The Central Mound Pedicle: A Safe and Effective Technique for Reduction Mammaplasty

Abstract

Background: The central mound technique offers a relatively less common approach for breast reduction. This study evaluated the expected safety and efficacy outcomes using this technique in a large patient series. Methods: A retrospective review of all patients undergoing central mound breast reduction at the authors’ institution between June of 1999 and November of 2018 was performed. Both bilateral macromastia and unilateral symmetrizing reduction patients were included but evaluated separately for some outcomes. Patient demographics and comorbidities, operative details, postoperative adverse events, and BREAST-Q scores were recorded. Associations between preoperative variables and outcomes were assessed with chi-square tests, Wilcoxon tests, and Kendall tau-b correlations. Results: A total of 325 patients were identified for inclusion (227 bilateral and 98 unilateral; 552 breasts). The average patient age was 46 years, and the average body mass index was 27.4 kg/m2. Among the bilateral macromastia patients, the average operative time was 3 hours 34 minutes, and average breast tissue removed was 533 g (right breast) and 560 g (left breast). Among all patients, average follow-up was 169 days. On a per-breast basis for all patients, the following complication rates were observed: seroma, 0.2 percent; hematoma, 1.1 percent; dehiscence, 2.9 percent; infection, 1.5 percent; hypertrophic scar, 4.6 percent; nipple necrosis, 0.4 percent; fat necrosis, 0.9 percent; and skin flap necrosis, 1.7 percent. Using the BREAST-Q Reduction/Mastopexy questions on a Likert scale ranging from 1 to 5, restricted to the bilateral macromastia patient population, all scores improved with statistical significance. Conclusion: The central mound pedicle is a safe and effective approach for reduction mammaplasty for both bilateral macromastia patients and unilateral symmetrizing operations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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

“… 1 The authors remove a wedge of tissue from the upper pole. 3 Not surprisingly, measurements reveal a loss of breast projection and upper pole projection after a central mound dissection (Fig. 1 ).…”

“…Closing this ellipse trades width for projection. A circumferential resection 3 does not benefit from this favorable change in shape. A Wise pattern trades projection for width.…”

“… 1 The authors’ surveys indicated a decrease in nipple sensation after surgery ( P < 0.001). 3 Its safety is questionable. The authors reported 2 cases of nipple necrosis (among 227 bilateral and 98 unilateral reductions) and 9 cases of skin necrosis.…”

“…The authors occasionally resort to nipple grafting. 3 …”

“…1 ). 3 In contrast, a vertical mammaplasty preserves breast projection despite a reduction in breast volume (Fig. 2 , Table 2 ).…”