The “Dermal Cage”: A Modification of the Inferior Pedicle Breast Reduction

Abstract

Abstract:In spite of more recent techniques for breast reduction, the inferior pedicle technique has proven to be enduring being a still a very popular option in the plastic surgeons armamentarium despite certain shortcomings. This utility is especially so for the treatment of large breasts with a long sternal notch to nipple distance. The modifications we describe in this article, overcome some of the main drawbacks of the standard inferior pedicle technique, and is particularly effective when used with appropriately selected patients. This is achieved principally by the making of a strong, durable and internalized "dermal cage" that remains fixed to the chest wall in the upper part, as well as on both sides, to support the majority of the remaining breast tissue. This serves several purposes, including the narrowing of the breast, thereby giving good projection and reduction of the N-IMF length of the inferior pedicle.Through suspension and fixation of the inferior pedicle to the chest wall, one can obtain mitigation of the effects of gravity on the inferior pedicle. The benefits include reduced tension on the T junction, thereby reducing the incidence of wound dehiscence in the immediate post-operative phase; whilst reduction of tension on the NAC reduces "bottoming" out over the longer-term. This process has been the main short coming of the inferior pedicle technique to date.The technique was used for 26 patients over a 7 year period with a mean long term follow up of 41 months. The results demonstrate the short and long time effectiveness of our own particular combination of modifications to previously described techniques and modifications of the inferior pedicle breast reduction.EBM level: V 2

Accordion-style pedicle suspension in inferocentral pedicled mammoplasty

“…Drawbacks of the technique include the tendency to develop pseudoptosis (or 'bottoming out'), tedious de-epithelialisation, poor or inadequate projection, upward NAC rotation, and tension at the inverted T-junction. Many modifications have been proposed to alleviate or avoid these issues [2][3][4][5]7,[11][12][13][14][15]. Most of these modifications are based on plication and fixation of the pedicle on the pectoral fascia via dermal flaps extending from it [2,4,7,[13][14][15][16].…”

“…Echo et al [4] reported better medial fullness and NAC projection with a horizontal dermal suspension sling and plication of the dermal flaps. Based on a similar approach, Zic et al [2] published their technique involving support of the pedicle in multiple directions by a 'dermal cage' they fashioned. As a modification of McKissock's technique, Yazici et al [12] reported plication of the vertical pedicle in the superior and inferior directions, thus fashioning a new breast meridian, and suturing the medial and lateral pillars to it.…”

“…Since its introduction by Ribeiro [1] in 1975, the inferior pedicled reduction mammoplasty technique has been enhanced by various modifications to increase its reliability. Today, it remains the most widely used technique for reducing moderately and severely enlarged breasts [2][3][4]. Its pyramidal design is its major advantage for sustaining the perfusion and sensation of the nipple-areola complex (NAC).…”

“…However, when the pedicle is substantially long with a broad base, the resulting volume can lead to breast distortion, leading to complications such as bottoming out and pseudoptosis. Various methods, including suspension to the pectoral fascia, plication, and support with alloplastic materials, have been proposed to avoid these issues [2][3][4][5].…”

Optimizing the Aesthetic Outcome of Short Scar Periareolar Inferior Pedicle Reduction Mammaplasty

“…The inferior pedicle with inverted T scar reduction Mammaplasty, one of the most regularly performed technique [8], was first introduced by Riberio [9] followed by many modifications. These include the use of synthetic mesh [10,11] suspending the pedicle [12,13] and a superficial fascial system suspension [14] thus becoming less reliant upon the skin brassiere.…”