The central mound technique for reduction mammaplasty

Abstract

The central mound technique (also known as the central pedicle technique) of breast reduction was first described by Hester et al in 1985 [1]. This technique is extremely versatile in that it involves separation of the breast skin from the gland, direct reduction of the glandular tissue, and custom tailoring of the skin to obtain projection while controlling the amount of tension on the closure. This method maintains the robust vascular supply to the gland which consists of branches of the lateral thoracic and thoracoacromial arteries superiorly and laterally. Additional vessels enter the gland posteriorly consisting of pectoralis major perforators supplied by the anterolateral and anteromedial intercostal perforators, and the internal mammary perforators. The primary sensory nerve to the nipple is the lateral cutaneous branch of the fourth intercostal nerve which is preserved with this technique. The majority of the lactiferous ducts and underlying glandular tissue are maintained, allowing breast-feeding postoperatively for most patients. Extensive clinical experiences attest to the safety and reliability of this technique even in patients requiring large reductions or with marked pto-sis, therefore obviating the need for free nipple/areola grafting [2-5] © 2009 Springer-Verlag Berlin Heidelberg.