Avoiding Free Nipple Grafts During Reduction Mammaplasty in Patients With Gigantomastia

Abstract

Excessive breast hypertrophy or gigantomastia (>2000 g excision of tissue per breast) has traditionally been approached with breast amputation and free nipple grafting during reduction mammaplasty procedures. Disadvantages of free nipple grafts include loss of sensation, poor projection, uneven nipple-areolar complex pigmentation, and loss of lactation. We report our experiences utilizing the inferior pedicle technique of reduction mammaplasty with successful preservation of the nipple-areola complex for patients with gigantomastia. Between 2001 and 2003, 15 patients (ages 19--45) were identified with gigantomastia through review of pathology and operative reports. The inferior pedicle technique was performed in all cases by the attending staff assisted by plastic surgery residents. Patients were followed regularly from 1 week up to 1 year postoperatively. All patients reported relief from the physical sequelae of breast hypertrophy. One patient experienced bilateral partial nipple desquamation; she maintained sensation throughout and healed well with moist dressings. Otherwise, there were no complications and all patients achieved satisfactory esthetic outcomes. Our results suggest that inferior pedicle technique can be successfully performed in patients with gigantomastia. Breast amputation with free nipple grafting need not be considered standard practice for this patient population. Maintaining a wider pedicle base and meticulous intraoperative handling of the pedicle may contribute to the increased viability of the nipple-areolar complex during these cases.

Breast reduction with the posterosuperior pedicle: a series of 200 consecutive patients

“…We noted delayed healing in 12% of the cases at the junction of the inverted T, which is less than other reported results, but not signifi cantly different. 28,29 Other reports give similar complication rates. Landau et al reported an overall complications rate of 22.5% with partial areola necrosis in 8 patients (6.5%) and other minor complications, including T-junction breakdown in 22 breasts (18%) and dog-ear excisions.…”

Inferior Pedicle Breast Reduction for the Management of Gestational Gigantomastia: Literature Review and a Case Presentation

“…The complication mostly associated with the inferior pedicle method is the widening of the inferior portion of the inverted T incision, 7% to 20% of the time [4] [20]. Fortunately, this complication was not observed in our patient.…”

“…The pedicle technique for Gestational gigantomastia breast reduction has been recommended by several authors [20]. Amongst these techniques, the inferior and superior pedicle methods have been used the most with varying outcomes.…”

“…The inferior pedicle technique is among the four pedicle breast reduction techniques [4]. Also known as the Wise pattern technique, this technique is highly recommended by most authors for breast reduction because it gives the best post-operative results [20] especially for women in their reproductive age. The technique also gives a very good nipple areolar sensation, breast mound and reduced scar appearance.…”

Avaliação das técnicas de mamoplastia quanto a sua influência tardia na distância do complexo areolopapilar ao sulco inframamário

“…The treatment of mammary ptosis is aimed at the removal of excess skin while preserving as much tissue as possible in the absence of hypertrophy, thus resulting in satisfactory shape, projection, and dimensions and minimizing long-term scars [8][9][10][11][12][13][14][15][16][17][18][19][20] . The effect of sagging skin on the shape of the breast content vs. its support is important to keep in mind, in particular with respect to the effect of gravity on the lower pole of the vertical scar.…”