A Review and Measurement Study of the Central Mound Pedicle for Breast Reduction

Abstract

Background: The central mound approach to breast reduction has been the subject of recent interest in the literature. However, quantitative evaluation using measurements is lacking. This review was undertaken to objectively evaluate changes in breast dimensions, and to compare the results to a popular alternative method, vertical mammaplasty. Methods: An electronic search was performed using PubMed to identify all publications endorsing the central mound technique. Published lateral photographs were matched for size and orientation, with computer assistance. Measurements included breast projection, upper pole projection, lower pole level, breast mound elevation, nipple level, and breast parenchymal ratio. Results were compared with published measurement data for the vertical technique. Results: Twenty-three manuscripts were identified. Ten included photographs suitable for analysis. On average, breast projection decreased 1.1 cm after central mound breast reduction ( P < 0.05). Upper pole projection dropped 0.4 cm (not significant). The lower pole level was raised 2.6 cm ( P < 0.05). The nipple level was over-elevated 0.6 cm, on average. The breast parenchymal ratio increased by 0.54. A central mound dissection decreased breast projection. In contrast, publications using a vertical breast reduction demonstrated maintenance of upper pole and breast projection and a modest (<1 cm) increase. Conclusions: For each measurement comparison, the vertical method outperforms the central mound. Because of its anatomy and geometry, measurements show that the vertical method for breast reduction is more favorable than a central mound dissection. This method can also be used safely for secondary breast reductions.

“Safety and efficacy of a central pedicle technique for mastopexy and mastopexy with implant augmentation”

“…In 1985, Hester et al 8 called it the “maximally vascularized pedicle.” The CPT is not commonly used because of extensive dissection, concerns over perfusion, and scar burden. 9–11 In 1998, Würinger 12 performed anatomic studies describing the horizontal septum in the inferior part of the breast, which contains vascular and neural components to the central breast tissue. DeLong et al, 13 in their 2020 publication, used a CPT with a Wise pattern skin incision that separated the skin from the breast mound and NAC when performing breast reductions.…”