Pseudoptosis Correction With the 270° Pedicle Reduction Mammoplasty: An Anatomic and Clinical Study

Abstract

Background: Reduction mammoplasty techniques have evolved considerably. Today, aesthetically pleasing results and preservation of nipple sensation and vascularity are emphasized. Achieving the aforementioned goals for the patient with pseudoptosis remains challenging. Objective: We present 270° pedicle reduction mammoplasty as a safe and direct technique for treatment of pseudoptosis to reduce size and improve breast shape. Methods: Circumareolar subcutaneous dissection of 10 breasts (5 cadavers) was performed to identify the nerves from the chest wall to the nipple. The trajectory of the nerves to the nipple was identified and dissected to their origin of penetration of the chest fascia. This information provides the basis for lateral chest wall tissue preservation for preserved nipple-areolar innervation, which is incorporated into this technique. Retrospective review of a single surgeon's experience with the 270° pedicle technique for reduction mammoplasty over a 1-year period was performed. Results: Anatomic dissection identified 3 to 5 branches of the fourth intercostal nerve to primarily innervate the nipple on 8 of 10 breast dissections. Accessory innervation from the fifth intercostal nerve provided lateral branches to the nipple in 5 of 10 specimens. Five patients underwent reduction mammoplasty with the 270° pedicle technique. No complications were identified. Excellent aesthetic outcomes were achieved on the basis of patient-reported satisfaction and the surgeon's judgment. All patients demonstrated normal nipple sensation at postoperative follow-up. Follow-up at 1 year did not demonstrate recurrence of ptosis/pseudoptosis or change in nipple position. Conclusions: The 270° technique for pedicle reduction mammoplasty yields aesthetically pleasing results and symptomatic relief from macromastia and preserves nipple sensation.

Keywords: 270° pedicle; breast nipple innervation; breast reduction; reduction mammoplasty.

Figure 1

Preoperative photograph of a 50-year-old patient. Markings are made with the patient standing.

Figure 2

(a) Horizontal limbs of the resection meet the vertical limbs and inframammary fold incision demarcating the mass of tissue to be resected en bloc. (b) Inferiorly based V-flap is placed at the T-conversion of the Wise pattern closure.

Figure 3

(a) Incision along preoperative markings. (b) Resected breast tissue and the remaining 270° pedicle.

Figure 4

Final approximation of tissue and closure.

Figure 5

Fifty-year-old woman from Figure 1 at 1-year postoperative follow-up.