Re: Does knowledge of the initial technique affect outcomes after repeated breast reduction?

BACKGROUND This article examines outcomes following repeated breast reduction using vertical scar reduction mammaplasty. The results of performing repeated breast reduction in patients for whom operative records were available for the previous breast reduction were compared with those for whom these records could not be obtained. METHODS A retrospective review of all patients who underwent repeated breast reduction for recurrent symptomatic mammary hypertrophy, inadequate volume reduction during the primary operation, and significant postoperative breast volume asymmetry was performed. RESULTS Twenty-five patients had repeated breast reduction. The initial technique was known in 13 patients and unknown in 12 patients. The average total reduction per breast (including liposuction) was 658 g (range, 30 to 1150 g). Liposuction was used more often in cases for which the initial technique was unknown (p = 0.000). No patients experienced necrosis of the nipple-areola complex, and there was no significant difference in the complication rates between patients for whom the previous pedicle was known versus those in whom it was unknown (p = 0.220). CONCLUSIONS Using vertical scar reduction mammaplasty, repeated breast reduction is a safe procedure, even when the initial technique is unknown. A vertically oriented, inferior wedge excision of tissue can be safely excised, irrespective of the initial pedicle. For patients with ptosis in whom the nipple-areola complex needs to be transposed superiorly, a carefully planned and de-epithelialized superior pedicle should be used. In addition, liposuction is an important adjunct to achieve volume reduction, while limiting the amount of dissection during repeated breast reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE : Therapeutic, IV.