A Step-by-Step Approach to a Successful Cosmetic Breast Reduction

Abstract

Evolution of breast reduction techniques has been a result of combining different skin marking patterns with a wide variety of pedicles. Despite the many differences that may exist among these procedures, they all rely on a few key principles. To make surgery more expeditious and minimize technical challenges, these principles can be incorporated into simple surgical strategies. The authors present a step-by-step approach to help to achieve a successful cosmetic breast reduction for patients with small to moderate breast hypertrophy. Special emphasis is given to intraoperative clues that make this procedure more reproducible and straightforward.

Fig. 1.

Preoperative breast markings. It is easier to trace the breast meridian by placing a tape measure around the patient’s neck, while the patient keeps a standing position. When using a mosque dome skin pattern, we take advantage of an “assistant square box.” A 3 × 3 cm incomplete square is drawn extending at both sides from the breast meridian. Then the dome is drawn freehand by uniting the mid-point of the inner sides of the square. The pedicle base width is outlined by tracing an oblique line which starts in the superior medial two thirds of the dome, then goes caudally leaving a 1 cm margin of skin surrounding the areola and ends around the mid-third of the medial vertical marking, keeping a base width of 6–8 cm.

Video Graphic 1.

See video, Supplemental Digital Content 1, which displays a detailed explanation of the marking procedure and the steps outlined in this article. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A988.

Fig. 2.

Postoperative, anterior view at 6-month follow-up (same patient shown in Fig. 1 and video). Weight of resected breast was 580 g on the right side, 520 g on the left side, and 50 mL of lipoaspirate from the lateral breast on each side.

Fig. 3.

Preoperative, anterior view of 38-year-old woman with moderate bilateral breast hypertrophy.

Fig. 4.

Postoperative, anterior view at 8-month follow-up. Weight of resected breast was 800 g on each side and 400 mL of lipoaspirate from the lateral breast on each side.