Superior Medial Pedicle Breast Reduction and Auto Augmentation

  • Mike Huntly
  • Ronald Finger

For most plastic surgeons emerging from residency programs in the 1980s, the central pedicle or inferior pedicle breast reduction technique was the method of choice. This technique, incorporating the Wise pattern, was reliable and produced good results of en maintaining the ability to breast feed. Disadvantages were extensive dissection of breast tissue, long operating times, and a tendency to “bottom out” over time. Nipple movement more than 15 cm vertically could become unreliable and if nipple loss occurred, reconstruction could be difficult because skin and underlying breast tissue could be lost. For larger breast reductions, the authors, like many, adopted a breast amputation technique with free nipple graft. This technique had advantages including simplicity, easy reproducibility, and shorter operating times. This involved removal of the lower segment of the breast as a horizontal ellipse and removal of a vertical wedge of central breast tissue, which when closed created the projection and desired shape. The nipple—areola complex was reapplied as a full thickness skin graft. The upper segments of the breast were left relatively undisturbed including blood supply from medial and lateral perforators and the innervation from intercostal nerve branches (Fig. 49.1). This method yielded excellent shape which could easily be reproduced on the second side. Surprisingly good preservation of nipple sensation was achievable. Disadvantages of this technique were that some loss of nipple projection and changes in texture of the skin of the areola and occasionally loss of pigmentation in patients of color could result. Over time, in my experience, shape held up very well with less tendency for “bottoming out.”


Breast Tissue Breast Reduction Inframammary Fold Areola Complex Full Thickness Skin Graft 
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© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Mike Huntly
  • Ronald Finger

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