Breast Reduction: The Superolateral Dermoglandular Pedicle Revisited

Aesthetic Plast Surg. 2019 Feb;43(1):36-45. doi: 10.1007/s00266-018-1225-8. Epub 2018 Sep 26.


Background: Breast hypertrophy, generally found in association with ptosis, is a common problem in postadolescent women. Beyond the psychological burden of excessively heavy, droopy breasts, physical symptoms compound the condition, with neck, shoulder and back pain. Reduction mammaplasty is one of the most common cosmetic operations, especially to improve patient's musculoskeletal symptoms, with proven benefits in patient satisfaction and self-esteem postoperatively. Multiple techniques exist for breast reduction, with no clear evidence of benefit of one over another.

Methods: We review the senior author's experience in using a superolateral pedicle for breast reduction in 726 patients over the past 40 years. Over the past 10 years, the technique has also been adapted for simultaneous augmentation-mastopexy, especially in post-bariatric surgery patients. Benefits include recruitment of lateral breast tissue to fill the upper pole and correct axillary fullness. The technique has the advantages of ease of execution and a low complication rate.

Results: Complete data were available for 397 patients. Resection weights varied from 380 to 1248 g, and mean sternal notch-nipple distance was 25.3 cm. Mean follow-up was 22 months. Complications were uncommon: four cases of partial nipple-areola complex loss, dehiscence in 14 patients, three hematomas and seven cases of superficial surgical site infection. Nipple sensitivity was decreased in eight patients, and three patients were unable to breastfeed following surgery. Revision surgery was requested by 14 patients.

Conclusions: Breast reduction using the superolateral dermoglandular flap is easy to execute, versatile, safe and effective, preserving physiological functions, and is an excellent option when treating patients with medium-to-large breasts.

Level of evidence iv: 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 .

Keywords: Blood supply; Breast reduction; Breast surgery; Flap; Mammaplasty; Nipple-areola complex; Pedicle; Vascular.

MeSH terms

  • Adult
  • Body Mass Index*
  • Breast / abnormalities*
  • Breast / surgery
  • Cohort Studies
  • Esthetics
  • Female
  • Graft Survival
  • Humans
  • Hypertrophy / surgery*
  • Mammaplasty / methods*
  • Mastectomy, Subcutaneous / methods*
  • Middle Aged
  • Nipples
  • Patient Satisfaction*
  • Retrospective Studies
  • Risk Assessment
  • Surgical Flaps / blood supply
  • Surgical Flaps / transplantation*
  • Suture Techniques
  • Treatment Outcome
  • Wound Healing / physiology

Supplementary concepts

  • Gigantomastia