Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2024; 57(06): 440-446
DOI: 10.1055/s-0044-1787721
Original Article

Gigantic Macromastia: Modified Superomedial Pedicle is a Good Solution

James Roy Kanjoor 
1   Roys Cosmetic Surgery Centre, Coimbatore, Tamil Nadu, India
,
Aakansh Jain 
1   Roys Cosmetic Surgery Centre, Coimbatore, Tamil Nadu, India
,
Sathya Pakkiri
1   Roys Cosmetic Surgery Centre, Coimbatore, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Reduction of very huge breast—gigantic macromastia—is a challenge to breast surgeons in choosing the right procedure to obtain an optimal outcome. The feasibility of a superomedial pedicle (SMP) with some modifications proves to be a good option to achieve a viable nipple areolar complex (NAC) with good size and shape after good resection above 800 g.

Materials and Methods Out of the 35 patients with 70 breast reductions, 15 can be considered gigantic macromastia with reductions above 800 g. A retrospective analysis of 30 breast reductions in these 15 patients from 2010 to 2023 was done. All cases were done using SMP with some modifications. The sternal notch to the nipple, the new NAC site, pedicle length, resection weight, and complications were analyzed. The modifications followed were lowering the new NAC, narrowing the distance between medial and lateral pillar width, medializing the pedicle, and lengthening the vertical limb.

Results There was no total necrosis of the NAC. Partial necrosis occurred in three patients that were managed conservatively and one case of fat necrosis needed debridement. All of them had a good size, shape, and form.

Conclusion SMP is a versatile technique with flexibility to modify the dimensions to get a robust blood supply to the NAC, after obtaining an adequate resection.

Keywords

gigantic macromastia - superomedial pedicle (SMP) - nipple areolar complex (NAC) - partial necrosis


Publication History

Article published online:
20 June 2024

© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Hall-Findlay EJ, Shestak KC. Breast reduction. Plast Reconstr Surg 2015; 136: 531-544
    CrossrefPubMedSearch in Google Scholar
  • 2 Wettstein R, Christofides E, Pittet B, Psaras G, Harder Y. Superior pedicle breast reduction for hypertrophy with massive ptosis. J Plast Reconstr Aesthet Surg 2011; 64 (04) 500-507
    CrossrefPubMedSearch in Google Scholar
  • 3 Dancey A, Khan M, Dawson J, Peart F. Gigantomastia–a classification and review of the literature. J Plast Reconstr Aesthet Surg 2008; 61 (05) 493-502
    CrossrefPubMedSearch in Google Scholar
  • 4 Landau AG, Hudson DA. Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia. Plast Reconstr Surg 2008; 121 (03) 735-739
    CrossrefPubMedSearch in Google Scholar
  • 5 Fino P, Di Taranto G, Toscani M, Scuderi N. Surgical therapy of breast hypertrophy: a comparison of complications and satisfaction rate in large and small superior pedicle custom-made reduction mammaplasty. Eur Rev Med Pharmacol Sci 2016; 20 (21) 4411-4415
    PubMedSearch in Google Scholar
  • 6 Singolda R, Bracha G, Zoabi T. et al. Superiomedial pedicle breast reduction for gigantic breast hypertrophy: experience in 341 breasts and suggested safety modifications. Aesthetic Plast Surg 2021; 45 (02) 375-385
    CrossrefPubMedSearch in Google Scholar
  • 7 Bar-Meir ED, Lin SJ, Momoh AO. et al. The lateral chest wall: a separate aesthetic unit in breast surgery. Plast Reconstr Surg 2011; 128 (06) 626e-634e
    CrossrefPubMedSearch in Google Scholar
  • 8 Bauermeister AJ, Gill K, Zuriarrain A, Earle SA, Newman MI. “Reduction mammaplasty with superomedial pedicle technique: a literature review and retrospective analysis of 938 consecutive breast reductions”. J Plast Reconstr Aesthet Surg 2019; 72 (03) 410-418
    CrossrefPubMedSearch in Google Scholar
  • 9 Sak MC, Akın S, Ersen B, Tunalı O, Ismail A. Management of gigantomastia: outcomes of superomedial pedicle with vertical scar or wise pattern skin excision. World J Plast Surg 2017; 6 (02) 206-211
    PubMedSearch in Google Scholar
  • 10 Colen SR. Breast reduction with use of the free nipple graft technique. Aesthet Surg J 2001; 21 (03) 261-271
    CrossrefPubMedSearch in Google Scholar
  • 11 Lacerna M, Spears J, Mitra A. et al. Avoiding free nipple grafts during reduction mammaplasty in patients with gigantomastia. Ann Plast Surg 2005; 55 (01) 21-24 , discussion 24
    CrossrefPubMedSearch in Google Scholar
  • 12 Gerzenshtein J, Oswald T, McCluskey P, Caplan J, Angel MF. Avoiding free nipple grafting with the inferior pedicle technique. Ann Plast Surg 2005; 55 (03) 245-249
    CrossrefPubMedSearch in Google Scholar
  • 13 Ashour T, Khachaba Y, El Naggar A. Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis. Electron Physician 2018; 10 (08) 7230-7234
    CrossrefPubMedSearch in Google Scholar
  • 14 Hammond DC, Loffredo M. Breast reduction. Plast Reconstr Surg 2012; 129 (05) 829e-839e
    CrossrefPubMedSearch in Google Scholar
  • 15 Hall-Findlay EJ. Pedicles in vertical breast reduction and mastopexy. Clin Plast Surg 2002; 29 (03) 379-391
    CrossrefPubMedSearch in Google Scholar
  • 16 Nahabedian MY, McGibbon BM, Manson PN. Medial pedicle reduction mammaplasty for severe mammary hypertrophy. Plast Reconstr Surg 2000; 105 (03) 896-904
    CrossrefPubMedSearch in Google Scholar
  • 17 Kerrigan CL, Comizio RC, Ho O. Superomedial pedicle breast reduction using a vertical pattern. In: Hall-Findlay EJ, Evans GRD. eds. Aesthetic and Reconstructive Surgery of the Breast. 1st ed.. London: Saunders Ltd; 2010: 284-285
    Search in Google Scholar
  • 18 van Deventer PV, Graewe FR. The blood supply of the breast revisited. Plast Reconstr Surg 2016; 137 (05) 1388-1397
    CrossrefPubMedSearch in Google Scholar
  • 19 Cunningham BL, Gear AJ, Kerrigan CL, Collins ED. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg 2005; 115 (06) 1597-1604
    CrossrefPubMedSearch in Google Scholar
  • 20 Lista F, Ahmad J. Vertical scar reduction mammaplasty: a 15-year experience including a review of 250 consecutive cases. Plast Reconstr Surg 2006; 117 (07) 2152-2165 , discussion 2166–2169
    CrossrefPubMedSearch in Google Scholar
  • 21 Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Plast Reconstr Surg 2009; 123 (02) 455-462
    CrossrefPubMedSearch in Google Scholar