS  Google Scholar 

  3. Jackson IT, Bayramicli M, Grupta M, Yavuzer R (1999) Importance of the pedicle length measurement in reduction mammaplasty. Plast Reconstr Surg 104:398

    Article  PubMed  CAS  Google Scholar 

  4. Erdogan B, Ayhan M, Deren O, Tuncel A (2002) Importance of pedicle length in inferior pedicle technique and long-term outcome of areola-to-fold distance. Aesthetic Plast Surg 26:436

    Article  PubMed  Google Scholar 

  5. Abramo AC (2009) Superior vertical dermal pedicle for the nipple–areola. In: Shiffman MA (ed) Mastopexy and breast reduction: principles and practice, chapter 47. Springer, London, p 351

    Chapter  Google Scholar 

  6. Mojallal A, Moutran M, Shipkov C, Saint-Cyr M, Rohrich RJ, Braye F (2010) Breast reduction in gigantomastia using the posterosuperior pedicle: An alternative technique based on preservation of the anterior intercostal artery perforators. Plast Reconstr Surg 125:32

    PubMed  CAS  Google Scholar 

  7. Blondeel PN, Handi M, Van de Sijpe KA, Van Landeryt KH, Thiessen FE, Monstrey SJ (2003) The laterocentral glandular pedicle technique for breast reduction. Br J Plast Surg 56:348

    Article  PubMed  Google Scholar 

  8. Datta G, Carlucci S (2009) Selective breast reduction: a personal approach with a central-superior pedicle. Plast Reconstr Surg 123:433

    Article  PubMed  CAS  Google Scholar 

  9. Hamdi M, Greuse M, De Mey A, Webster MH (2001) A prospective quantitative comparison of breast sensation after superior and inferior pedicle mammaplasty. Br J Plast Surg 54:39

    Article  PubMed  CAS  Google Scholar 

  10. Kreithen J, Caffee H, Rosemberg J, Chin G, Clayman M, Lawson M, Seagle MB (2005) A comparison of the Lejour and Wise pattern methods of breast reduction. Ann Plast Surg 54:236

    PubMed  CAS  Google Scholar 

  11. Nahabedian M, Mofid M (2002) Viability and sensation of the nipple–areolar complex after reduction mammaplasty. Ann Plast Surg 49:24–31

    Article  PubMed  Google Scholar 

  12. Hinderer U (1978) Mammaplasty: the dermal brassiere technique. Aesthetic Plast Surg 2:1

    Article  Google Scholar 

  13. Serafin D (1979) Surgical anatomy of the breast. In: Georgiade NG (ed) Breast reconstruction following mastectomy. The CV Mosby Company, St. Louis, pp 35–53

    Google Scholar 

  14. Lockhart RD, Hamilton GF, Fyfe FW (1959) Anatomy of the human body. Faber and Faber Limited, London, pp 598–654

    Google Scholar 

  15. Hamdi M, Greuse M, Nemec F, Deprez C, De Mey A (2001) Breast sensation after superior pedicle versus inferior pedicle mammaplasty: anatomical and histological evaluation. Br J Plast Surg 54:43

    Article  PubMed  CAS  Google Scholar 

  16. Schlenz I, Kasbari R, Gruber H, Holle J (2000) The sensitivity of the nipple–areola complex: An anatomic study. Plast Reconstr Surg 105:905

    Article  PubMed  CAS  Google Scholar 

  17. Schlenz I, Rigel S, Schemper M, Kusbari R (2005) Alteration of nipple and areola sensitivity by reduction mammaplasty: A prospective comparison of five techniques. Plast Reconstr Surg 115:743

    Article  PubMed  CAS  Google Scholar 

  18. Wray RC, Luce EA (1981) Treatment of impending nipple necrosis following reduction mammaplasty. Plast Reconstr Surg 68:242

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

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  1. Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil

    Antonio Carlos Abramo

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  1. Antonio Carlos Abramo
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Correspondence to Antonio Carlos Abramo.

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Abramo, A.C. A Superior Vertical Dermal Pedicle for the Nipple–Areola: An Alternative for Severe Breast Hypertrophy and Ptosis. Aesth Plast Surg 36, 134–139 (2012). https://doi.org/10.1007/s00266-011-9784-y

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  • DOI: https://doi.org/10.1007/s00266-011-9784-y

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