Periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle

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Summary

The goals of reduction mammoplasty are to reduce the volume of a breast, to create an aesthetic shape that is stable over time, to maintain blood supply and innervation to the areolar complex, and to make fine limited scars. The present authors used periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle. To minimise the scar, periareolar incision was performed. To reduce the volume of breast and to preserve blood supply and innervation to the nipple-areolar complex, a central or an inferior pedicle technique was used. To prevent areolar widening, a purse-string suture was used.

A total of 82 breasts in 41 patients with very large breasts were operated on between July 1998 and June 2004. The mean age was 39, and the mean resection amount was 389 g per breast (right 413 g, left 364 g) with an average follow up of 28 months. Most of the patients were satisfied with the fine periareolar scar, the size of the breasts and the sensation of the nipple-areolar complex. The present authors have applied this procedure to all kinds of macromastia.

Although the advantages of the periareolar reduction mammoplasty are an inconspicuous limited scar, a preservation of sensation to the nipple-areolar complex and a short operation time, 24 breasts (29%) showed areolar widening. There were persistent periareolar wrinkles in eight breasts (10%) and poor sensation to the nipple-areolar complex in 12 breasts (15%), in which more than 500 g of breast tissue was removed per breast.

In conclusion, the periareolar reduction mammoplasty is optimal for patients who require a reduction of less than 500 g per breast. In severe macromastia with or without ptosis, the inverted T-incision is more preferable to periareolar incision, and periareolar incision can be modified by adding a wedge resection of the outer excess in skin flap inferiorly, which results in periareolar and vertical scars below the nipple-areolar complex.

Section snippets

Preoperative design

The patient is marked in the upright position. From the midclavicular point, the breast meridian is outlined along the breast and down on to the chest wall. A circular pattern is drawn around the most anterior projecting portion of the breast by determining four points. The superior point (point A) is determined by placing the fingers under the breast and transposing the location of the inframammary fold to the anterior skin of the breast. This point is supposed to be the position of new

Results

A periareolar reduction mammoplasty was performed on 82 breasts in 41 patients between July 1998 and June 2004. The mean age was 39 and the resection amount ranged from 155 g to 923 g per breast with a mean amount of 389 g and an average follow up of 28 months. Most of the patients were satisfied with their fine periareolar scar, an adequate breast size and the sensation of the nipple-areolar complex (Figure 3, Figure 4). Questionnaires on the degree of satisfaction with their surgery were

Discussion

A periareolar incision was first reported by Noel1 in 1927. Peled et al.2 applied a purse-string suture for the reduction and closure of periareolar wide skin defects and Benelli3 reported the ‘round block’ technique, which is a kind of purse-string suture. Felicio4 divided the mammary gland into four quadrants, superior, inferior, lateral and medial to make a central glandular pedicle. Gose5 used the de-epithelialised periareolar circular flap to fix the glandular tissue and he called it the

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