Periareolar reduction mammaplasty utilizing the inferior dermal pedicle

The critical points which should not be overlooked when performing reductio n mammaplasty are to minimize scar on the breast and to ensure a sufficient blood supply for the viability of the nipple-areolar complex. Periareolar reduction mammaplasty has been widely used because it left only one scar ar ound the areola. However, with the typical periareolar reduction mammaplast y technique, it is difficult to remove a large amount of breast tissue and mobilize the remaining breast tissue. It may result in necrosis of the nipp le-areolar complex in some cases. To overcome these limitations we combined the periareolar incision with the inferior dermal pedicle, which has a rel atively good blood supply. This new technique was employed in 22 consecutiv e women (44 breasts) with hypertrophy and a varying degree of ptosis. Infil tration of a tumescent solution and liposuction were performed in all cases . After peri areolar incision, dissection of the skin was performed, and th e breast was elevated from the fascia of the pectoralis major muscle, leavi ng the inferior dermal pyramidal pedicle. An adequate amount of tissue was resected in the superior, medial, and lateral areas. After mastopexy, closu re was done with a purse-string suture. The amount of tissue resected range d from 180 to 1510 g per breast, and the mean was 466.1 g. The mean length of elevation of the nipple was 10.6 cm along the meridian of the breast. Th ere were a few complications which needed revision operation: hematoma coll ection in one breast (2.3%), wound dehiscence in one breast (2.3%), and fat necrosis in one breast (2.3%). There was no necrosis of the nipple-areolar complex. With this new technique of periareolar reduction mammaplasty util izing the inferior dermal pedicle, we were able to minimize the scar, prese rve the nipple-areolar complex, and improve the motility of the breast tiss ue. But we also observed a flat or square appearance in the case of a large amount of resection in the patients with poor skin elasticity. This techni que is safe and versatile and produces aesthetically acceptable results in selected patients.