The versatility of the superomedial pedicle with various skin reduction patterns.

Background: The inferior pedicle technique remains one of the most commonly used techniques in breast reduction surgery, despite lengthy operating times, poor nipple sensation, and bottoming-out over time. The superomedial pedicle in reduction mammaplasty has previously been described using limited incision patterns. This study evaluated the safety and reliability of the superomedial pedicle with various skin reduction patterns and compared the surgical time with the inferior pedicle technique.

Methods: A total of 279 superomedial breast reductions were reviewed over a 6-year period, representing the transition period from inferior pedicle to superomedial pedicle techniques of three attending surgeons. Among these reductions, 215 had complete records and were included in the data analysis. The remaining 64 records were evaluated for viability of the nipple-areola complex. Assessments included skin pattern markings, average size of reduction, average body mass index, and complications. Risk factors and patient comorbidities were also recorded.

Results: There were no cases of nipple loss in the series. The overall complication rate was 18 percent; patients' average body mass index was 29. The revision rate for contour or scar improvement was 4 percent. A statistically significant reduction in operating time of 41 minutes (p = 0.0001) was seen in comparison with the inferior pedicle reduction.

Conclusions: The superomedial dermoglandular pedicle is a safe and reliable technique for reduction mammaplasty. Its versatility allows for reproducible results in a broad range of patients with various skin excision patterns. Use of the superomedial pedicle provides consistent results with respect to breast contour, nipple viability, and lasting superomedial fullness, and saves operating time compared with the inferior pedicle technique.