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.

Inverted-T pattern reduction mammoplasty in bilateral breast ptosis: cosmetic and oncological outcomes

“…Oncological safety is always a concern for OPS procedure. Owing to a larger resection of breast tissue, the positive incision margin rates were much lower in OPS techniques than that in classic BCS process (10-12% vs. 19 Some limitations exist in this retrospective study. The overall number of patients in the cohort of breast cancer with ptosis is small.…”

“…Orlando described the superomedial pedicle in 1975 (17). All these pedicle techniques were demonstrated to be reliable and safe in various literatures (6,11,18,19).…”

Risk factor stratification of three different pedicle techniques in reduction mammaplasty—the importance of an armamentarium of techniques individually addressing mild to severe breast hypertrophy

“…The IP is a well-established technique in a wide range of macromastic breast types and the complication rate is rather low (7). A major criticism is a potential development of "bottoming out" in the lower pole, especially in gigantomastic breasts with severely impaired skin quality (8). On the other hand, the SMP can be used with various skin reductions and has been frequently reported to be reliable and safe (8)(9)(10) and has some advantages: Compared to the SP, the SMP incorporates more medial parenchyma and thereby provides better vascularity of the NAC, a lower risk for bottoming out and an improved cosmetic durability (11).…”

“…A major criticism is a potential development of "bottoming out" in the lower pole, especially in gigantomastic breasts with severely impaired skin quality (8). On the other hand, the SMP can be used with various skin reductions and has been frequently reported to be reliable and safe (8)(9)(10) and has some advantages: Compared to the SP, the SMP incorporates more medial parenchyma and thereby provides better vascularity of the NAC, a lower risk for bottoming out and an improved cosmetic durability (11). The superomedial pedicle can also be improved by combining the 2 nd and 3 rd intercostal perforators with the perforators rising from the "Wueringer's breast septum" as a Double-Unit-Superomediocentral (DUS) pedicle, especially in gigantomastic cases (8).…”

“…On the other hand, the SMP can be used with various skin reductions and has been frequently reported to be reliable and safe (8)(9)(10) and has some advantages: Compared to the SP, the SMP incorporates more medial parenchyma and thereby provides better vascularity of the NAC, a lower risk for bottoming out and an improved cosmetic durability (11). The superomedial pedicle can also be improved by combining the 2 nd and 3 rd intercostal perforators with the perforators rising from the "Wueringer's breast septum" as a Double-Unit-Superomediocentral (DUS) pedicle, especially in gigantomastic cases (8). The advantage of two independent sources of blood supply can potentially enhance the vascularity of the NAC and thereby potentially Editorial Risk factor stratification of three different pedicle techniques in reduction mammaplasty-the importance of an armamentarium of techniques individually addressing mild to severe breast hypertrophy lower the NAC loss risk (12).…”