Inferior pedicle breast reduction and long nipple-to-inframammary fold distance: How long is safe?

Samyd S Bustos; Vanessa Molinar; Doga Kuruoglu; Omar Cespedes-Gomez; Basel A Sharaf; Jorys Martinez-Jorge; Oscar J Manrique; Nho V Tran; Minh-Doan T Nguyen

doi:10.1016/j.bjps.2020.08.123

Inferior pedicle breast reduction and long nipple-to-inframammary fold distance: How long is safe?

J Plast Reconstr Aesthet Surg. 2021 Mar;74(3):495-503. doi: 10.1016/j.bjps.2020.08.123. Epub 2020 Sep 20.

Authors

Samyd S Bustos¹, Vanessa Molinar², Doga Kuruoglu², Omar Cespedes-Gomez², Basel A Sharaf², Jorys Martinez-Jorge², Oscar J Manrique², Nho V Tran², Minh-Doan T Nguyen³

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Center for Regenerative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
² Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
³ Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: nguyen.Minh-Doan@mayo.edu.

PMID: 33127349
DOI: 10.1016/j.bjps.2020.08.123

Abstract

Background: Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle.

Methods: A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis.

Results: Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16-48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5-27). The mean resection weight was 699.6 g (SD:310.4; r:125-2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8-9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88-1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001-1.005), adjusting for N-IMF and SNN distances.

Conclusion: Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.

Keywords: Breast; Breast reduction; Gigantomastia; Inferior pedicle mammaplasty; Macromastia; Mammaplasty.

MeSH terms

Adult
Breast / abnormalities*
Breast / pathology
Breast / physiopathology
Breast / surgery
Female
Humans
Hypertrophy* / diagnosis
Hypertrophy* / physiopathology
Hypertrophy* / surgery
Mammaplasty* / adverse effects
Mammaplasty* / methods
Middle Aged
Necrosis* / diagnosis
Necrosis* / etiology
Necrosis* / prevention & control
Nipples* / pathology
Nipples* / transplantation
Organ Size
Outcome Assessment, Health Care
Postoperative Complications* / diagnosis
Postoperative Complications* / prevention & control
Risk Adjustment / methods*
Tissue Transplantation / methods
Tissue Transplantation / standards
United States

Supplementary concepts

Gigantomastia