Macromastia and gigantomastia: efficacy of the superomedial pedicle pattern for breast reduction surgery.

BACKGROUND Reduction mammoplasty procedures in patients with macromastia and gigantomastia can prove a major challenge to the plastic surgeon. Although several techniques have been described to reduce very large breasts, they can often result in vascular compromise to the nipple-areola complex (NAC) and skin flaps, decrease in NAC sensation and inability to breast-feed. The superomedial pedicle (SMP) procedure is often used in patients with moderate to large breast reductions. For extremely large breast reductions, macromastia and gigantomastia breast amputation with a free nipple graft is often recommended. For large resections and long suprasternal notch-nipple (N-N) distances there is no consensus in terms of approach. OBJECTIVE To evaluate the efficacy and complication rate of the SMP reduction mammoplasty technique for extremely large, macromastia and gigantomastic breasts at two institutions in Johannesburg. METHOD Retrospective review of patient records with macromastia and gigantomastia who had undergone the SMP technique reduction mammoplasty between 2008 and 2012. Complications were assessed at 1 week, 3 weeks, 6 months and a mean of one year postoperatively. RESULTS There was a total of 31 patients, 62 breasts, with macromastia and gigantomastia who had an SMP pattern of reduction. The mean age was 30.1 years, mean BMI was 28.1 and average resection weight from each breast was 1835 g. The mean N-N was 44.13 cm. The majority, 90% of patients had a good aesthetic outcome with less than 20% having any long-term complications, which were all relatively minor. CONCLUSION The SMP reduction mammoplasty efficiently reduces extremely large breasts while preserving the vascular integrity and sensation of the NAC, while simultaneously providing a well-shaped, projecting breast in macromastia and gigantomastia patients.