Supero-Septum Pedicle Mammaplasty: A New Modification for Reduction Mammaplasty

Abstract

Background Many techniques have been introduced for reduction mammaplasty and are utilized in diverse rates by different surgeons according to patient needs. Each technique is evaluated based on the aesthetic result, longevity, complication rate, and preservation of the nipple-areola complex (NAC) sensation. Objectives This study introduces the new modified technique of supero-septum pedicle mammaplasty (SSPM) that makes use of both the septum and superior pedicle and is suitable for macromastia and gigantomastia cases. Methods Between 2015 and 2018, 60 women who underwent SSPM were evaluated in a prospective study after undergoing superior pedicle deepithelialization and resection of the inferior, lateral, and medial segments. In the lateral pillar, a tongue of tissue was preserved for fixation to the medial pectoral fascia through a window created in superior pedicle at the third intercostal space. Finally, a septum pedicle was sutured to the fascia and muscle at the upper border of the sixth rib somewhat medially. Patients were followed up for a minimum of 13 months. Results The mean sternal notch to nipple (SN-N) distance was 33.05 cm, and the mean NAC elevation was 10.92 cm. Breast reductions varied from 270 to 2800 g/breast. Complications included wound dehiscence (5%), wound infection (2.5%), and partial areolar necrosis (2.5%). At 6 months postoperation, the NAC sensation was significantly better compared to preoperative values (P < 0.005). Conclusion SSPM is a relatively safe method of reduction mammaplasty, even for very large breasts, that leads to good aesthetic form along with preserving circulation and sensation of the NAC.

Response to “The Supero-Septum Pedicle Mammaplasty: How Does It Perform?”

“…Hence, its preservation will improve nipple-areola complex neurovascular supply. As depicted in our 1B image, 2 a transverse septum-like feature is visible in living tissue dissection containing nerves and vessels.…”

“… 2 , 3 Dr Swanson has comparatively mentioned the before and after photos of the Supero-Septum Pedicle Mammaplasty (SSPM) technique ( Figure 1 ) and the prevalent vertical technique ( Figure 2 ) at the beginning of the discussion. 1 As acknowledged in our study 2 and frequently described by masters of mammaplasty, 4-6 the outcome of mammaplasty is not solely dependent on surgical technique, although it is one of the significantly effective factors. Other efficacious factors include skin quality, tissue consistency, presence of pseudoptosis, and low or high breasts.…”

“…A length ratio >1 negatively affects the result. This ratio seems better than the ratio of IMF-N to N-SN, because the anatomical difference of high- or low-breasted chests has not been observed in the IMF-N to N-SN ratio.” 2 …”

“…On the other hand, we were requested to remove the results of less than 1 year from our study, 2 whereas Figure 2 in Dr Swanson’s study is a 6-month postoperative image; 1 comparing it to 1 year postoperative would be questionable. 4-6 Dr Swanson denies the existence of septum, quoting the Matousek study: “Matousek et al were unable to replicate Würinger’s septum in their cadaveric dissections and cautioned that its existence is likely artefactual, created by the dissection itself.” 1 Matousek explains cadaveric dissections: “while there was a thin structure visible transmitting neurovascular supply to the breast in the specimen, there was no distinct septum dividing the breast superiorly and inferiorly.” 9 …”

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

“…This technique has been promoted in recent publications. 2 – 4 It has also been recommended for re-reduction cases. 4 …”