Breast Reduction: The Superolateral Dermoglandular Pedicle Revisited

"Identifying complication risk factors in reduction mammaplasty: a single-center analysis of 1021 patients applying machine learning methods"

Various surgical approaches and pedicles have been described to ensure safe and satisfactory results in reduction mammaplasty. Although different breasts require different techniques, complications are common. This study aims to assess the incidence of complications following primary bilateral reduction mammaplasties across a diverse range of pedicle methods within one of the largest single-center cohorts to date, utilizing machine learning methodologies. A retrospective review of primary bilateral reduction mammaplasties at a single surgical center between January 2016 and March 2020 was performed. Patient medical records and surgical details were reviewed. Complications were compared among three different pedicles. Binary recursive partitioning (CART) machine learning was employed to identify risk factors. In total, 1021 patients (2142 breasts) met the inclusion criteria. The superomedial pedicle was the most frequently utilized (48.0%), with an overall complication rate of 21%. While pedicle-based subgroups demonstrated significant demographic variance, overall complication rates differed most between the inferior (24.9%) and the superomedial pedicle (17.7%). Statistical analysis identified resection weight as the sole significant independent risk factor (OR 1.001, p = 0.007). The machine learning model revealed that total resection weights exceeding 1700 g significantly increased the risk of overall complications, while a sternal notch to nipple (SNN)-distance > 36.5 cm correlated with complications involving the nipple-areola complex (NAC). Higher resection weights are associated with elevated complication rates. Preoperative assessment utilizing SNN-distance can aid in predicting NAC complications.

Application of Liposuction and Superior Pedicle Vertical Mammoplasty for Severe Breast Hypertrophy

BACKGROUND

Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction.

METHODS

A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded.

RESULTS

Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications.

CONCLUSION

This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair.

LEVEL OF EVIDENCE V

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 .

Expanding Usage of Superior Pedicled Techniques with Reducing Resistance in the Pedicle by Lipoaspiration

BACKGROUND

Despite the advantages of the superior pedicles in breast reduction, there are some limitations with this technique. The mobility of the pedicle may be augmented by liposuction in the pedicle area which may relieve tissue resistance and decrease pedicle compression in order to overcome circulation problems. In fact, the indications of breast reduction using superior pedicles may be expanded by liposuction in the pedicle area.

METHODS

The patients who underwent breast reduction with superior pedicle techniques between March 2014 and November 2020 and whose pedicle resistances were decreased by liposuction were included in this study. Internal breast morphology was classified into three groups based on the morphology of the periareolar tissues. Group 1 breasts were lipomatous, Group 2 breasts were lipo-glandular and Group 3 breasts were fibroglandular. During the short-term follow-up, the circulation of the nipple-areola complex (NAC) was evaluated both clinically and with an hand held Doppler device. The long-term aesthetic results were evaluated at the postoperative twelfth month with a visual analogue scale.

RESULTS

One hundred eighty-nine patients with either Group 1 or Group 2 breasts were included in this study. The mean age of the patients was 38.3 years. The mean follow-up period was 31.7 months. Neither partial nor total NAC loss was observed and none of the patients had bottoming-out deformity.

CONCLUSION

Liposuction to the pedicle area is an effective and reliable method that both reduces the resistance in the pedicle and overcomes the circulation problems in certain patient groups (groups 1 and 2), increases the mobilization of the pedicle, reduces the breast to the desired size and prevents bottoming-out in the long term and increases the use of superior pedicle techniques. According to our clinical results, it was demonstrated that pedicle vascular mapping with preoperative Doppler sonography was not necessary in these 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 .

Inverted-T pattern reduction mammoplasty in bilateral breast ptosis: cosmetic and oncological outcomes

Background

Breast ptosis is directly caused by Cooper's ligament laxity, with the decline of nipple areola complex (NAC) and mammary parenchyma. Breast cancer with ptosis is always a knotty problem that can hardly be repaired by classic breast conservation surgery (BCS) ending up with a pleasing appearance. We analyzed our 12 years' experience of performing inverted-T pattern techniques to treat bilateral breast ptosis, with or without breast cancer.

Methods

One hundred forty-eight breasts in 74 patients undergoing inverted-T pattern reduction mammoplasty were included in this study. Information about patients' clinical and surgical characteristics, complications, NAC sensitivity, cosmetic and oncological outcomes were collected and retrospectively analyzed.

Results

In the cohort of 57 patients with pure breast ptosis, the mean body mass index (BMI) was 25.2 kg/m², and the mean weight of resected tissue from the left and right breast reductions were 744.9 and 756.7 g. In the cohort of 17 patients diagnosed as breast cancer with ptosis, the mean BMI was 25.1 kg/m², and the mean weight of resected tissue were 504.1 g for left and 535.6 g for right side. The majority of repairs were performed for tumors located in the upper outer (58.8%), mostly with inferior or superomedial pedicles (90%). All the upper inner tumors were repaired with inferior pedicles. Minor complications such as seroma (8.1%), NAC epidermolysis (8.1%), delayed wound healing (4.1%) were detected postoperatively. Partial NAC necrosis occurred in one patient (1.4%). 82.4% of all the patients rated "very satisfied" or "satisfied" as the final cosmetic outcomes. NAC sensitivity was "very high" and "high" in 82.4% patients. No local occurrence, distant metastasis and mortality occurred in tumor patients.

Conclusions

The inverted-T pattern reduction mammoplasty is a reliable technique to treat bilateral breast ptosis with a low complication rate. For cases with breast cancer, this technique can achieve both satisfying cosmetic outcomes and oncological safety.

Breast Reduction: 33 Years Using a Single Central Block

BACKGROUND

Since 1985, the author has been using the single central block technique for breast reduction and mastopexy, prioritizing the good relation between the final breast shape and the length of the scars, different from other authors who emphasize only the shape of the breast (Peixoto in Plast Reconstr Surg 65(2):217-225, 1980; Aesthet Plast Surg 8:231-236, 1984) and others who have drawn attention to the length of the scars (Arié in Rev Latinoam Cir Plast 3:23-31, 1957; Bozola in Plast Reconstr Surg 85:728-738, 1990; Sepúlveda in Rev Bras Cir 71(1):11-18, 1981). In this study, the author describes the use of a single central block of the mammary tissue and the nipple-areolar complex (NAC), dissected from the skin flaps and based on the superior vascular pedicle for reduction mammoplasty and mastopexy (Erfon et al. in Annals of the international symposium recent advances in plastic surgery, São Paulo, 1989; Hinderer (ed) Plastic surgery, Elsevier, Madrid, 1992; Proceedings of the 65th annual scientific meeting of the American society of plastic and reconstructive surgeons, Dallas, 1996).

METHODS

A retrospective study was performed, evaluating patients who underwent breast reduction and mastopexy using the single central block technique from July 1985 to December 2018 by a senior author.

RESULTS

A total of 2097 procedures were performed using this technique, 1556 being reduction mammoplasties and 541 mastopexies. The mean patient age was 44, and the mean weight of tissue resected was 455 g. Fat necrosis on the distal area of the flap was observed in 47 cases (2.24%). Hematoma was observed in 6 patients (0.28%). Surgical revisions were undertaken in 75 patients (3.57%). Hypertrophic scars occurred in 12 of the cases (0.57%). Dehiscence in the inverted "T" scars occurred in 78 of the surgeries (3.71%).

CONCLUSIONS

This technique allows the surgeon to easily form a good cone shape of the breast, repositioning the NAC and preserving its vascularization and sensation without tension on the skin flaps sutures, resulting in smaller and better scars.

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.