Improving long-term breast shape with the medial pedicle wise pattern breast reduction.
BACKGROUND: Reduction mammaplasty has both a reconstructive and an aesthetic component. Relief of neck, back, and shoulder pain, as well as psychosocial improvement, is the main indication for intervention. Patient satisfaction is high, with early improvement in most cases. Preoperative planning confirms the anatomical variations as well as the best technique to achieve optimal cosmetic and functional results. Techniques for breast reduction have evolved in response to the great variety of challenges. The surgeon must tailor the surgical approach by considering a wide range of anatomic deformities, from gigantomastia to mild ptosis. Medial pedicle techniques have been shown to be reliable in severe breast hypertrophy. METHODS: The authors present a series of 88 consecutive patients who underwent reduction mammaplasty using a medial pedicle technique with a Wise pattern skin resection. The purpose of the study was to evaluate the complication rate, operative time, and long-term effects on pseudoptosis. RESULTS: The average weight reduction was 1814 g (both breasts combined), and the average operative time was 104.5 minutes. Patients were followed up for a minimum of 1 year, and the complication rate was 6.8 percent. The distance from the inframammary fold to the nipple was measured in patients with more than 1 year of follow-up. The results exhibited an average increase in this length of only 11 percent for reductions between 500 and 1200 g per side and of 34 percent for reductions greater than 1200 g per side. CONCLUSIONS: The authors conclude that this technique is an effective and reliable approach to a wide range of breast hypertrophy, with reproducible breast weight reduction and less long-term pseudoptosis or "bottoming out." In addition, the operative time is short and the complication rate is acceptably low.