Medial and inferior bipedicle breast reduction for gigantomastia and mammary hypertrophy

Abstract

The excessive size of a woman's breasts causes her both physical and psychological impairment. Pendulous and heavy breasts cause back and shoulder pain, headaches, ulnar nerve paresthesias, grooves from the bra straps pressure. Breasts can even be painful by themselves. The skin in the inframammary fold skin can be chronically irritated and macerated (intertrigo) which can lead to recurrent fungal infections and mastitis; the spine can be deviated (scoliosis and kyphosis). The physical activity is limited. From the psychological point of view, very large breasts can be a troublesome focus of embarrassment for teenagers and even for the adult woman. Patients feel very limited in choosing clothes and in physical activities, like fitness, which leads to obesity. All these favor a very low self-esteem [1] and depression. The goals of massively enlarged breast surgery are reducing the overall breast volume while maintaining nipple-areola viability and obtaining an aesthetically pleasing shape and a lasting comfort for the patient. There is no doubt that reduction mammaplasty gives a high degree of satisfaction to majority of patients and its efficacy has been well demonstrated throughout the years. Many techniques have been described for breast reduction. Th ey evolve and are being constantly refined. Classically, for severe breast hypertrophy and gigantomastia partial breast amputation with free nipple- areola graft ing has been used. Disadvantages of this technique include loss of sensation, unnatural appearance of NAC, poor projection of the breast and inability to breast feed, which is extremely important for young women. Subsequently several different techniques have been developed successfully in order to avoid free-nipple graft ing and to preserve sensibility and blood supply of the nipple-areola complex (NAC) through a dermoglandular pedicle. Among the most frequently used are inferior pedicle, vertical bipedicle, lateral pedicle, medial pedicle. These techniques are a testimony that no one technique is suited to all occasions and every method used has its own advantages and shortcomings. The authors use a different technique of breast reduction based on medial and inferior pedicles. This technique can be successfully used in severe breast hypertrophy and gigantomastia with the possibility to preserve safely the vascularization of NAC through the pedicles. © 2009 Springer-Verlag Berlin Heidelberg.