Superomedial-Posterior Pedicle-Based Reduction Mammaplasty: Evaluation of Effectiveness and BREAST-Q Outcomes of a Rapid and Safer Technique

Abstract

Introduction: Breast hypertrophy, a common pathological condition, often requires surgical intervention to alleviate musculoskeletal pain and improve patients' quality of life. Various techniques have been developed for breast reduction, each with its own advantages and complications. The primary aim of this study is to evaluate the efficacy, safety, and patient-reported outcomes of the authors technique: the Superomedial-Posterior Pedicle-Based Reduction Mammaplasty.

Material and methods: A prospective study was conducted on 912 patients who underwent breast reduction surgery between November 2012 and July 2020. The surgical technique involved preserving all glandular tissue from the areola to the pectoralis major muscle using the superomedial-posterior pedicle. The patients' demographic data, operative details, complications, breast-related quality of life (measured using the Breast-Q questionnaire), and nipple-areola complex sensitivity were analyzed.

Results: The average operative time was 62.12 ± 10.3 minutes. Complications included minor wound dehiscence (4.05%) and hematoma (1.2%), with no cases of nipple-areola complex necrosis. Nipple-areola sensitivity was fully restored in all patients at the 2-year follow-up. Patient satisfaction with the procedure was high with a statistically significant difference observed between pre- and postoperative scores (p < 0.001) of the Breast-Q questionnaire.

Conclusion: Authors technique offers reliable vascularization and innervation of the nipple-areola complex and achieves satisfactory aesthetic outcomes. It is associated with shorter operative times compared to other techniques reported in the literature. The Superomedial-Posterior Pedicle-Based Reduction Mammaplasty represents a safe and effective method for breast reduction surgery, providing significant benefits to patients with breast hypertrophy.

Level of evidence i: 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 Q; Breast hypertrophy; Breast reduction mammoplasty; Nipple–areola complex (NAC) sensitivity; Operative time in breast reduction mammaplasty; Suction drains.

Fig. 1

The Superomedial-Posterior Pedicle (a-b). The superomedial-posterior pedicle technique preserves all breast tissue from the nipple–areolar complex to the pectoralis muscle, ensuring a triple vascular supply. This is achieved through two vascular axes associated with the superomedial pedicle, as well as septal vascularization. The area between the two dashed lines illustrates the superomedial-posterior pedicle. In this area, the course of multiple perforating vessels that vascularize the nipple–areolar complex (NAC) can be observed (a). Appearance of the pedicle after the desired amount of tissue removal has been performed (b). By utilizing this pedicle, even in cases where there is a considerable distance between the jugulum and the nipple, and a substantial elevation of the areola is required, the vascularization and innervation of the nipple–areolar complex is preserved

Fig. 2

ANOVA test results (a-e). Drainage duration (for SDG patients), length of hospital stay, operative time, complication rate, and outpatient follow-up time (for all patients) based on the amount of tissue resection ( < 500g, between 500 and 1000 g, and > 1000 g)

Fig. 3

Preoperative (a-b) and one-year postoperative (c-d) appearance of a 29-year-old young woman

Fig. 4

Preoperative (a-b) and one-year postoperative (c-d) appearance of a 62-year-old woman. This patient, who had previously experienced severe back pain and had never ventured to the beach before the surgery, expressed profound satisfaction with the results. Furthermore, she had received comprehensive information regarding the potential for less aesthetically pleasing scars. Consequently, in this instance, the advantages gained significantly surpassed the patient’s initial expectations. Remarkably, she barely noticed the periareolar scar outcomes, which were admittedly not very aesthetically pleasing. The postoperative symmastia effect (c) can be attributed primarily to the anatomical configuration of the patient’s breast, and its presence can be anticipated in the preoperative images, particularly when examining the upper medial area of both breasts (a). After the procedure, the patient expressed extreme satisfaction with the outcome and significant improvement in chronic back pain caused by the weight of her breasts

Fig. 5

Preoperative (a-b) and one-year postoperative (c-d) appearance of a highly active 45-year-old woman. After the procedure, the patient expressed extreme satisfaction with the outcome