Commentary on: Power-Assisted Liposuction Mammaplasty (PALM): A New Technique for Breast Reduction.

BACKGROUND Resection and reshaping of the parenchyma are common procedures to produce a natural breast shape in reduction mammaplasty and mastopexy. The challenges of these practices include maintaining sensitivity of the nipple-areola complex (NAC), achieving upper-pole fullness, and preserving an adequate blood supply for patients with massive breast ptosis. OBJECTIVES The authors describe their experience with power-assisted liposuction mammaplasty (PALM), a novel technique for breast reduction. METHODS One hundred fifty consecutive women (300 breasts) who underwent PALM were evaluated in a prospective study. Minimizing skin undermining and glandular resection ensured maximal blood supply to the breast. A lateral pedicle was created to preserve NAC sensitivity. The transposed gland was contained within a large pocket made in the upper-inner quadrant. Glandular suspension sutures from the dermis to the chest wall stabilized the breast and recreated the inframammary fold. RESULTS The mean distance from the nipple to the sternal notch was 36 cm, the mean NAC elevation was 16 cm, the mean lipoaspirate volume per breast was 650 cc, and the mean glandular resection mass per breast was 240 g. Complications included wound infection (6 of 300 breasts, 2%), wound dehiscence (3 breasts, 1%), and seroma (9 breasts, 3%). Partial areolar necrosis occurred in 2 of 150 patients (1.3%), and 9 patients (6%) underwent revisional surgery. CONCLUSIONS PALM is a safe and reliable option for breast reduction and is indicated for patients with massive breast ptosis. LEVEL OF EVIDENCE 4: Therapeutic.