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Septum-Enhanced Mammaplasty in Inferocentral Pedicled Breast Reduction for Macromastia and Gigantomastia Patients

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  • Breast Surgery
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Abstract

Background

Inferior pedicle and free nipple grafting are commonly used as breast reduction techniques for patients with breast hypertrophy and gigantomastia. Limitations of these techniques are, respectively, possible vascular compromise and total/partial necrosis of the nipple–areola complex (NAC). The authors describe the innovative inferocentral pedicled reduction mammaplasty (ICPBR) enhanced by preservation of Würinger’s septum for severe hypertrophic breasts.

Materials and Methods

Among 287 breast reductions performed between January 2001 and 2015, 83 (28.9%) macromastia and gigantomastia patients met the inclusion criteria (breast volume resection ≥400 g–sternal notch-to-nipple distance ≥33 cm) and were included in the study. Patients were stratified according to pedicle type: Group A (51 patients) underwent ICPBR with Würinger’s septum preservation; group B (32 patients) underwent IPBR. Groups were compared for NAC vascular complications, surgical revisions, wound-healing period and patient satisfaction at a minimum 6-month follow-up assessed by a five-category questionnaire (breast size, shape, symmetry, texture and scars appearance), with five Likert subscales (1 = poor to 5 = excellent). Descriptive statistics were reported, and comparisons of performance endpoints between groups were performed using Chi-squared, Fisher’s exact and Mann–Whitney U tests, with p value <0.05 considered significant.

Results

Group A and group B had, respectively, a mean age of 48.3 ± 12.4 and 50.1 ± 11.7 years, mean BMI of 23.8 and 24.6, mean weight resected of 560 ± 232 g and 590 ± 195 g, mean sternal notch-to-nipple distance of 35.1 and 34.3 cm, average nipple elevation of 9.7 and 9.5 cm. Among group A and group B, NAC complication rates were, respectively, 6.2 and 24.2% (p = 0.03), surgical revision rates were 33.3 and 60% (p = 1.00), healing time was 15.90 ± 3.2 and 19.03 ± 5.9 days (p = 0.002), and mean patient satisfaction scores were 19.9 ± 2.6 and 18.7 ± 3.4 (p = 0.07).

Conclusions

The ICPBR technique enhanced by Würinger’s septum preservation was found to be a reproducible and effective procedure for hypertrophic breasted and gigantomastia patients, improving the reliability of the vascular supply to the inferior–central pedicle. The authors do believe this procedure should be regarded as an innovative and safe option giving optimal aesthetic outcomes in this demanding group of patients.

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.

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References

  1. Lalardrie JP, Jouglard JP (1973) Chirurgie Plastique du Sein. Masson, Paris

    Google Scholar 

  2. Lejour M (1999) Vertical mammaplasty: early complications after 250 personal consecutive cases. Plast Reconstr Surg 104:764–770

    Article  CAS  PubMed  Google Scholar 

  3. Zubowski R, Zins JE, Foray-Kaplon A et al (2000) Relationship of obesity and specimen weight to complications in reduction mammaplasty. Plast Reconstr Surg 106:998–1003

    Article  CAS  PubMed  Google Scholar 

  4. Landau AG, Hudson DA (2008) Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia. Plast Reconstr Surg 121:735–739

    Article  CAS  PubMed  Google Scholar 

  5. Karacaoglu E, Zienowicz RJ (2017) Septum-inferior-medial (SIM)-based pedicle: a safe pedicle with well-preserved nipple sensation for reduction in gigantomastia. Aesthet Plast Surg 41(1):1–9. doi:10.1007/s00266-016-0763-1

    Article  Google Scholar 

  6. Sandsmark M, Amland PF, Abyholm F, Traaholt L (1992) Reduction mammaplasty: a comparative study of the Orlando and Robbins methods in 292 patients. Scand J Plast Reconstr Surg Hand Surg 26:203

    Article  CAS  PubMed  Google Scholar 

  7. Würinger E, Mader N, Posch E et al (1998) Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg 101:1486–1493

    Article  PubMed  Google Scholar 

  8. Strong B, Hall-Findlay EJ (2015) How does volume of resection relate to symptom relief for reduction mammaplasty patients? Ann Plast Surg 75(4):376–382. doi:10.1097/SAP.0000000000000190

    Article  CAS  PubMed  Google Scholar 

  9. Sahin I, Iskender S, Ozturk S et al (2013) Evaluation of breast reduction surgery effect on body posture and gait pattern using three-dimensional gait analysis. Aesthet Plst Surg 37(3):549–553

    Article  Google Scholar 

  10. Ak Antony, Yegiyants SS, Danielson 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 outcome study over 3 years. Plast Reconstr Surg 132(5):1068–1076

