Outcomes of Extended Pedicle Technique vs Free Nipple Graft Reduction Mammoplasty for Patients With Gigantomastia

Abstract

Background Optimal reduction mammoplasty techniques to treat patients with gigantomastia have been debated and can involve extended pedicles (EP) or free nipple grafts (FNG). Objectives We compared clinical, patient-reported, and aesthetic outcomes associated with reduction mammoplasty using EP vs. FNG. Methods A multi-institutional, retrospective study of adult patients with gigantomastia undergoing reduction mammoplasty at two tertiary care centers from 2017-2020 was performed. Gigantomastia was defined as reduction weight >1500 grams per breast or sternal notch-to-nipple distance ≥40 cm. Surgeons at one institution used EP technique, while those at the other used FNG. Baseline characteristics, preoperative and postoperative BREAST-Q, and clinical outcomes were collected. Aesthetic outcomes were assessed in 1:1 propensity score-matched cases across techniques. Preoperative and postoperative photographs were provided to reviewers across the academic plastic surgery continuum (students to faculty) and non-medical individuals to evaluate aesthetic outcomes. Results Fifty-two patients met inclusion criteria (21 FNG, 31 EP). FNG patients had a higher incidence of postoperative cellulitis (23% vs 0%, p < 0.05), but there were no other differences in surgical or medical complications. There were no differences in baseline BREAST-Q scores between groups. Postoperative BREAST-Q scores revealed greater satisfaction with the EP technique (p < 0.01). The aesthetic assessment of outcomes in 14 matched pairs of patients found significantly better aesthetic outcomes in all domains with the EP procedure (p < 0.05), independent of institution or surgical experience. Conclusions This multi-institutional study suggests that, compared with FNG, the EP technique for reduction mammoplasty provides superior clinical, patient-reported, and aesthetic outcomes for patients with gigantomastia.