Breast reduction with total superior pedicle

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Rodrigo Escobar

Hospital Metropolitano de Santiago, Dominican Republic

: J Plast Surg Cosmetol

Abstract

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Introduction: The excessive growth of the breasts (currently known as macromastia) proposes a health problem in women. Symptoms, such as chronic upper/lower back pain, neck pain, intertrigo, paresthesias, grooves in bra slots, and inability to do sports, are predominant. Several techniques have been developed for breast reduction, the inferior pedicle and free nipple graft have been favored as the first option in cases of displacement of the NAC from the sternal notch (SN) of 40 cm or more, along with the need for large volume resection. This is due to the apparent risk of partial or total necrosis, venous congestion, conical shape, and the impossibility of ascending the NAC. This study’s objective is to present a different technique for long NAC ascending in patients with macromastia using a total superior pedicle lifting approach from a vertical marking with horizontal modification, without injuring the dermis around the NAC. Methods: A single-center descriptive study was performed in Santiago de los Caballeros, Dominican Republic, from 2006 to 2022. A total pedicle lifting technique from a vertical marking with horizontal modification was performed on approximately 283 patients where 232 had a resection greater than or equal to 500 grams in one or both breasts with NAC descending lengths greater than 30cm. Results: All cases were resolved without presenting tissue damage or NAC necrosis. The average patient's age was 34.5, and surgery time was approximately 3 hours. Considering both breasts, the average tissue extracted in the population was 1441.4+589.6 grams (SD, 95 %) with a median of 121 1.5 grams Conclusions: The total pedicle lifting approach is a safe and reproducible procedure, distinguished by the regard for the upper circulation of the breast.
Recent Publications:
1. Schnur PL, Schnur DP, Petty PM, et al. Reduction mammaplasty: An outcome study. Plast Reconstr Surg. 1997;100:875–883.
2. Hoppe IC, Patel PP, Singer-Granick CJ, et al. Virginal mammary hypertrophy: a meta-analysis and treatment algorithm. Plast Reconstr Surg. 2011;127:2224–2231.
3. Colohan SM, Massenburg BB, Gougoutas AJ. Breast reduction: surgical techniques with an emphasis on evidence-based practice and outcomes. Plast Reconstr Surg. 2020;146:339e–350e.
4. Cruz-Korchin N, Korchin L. Vertical versus wise pattern breast reduction: patient satisfaction, revision rates, and complications. Plast Reconstr Surg. 2003;112:1573–1578.
5. Escobar R, Merelo C.Breast Reduction with Total Superior Pedicle, Plast Reconstr Surg GO, 2023, DOI: 10.1097/ GOX.0000000000004735

Biography

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Rodrigo Escobar began his medical training in Mexico, from there began his passion for teaching and learning. Finishing the specialty of plastic and reconstructive surgery, he moved to the Dominican Republic where he began his work, operating patients with macromastia, with the techniques learned in the residency, without having satisfactory results, so he dedicated himself to improving his technique, having what it is today, it is known as superior pedicle, performing the technique for about 20 years, and with lasting results.