REDUCTION MAMMOPLASTY

1. Reduction Mammoplasty

2. Definition
Surgical reduction of breast volume to achieve
a smaller, aesthetically shaped breast mound
with concomitant relief of the potential
symptoms of mammary hypertrophy

3. Anatomy of breast

7. History
• Strombeck(1960)-Horizontal bipedicle
• Pitanguy,Weiner(1962)-superior pedicle
• Skoog(1963)-Superolateral pedicle
• McKissock(1972)-Vertical bipedicle
• Robbins(1975-1977)- Inferior pedicle
• Orlando(1975)-superomedial pedicle
• Biesenberger(1928),Hester(1985) – central
mound

8. • Vertical scar -Lassus, Lejour, Hammond(SPAIR),
Hall Findlay (1970 - 1999)

9. Etiology
• Mutifactorial
-genetic
-obesity
-pregnancy
• Gigantomastia

10. Physical Examination
• Complete general examination
• Local breast examination
-previous breast surgery
-expected reduction volume
-nipple-areola size &shape
-asymmetry
-nipple sensation
-right & left nipple to sternal notch measurement
-right to left nipple to inframammary fold
measurement.

11. Investigations
• Routine
• Specific
- Mammography - > 35 yrs.
-Ultrasound evaluation
- Psychological evaluation & counseling

12. Pre-op Photographs
• Front & lateral view
• Marks at the normal nipple height
• Nipple in relation to elbow

13. Indications for surgery
• Major – very large breast shoulder pain,
cervical & upper thoracic pain, severe
embarrassment
• Minor – inability to exercise due to breast
discomfort, difficulty with breathing during
exercise.

14. Contraindications
• Absolute-extreme obesity, inadequate cardiac,
pulmonary, renal reserve, current or recent
lactation, unevaluated breast mass or
mammographic findings
• Relative - current smoking history, > 30% ideal
body wt, inappropriate psychiatric evaluation

15. Selection of technique
• Depends on
- beast size
- estimated resection volume
- breast shape
- more elusive concept of appearance

16. Selection of technique
• Breast hypertrophy
Mild - (resection < 200gm./ side)
Moderate - (resection 200-500gm./ side)
Severe - (resection 500-1500gm./ side)
• Gigantic - (resection > 1500gm./ side)

17. Operative technique
• Liposuction- assisted reduction
• Wise pattern marking design
McKissock vertical bipedicle technique
Pitanguy superior pedicle technique
Inferior pyramidal pedicle technique
Free nipple graft technique
Central parenchymal pedicle

18. Short scar technique
• Vertical Mammoplasty
Hall-Findlay Vertical scar Mammoplasty
Hammond SPAIR technique

19. Liposuction- assisted reduction
• Grazer & Teimourian (1985 )
• Matarasso & Courtiss (1991)
• Selection criteria
– Elastic skin & predominantly fatty breast
– Wishing conservative reduction
• Advantages
– Preserve the glandular tissues, vessels, & nerves
– If used as adjunct with reduction surgery reduces
blood loss

20. Liposuction- assisted reduction

21. Wise pattern marking design

25. McKissock vertical bipedicle technique
• History
– Modification of Strombeck procedure(1972)
• Advantages
– Well vascularised pedicle
– Excellent exposure
– Maintenance of superior pole mass
– Good long term result with breast shape
– Flexibility in design
• Disadvantages
– Sensory return – 65%
– Nipple retraction

26. McKissock vertical bipedicle
technique

33. STROMBECK HORIZONTAL BIPEDICLE
TECHNIQUE

34. Pitanguy superior pedicle technique
• History
– Arie(1957) – first described
– Ivo Pitanguy (1967) – modification
• Advantages
– Reduction < 1200gm
– Excellent long term breast shape
– Well vascularised pedicle
– Preservation of nipple sensation
– Lack of interference with breast feeding

35. Pitanguy superior pedicle technique

41. Inferior pyramidal pedicle technique
• History
– Georgiade et al (1979)
• Advantages
– Very versatile – use for reduction upto 2500gm
– Long lasting result even with ptosis & macromastia
– Well vascularised pedicle, width 6-8cm for most reduction
– Less chances of nipple retraction
– Excellent glandular exposure
– Maintenance of nipple sensibility
• Criticism
– Flat breast with inadequate projection

42. Inferior pyramidal pedicle technique

47. Superomedial pedicle
• Large volume of upto 2000gm can be resected
safely.
• Get blood supply from descending artery from
2nd intercostal space and internal mammary
perforator.

48. SUPEROMEDIAL PEDICLE WITH WISE
PATTERN

49. Central parenchymal pedicle technique
• History
– Hester & associates (1985)
– Modified technique Biesenberger (1928) & Wise(1956,1963)
• Advantages
– Well vascularised pedicle
– Minimal difficulty with nipple transposition
– Minimal pre-operative markings
– Preservation of breast feeding & lactation
– Preservation of nipple-areola sensation
• Disadvantages
– Experience is required to perform freehand reduction

50. Central parenchymal pedicle
technique

55. Free nipple graft technique
• Procedure of choice in the treatment of
gigantomastia
• It is a composite graft of skin, smooth muscle &
ductal elements
• Advantages
– Rapid execution with minimal blood loss
– Maintenance of glandular shape
• Disadvantages
– Loss of nipple sensibility
– Loss of lactating ability

56. Free nipple graft technique

62. Vertical Mammoplasty
• Lassus(1964) emphasized
– Use of superior pedicle, inferior pyramidal glandular
resection, no skin undermining & closure with a
vertical scar only
• Lejour(1999)
– Modified Lassus technique
– Prior liposuction of the breast
– Superior pedicle for the nipple-areola complex
– Lower pole resection
– New breast mound from suture plication of lateral
pillars

63. Hall-Findlay Vertical scar
Mammoplasty
• Medial pedicle with inferolateral gland
resection
• Particularly effective for small to moderate
reduction
• Forms a conical, well supported breast

65. Complications
• Hematoma - < 1%
• Seroma - 1-5%
• Infection - cellulitis or abscess
• Skin necrosis
• Fat necrosis
• Nipple loss
• Nipple numbness
• Hypertrophic scars

66. • Asymmetry
• Inadequate reduction or over reduction
• Boxy breast deformity
• Recurrent enlargement
• Inability to breast feed
• Dog – ears
• Inadequate mastopexy result

67. Thank you