PURPOSE: Reduction mammoplasty remains one of the most common reconstructive procedures performed by plastic surgeons in the United States today.  The overall success rate of this procedure is high, as is the overall level of patient satisfaction.  At the Medical University of South Carolina (MUSC), an inferior-based pedicle technique for reduction mammoplasty is the procedure of choice.  There remains a debate as to if or when to use a free nipple grafting technique in larger volume breast reduction patients. A commonly used objective measurement in determining which reduction mammoplasty technique to use is the nipple to clavicular length (NCL).  The inferior-based pedicle technique has the advantage of possible preservation of nipple sensation as opposed to the use of an insensate free nipple graft.  We present our data regarding the use of inferior-based pedicle technique in women with NCL greater than or equal to 37 centimeters, without free nipple grafting.
METHOD: A retrospective chart review was performed of all reduction mammoplasties performed at the MUSC ambulatory surgical center by a single surgeon between January 2003 and December 2007.  Patient demographics, NCL, breast reduction weights, and incidence of complications were analyzed. 
RESULTS: Fourty-four female patients with symptomatic macromastia underwent reduction mammoplasty by a single surgeon at our institution’s ambulatory surgical center over a 5 year period. All patients underwent bilateral reduction mammoplasty utilizing an inferior-based pedicle technique with a 10 cm pedicle base.  Amongst these patients, 40 breasts in 22 patients measured a NCL of 37 cm or greater (Group A), while 48 breasts in 26 patients measured less than 37 cm NCL (Group B).  Average age of patients in group A and group B were 35.6 (range 16-69) and 37.6 years (range 17-63), respectively. Average NCL for group A was 40.1 cm (range 37-47) and average weight of tissue removed was 1713.3g (range 767-2690 g).  Group B measured an average of  32.8 cm (range 27.5-36.5) NCL  with an average 961.2 g (range 516-2689) of tissue resected. Patient demographics and comorbid conditions were similar in both groups. The following complications were observed:   

ComplicationsÂ	 ≥37 cm (n=40)	Â	 <37cm (n=48)	Â
 Decreased nipple sensation	 2 (5%)	Â	 1 (2.1%)	Â
 Nipple Necrosis	 2 (5%)	Â	 0 (0%)	Â
 Areolar hypopigmentation	 2 (5%)	Â	 0 (0%)	Â
 Wound Dehiscence  Â	 9 (22.5%)	Â	 6 (12.5%)	Â
 Hematoma	 1 (2.5%)	Â	 1 (2.1%)	Â
 Fat Necrosis	2 (5%)		0 (0%)
Scar Revision	0 (0%)		3 (6.3%)
Poor Nipple Projection	0(0%)		1 (2.1%)

CONCLUSION: Inferior-based pedicle reduction mammoplasty is safe in patients with a NCL of 37 cm or greater.  The rate of complications, specifically nipple necrosis and areolar hypopigmentation is similar to those patients undergoing free nipple grafting as reported in the literature.  The use of an inferior pedicle technique has the added advantage of maintaining nipple sensation in the vast majority of patients with long NCL measurements.