    Article  Google Scholar 

  11. Degeorge BR Jr, Colen DL, Mericli AF, Drake DB (2013) Reduction mammoplasty operative techniques for improved outcomes in the treatment of gigantomastia. Eplasty 13:e54

    PubMed  PubMed Central  Google Scholar 

  12. Georgiade NG, Serafin D, Morris R, Georgiade G (1979) Reduction mammaplasty utilizing an inferior pedicle nipple-areolar flap. Ann Plast Surg 3:211

    Article  CAS  PubMed  Google Scholar 

  13. Aryian S (1980) Reduction mammaplasty with the nipple–areola carried on a single narrow inferior pedicle. Ann Plast Surg 5:167

    Article  Google Scholar 

  14. Boger WE, Seyfer AE, Jackson SM (1987) Reduction mammaplasty using the inferior glandular “pyramid” pedicle: experiences with 300 patients. Plast Reconstr Surg 80:75

    Article  Google Scholar 

  15. Ribeiro LA (1975) A new technique for reduction mammaplasty. Plast Reconstr Surg 55:330

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  CAS  PubMed  Google Scholar 

  17. Robbins TH (1977) A reduction mammaplasty with the areola–nipple based on an inferior dermal pedicle. Plast Reconstr Surg 59:64

    Article  CAS  PubMed  Google Scholar 

  18. Hester TR, Bostwick J, Miller L, Cunningham SJ (1985) Breast reduction utilizing the maximally vascularised central breast pedicle. Plast Reconstr Surg 76:890

    Article  PubMed  Google Scholar 

  19. 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

    Article  CAS  PubMed  Google Scholar 

  20. Davis GM, Ringler SL, Short K et al (1995) Reduction mammaplasty: log-term efficacy, morbidity and patient satisfaction. Plast Reconstr Surg 96:1106

    Article  CAS  PubMed  Google Scholar 

  21. van Deventer PV (2004) The blood supply to the nipple–areola complex of the human mammary gland. Aesthet Plast Surg 27:393–398

    Article  Google Scholar 

  22. Moufarrege R, Beauregard G, Bosse JP, Muller G, Papillon J, Perras C (1985) Reduction mammoplasty by the total dermoglandular pedicle. Aesthet Plast Surg 9(3):227–232

    Article  CAS  Google Scholar 

  23. Innocenti A, Melita D, Mori F, Ciancio F, Innocenti M (2016) Management of gynecomastia in patients with different body types. Ann Plast Surg. doi:10.1097/SAP.0000000000000940

    PubMed Central  Google Scholar 

  24. Hammond DC (1999) Short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty. Plast Reconstr Surg 103:890

    Article  CAS  PubMed  Google Scholar 

  25. Hamdi M, Van Landuyt KV, Tonnard P et al (2009) Septum-based mammaplasty: a surgical technique based on Würinger’s septum for breast reduction. Plast Reconstr Surg 123(2):443–454

    Article  CAS  PubMed  Google Scholar 

  26. Bayramiçli M (2012) The central pillar technique: a new septum-based pedicle design for reduction mammaplasty. Aesthet Surg J 32(5):578–590

    Article  PubMed  Google Scholar 

  27. Van Deventer PV, Graewe FR (2010) Enhancing pedicle safety in mastopexy and breast reduction procedures: the posteroinferomedial pedicle, retaining the medial vertical ligament of Würinger. Plast Reconstr Surg 126(3):786–793

    Article  PubMed  Google Scholar 

  28. Ciancio F, Parisi D, Portincasa A, Innocenti A (2016) Discussion: a new method of salvaging breast reconstruction after breast implant using negative-pressure wound therapy and instillation. Aesthet Plast Surg. doi:10.1007/s00266-016-0734-6

    Google Scholar 

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Acknowledgements

The authors have no financial interest to declare in relation to the content of this article.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy

    Aurelio Portincasa & Domenico Parisi

  2. Department of Plastic and Reconstructive Surgery, University of Bari, Viale Pinto n1, 71122, Foggia, Italy

    Francesco Ciancio & Luigi Cagiano

  3. Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Florence, Italy

    Alessandro Innocenti

Authors
  1. Aurelio Portincasa
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  2. Francesco Ciancio
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  3. Luigi Cagiano
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  4. Alessandro Innocenti
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  5. Domenico Parisi
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Correspondence to Francesco Ciancio.

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Portincasa, A., Ciancio, F., Cagiano, L. et al. Septum-Enhanced Mammaplasty in Inferocentral Pedicled Breast Reduction for Macromastia and Gigantomastia Patients. Aesth Plast Surg 41, 1037–1044 (2017). https://doi.org/10.1007/s00266-017-0868-1

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  • DOI: https://doi.org/10.1007/s00266-017-0868-1

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