Sunday, October 10, 2004

Avoiding Free Nipple Grafts During Reduction Mammaplasty in Patients with Gigantomastia

Melinda Lacerna, MD, Scott Van Duzer, Adam Angeles, Mohammed Elahi, Julia Spears, and Amithaba Mitra.

Avoiding free nipple grafts during Reduction Mammaplasty in patients with gigantomastia M. Lacerna MD, S. Vanduzer, MD, A. Angeles, MD, M. Elahi, MD, J. Spears, MD, A. Mitra, MD FACS Division of Plastic and Reconstructive Surgery, Hand Center, Temple University School of Medicine 3322 N. Broad St., Philadelphia, PA 19140

Introduction: Excessive Breast Hypertrophy or gigantomastia (> 2000 gm excision of tissue per breast) has traditionally been approached with breast amputation and free nipple grafting during reduction mammaplasty procedures. Disadvantages of free nipple grafts include loss of sensation, poor projection, uneven nipple-areolar complex pigmentation, and loss lactation ability. We report our experience of utilizing the inferior pedicle technique of reduction mammaplasty with successful preservation of the nipple-areola complex for patients with gigantomastia. Materials and Methods: All consecutive reduction mammaplasty procedures performed at our University Hospital for the past two years (2001-2002) were reviewed. Pre-operative markings were performed with the patient in an upright position utilizing a keyhole pattern as described by West. All operations were performed by the attending staff assisted by plastic surgery residents. Results: One hundred three patients underwent reduction mammplasty at our hospital from January 2001 to December 2002. Fifteen patients (ages 23-45) were identified with gigantomastia through review of pathology and operative reports. All pre-operative markings were performed with the patient in an upright position utilizing a keyhole pattern as described by West. The width of the inferior pedicle base along the inframammary ridge were maintained at 9-15 cm for all patients. This is significantly wider than what has been previously described for the inferior pedicle technique (4-10 cm). The patients were followed regularly from one week up to 6 months post-operatively. There were no significant complications noted. Free nipple grafts were avoided, and in all patients, preservation of the nipple-areola complex with satisfactory aesthetic results were achieved. Conclusion: The inferior pedicle technique with preservation of the nipple areola complex can be successfully performed in patients with gigantomastia, thereby avoiding the untoward effects of free nipple grafts. Maintaining a wider pedicle base may contribute to the increased viability of the nipple-areolar complex in this patient population.