This presentation represent our extensive experience in preserving both sensation and lactation functions when operating to reduce the size of thee huge breasts ..technique, examples and complications will be presented.

3. Macromastia is a condition
causing
psychological and physical problems.
In particular, it has been consistently
shown that, besides psychological
considerations regarding self-esteem
and aestheticality,
Macromastia is responsible for a
number of complaints relating to the
skeletal system.“,

5. Main Complaints are:
NECK PAIN, BACK PAIN,HEADACHE AND
SHOULDER PAIN.
Furthermore,other complaints reported by
patients suffering from macromastia include :
PARESTHESIAE OF THE LITTLE FINGERS,
BRA STRAP GROOVE ,PAIN ,
BREATHING AND SLEEPING PROBLEMS.

6. Patients with massive macromastia, or severe
ptosis, should be candidates for a reduction
mammaplasty by the
INFERIOR PEDICLE TRANSPOSITION TECHNIQUE,
instead of
FREE NIPPLE AND AREOLA GRAFTING.

7.  In cases of severe macromastia, the free
nipple graft technique has been the
traditional alternative to pedicle
transposition.
 Distress over nipple survival in large
reduction mammaplasty and long pedicle
transposition is largely responsible for this.

8. Inferior pedicle reduction mammaplasty
technique is a reliable technique used in
reduction mammaplasty of the hugely enlarged
breasts.
This technique includes a well-vascularised
dermal parenchymal pedicle for safe nipple-
areola transposition, but it has been criticized
as resulting in a flat breast with inadequate
projection after long-term follow-up.
INFERIOR PEDICLE REDUCTION
MAMMAPLASTY

13. With the inferior pedicle
technique the blood
supply to the nipple and
areola remains generous,
coming from the entire
width of the
inframammary fold.
INFERIOR PEDICLE REDUCTION
MAMMAPLASTY

14.  The FIRST LINE is marked
4.5 to 6 cm below the
lowest point of the areola,
shown as “d”in .
 The SECOND LINE is drawn
halfway between the first
line and the inframammary
crease. This is where the
pedicle is folded.
After glandular resection, the pedicle
is marked with two horizontal lines .

15.  Heavy-caliber sutures
( 0 PDS) are passed
through the dermal
pedicle tissue at the
medial and lateral ends of
the second line and
sutured to the deep
pectoral fascia medially
and laterally,respectively,
usually 2 to 4 cm higher
than the inframammary
crease.

16. 
VIDEO
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67. 
The final appearance of the breasts
after reduction mammaplasty is
dictated by the volume and shape of
the remaining adipose tissue

68. 
In our experience, the inferior
pedicle, Wise pattern reduction is
a reliable and predictable method
of reduction, appropriate for all

breast sizes and pedicle lengths.

The technique is suitable for the
extra-ordinary large breasts, with
nipple to sternal notch distance
more than 35 cm to 48 cm.

69. 
By using a keyhole skin flap pattern, a
conical shape is achieved when the medial
and lateral skin flaps are brought together as
a skin brassiere. The methods seems safe
and simple, and the results have been
satisfactory.
An unexpected benefit has been the excellent
postoperative sensation of the nipple, areola,
and the skin of the breasts.

70. We have performed 243 reduction
mammoplasties
in the last 5years with this
orientation,
producing good results!

71. Thank
You!