Breast Reduction with Triple Blood Nourishing of the Nipple-Areola Complex: A Novel Concept of the Transverse Bi-Pedicle Reduction Mammaplasty Based on Wuringer's Septum

Introduction/Purpose

Numerous breast reduction techniques have developed over the years. The choice of pedicle depends on the degree of hypertrophy, position of nipple-areola complex (NAC), quality of skin, patient's age, surgeon's experience and long term breast shape. A modification of the transverse bi-pedicle reduction mammaplasty is presented for optimization of NAC sensation and blood supply, with satisfactory and durable aesthetic results.

 

Material and Methods

One hundred twenty patients underwent bilateral breast reduction over a 2-year period with this technique. The lateral/central pedicle carries an identifiable neurovascular supply to the NAC from the lateral thoracic and 4-5th intercostal vessels and nerves from Würinger’s septum. A thin medial pedicle provides additional nourishing from the subdermal plexus of internal thoracic perforators and anterior intercostal arteries and nerves. Reduction is achieved from the inferior and superior parts of the breast in a customized fashion. Thinning of the pedicle, under direct vision and preservation of Würinger’s septum, is carried out as desired in order to ease pedicle mobilization. Skin closure without tension is achieved with inverted-T scar incision. Patient demographics, size of reduction, complications, NAC sensitivity measured with Von Frey filaments and aesthetic assessment at 1 year are presented.

 

Results

Mean weight of reduced tissue was 760g per breast (range: 480-1200g) and distance of NAC transposition (range 8 to 23cm). All breasts had good projection and NAC sensitivity (87 percent similar to preoperative values) at 1 year. Cleavage fullness and inframammary fold definition persisted over time. Complications: 3 cases of small leaks of fat from the vertical scar.

 

Conclusion

The combination of bi-pedicle dermoparenchymal and Würinger's septum breast reduction is a technique that can be used for a wide range of macromastia with optimal NAC sensation and breast remodeling. It is safe and versatile and therefore has become our favored technique in a teaching hospital.