Double-Unit Superomedio-Central (DUS) Pedicle Inverted-T Reduction Mammaplasty in Gigantomastia: A 7-year Single-Center Retrospective Study

Abstract

Introduction: Reduction mammaplasty in patients with gigantomastia is challenging. The Double-Unit technique with a Superomedio-Central pedicle and inverted-T incision is the standard technique for reduction mammaplasty in our clinic. The aim of this study was to review our approach in cases with gigantomastia in comparison with the current literature.

Patients and methods: From 01/2011 to 12/2017, we performed 831 reduction mammaplasties in 630 patients. The Double-Unit Superomedio-Central (DUS) pedicle and inverted-T incision was implemented as a standard procedure for gigantomastia. Patient demographics and the outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensibility, and surgical revision rate were obtained and retrospectively analyzed.

Results: In 37 patients, 55 reduction mammaplasties were performed with more than 1000 g per breast. Mean resection weight was 1311 g on right side and 1289 g on left side. Mean age was 52.5 years, mean body mass index was 32.8 kg/m², mean sternal-notch-to-nipple distance was 38.3 cm. A free NAC graft was necessary in four breasts. Overall complication rate was 14.5%; secondary surgical revision rate was 12.7%. 91% of the patients were "very satisfied" and "satisfied" with the aesthetic result. Nipple sensibility was rated "high" and "medium" in 83%.

Conclusion: The Double-Unit technique with a Superomedio-Central pedicle and inverted-T incision is very effective to achieve volume reduction and aesthetically pleasing reproducible results with a low complication rate in cases with gigantomastia.

Level of evidence: Level of Evidence 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 .

Keywords: Breast reduction; Gigantomastia; Macromastia; Reduction mammaplasty; Severe mammahypertrophy; Superomedial pedicle.

Fig. 1

Patient example with Pedicle Marking (red color) of the Double-Unit Superomedio-Central (DUS) Pedicled Inverted-T Reduction Mammaplasty (green color)

Fig. 2

Patient example 1 with DUS-Pedicle marking. 37-year-old patient with cup size 90 G/H, SN-NAC distance 35 cm right side and 34 cm left side, ptosis grade III by Regnault, BMI 30.5 kg/m². Preoperative status (above), preoperative markings (middle), and 12 months postoperative (below) after Double-Unit Superomedio-Central (DUS) Pedicled Inverted-T Reduction Mammaplasty, form stable breast shape and good upper pole projection. Resection weight right side 1309 g and left side 1185 g (BMI: body mass index kg/m²; SN: sternal notch, NAC: sternal notch–nipple–areolar complex)

Fig. 3

Illustration of Surgical Markings and measurements of the Double-Unit Superomedio-Central (DUS) Pedicle in a schematic gigantomastic breast (NAC: Nipple–Areola Complex; IMF: Inframammary Fold)

Fig. 4

Illustration of Surgical Technique. A, B Double-Unit Superomedio-Central (DUS) Pedicle Inverted-T Reduction Mammaplasty with illustration of vascular supply. C Cranial rotation of DUS-Pedicle and inset of NAC in new position. D Skin closure and stitch-out laterally to vulnerable tripod zone. (NAC: nipple–areola complex)

Fig. 5

Anatomical Illustration of the Double-Unit Superomedio-Central (DUS) Pedicle, the vascular supply of the NAC and the Wueringer’s horizontal septum [26] in frontal view. (NAC: nipple–areola complex)

Fig. 6

Anatomical illustration of the Double-Unit Superomedio-Central (DUS) Pedicle, the vascular supply of the NAC and the Wueringer’s horizontal septum [26] in sagittal view. (NAC: nipple–areola complex)

Fig. 7

Patient examples (left side: patient Fig. 2 and right side: Fig. 10) pre- and postoperative with focus on the inframammary (IMF) scar; note: very slight bottoming out in the left case due to advanced age (37 years (left side) vs. 23 years (right side)), impaired skin quality and elasticity, more severe grade of breast ptosis and status after breast feeding

Fig. 8

Patient example 2. 31-year-old patient with cup size 80 M, SN-NAC distance 39 cm right side and 38 cm left side, ptosis grade III by Regnault, BMI 32 kg/m². Preoperative status (above), preoperative markings (middle), and 6 months postoperative (below) after Double-Unit Superomedio-Central (DUS) Pedicled Inverted-T Reduction Mammaplasty, form stable breast shape and good upper pole projection. Resection weight right side 2124 g and left side 2248 g (BMI: body mass index kg/m²; SN: sternal notch, NAC: sternal notch–nipple–areolar complex)

Fig. 9

Patient example 3. 20-year-old patient with cup size 75 G, SN-NAC distance 36 cm right side and 34 cm left side, ptosis grade II by Regnault, BMI 26 kg/m². Preoperative status (above), and 12 months postop (below) after Double-Unit Superomedio-Central (DUS) Pedicled Inverted-T Reduction Mammaplasty, form stable breast shape and good upper pole projection. Resection weight right side 1602 g and left side 1150 g. (BMI: body mass index kg/m²; SN: sternal notch, NAC: nipple–areolar complex)

Fig. 10

Patient example 4. 23-year-old patient with cup size 75 K, SN-NAC distance 34 cm right side and 34 cm left side, ptosis grade II by Regnault, BMI 24 kg/m². Preoperative status (above), and 18 months postop (below) after Double-Unit Superomedio-Central (DUS) Pedicled Inverted-T Reduction Mammaplasty, form stable breast shape and good upper pole projection. Resection weight right side 1850 g and left side 1800 g. (BMI: body mass index kg/m²; SN: sternal notch, NAC: nipple–areolar complex)

Fig. 11

Patient example 5. 46-year-old patient with cup size 85 N, SN-NAC distance 54 cm right side and 57 cm left side, ptosis grade III by Regnault, BMI 29 kg/m². Preoperative status (above), and 24 months postoperative (below) after free NAC graft and Double-Unit Superomedio-Central (DUS) Pseudopedicled Inverted-T Reduction Mammaplasty, form stable breast shape, good upper pole projection and mild NAC hypopigmentation. Resection weight right side 4200 g and left side 4600 g. (BMI: body mass index kg/m²; SN: sternal notch, NAC: nipple–areolar complex)