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• W2076134328 abstract "Sir: We read with great interest the article by Mojallal and colleagues about breast reduction with a posterosuperior pedicle.1 We welcome the fact that our idea of coupling the superior with the central pedicle is applied by other authors. The publication of the original technique in Plastic and Reconstructive Surgery in 20092 was followed by various demonstrations of appreciation, but we believe this procedure is not yet sufficiently known and used. We have described the technique as based on a central-superior pedicle, and not on a posterosuperior one, because the fibrous septum that provides the most blood supply to the nipple-areola complex has already been defined as a central pedicle3 by Würinger, who first described its anatomical features.4 As shown by our article results and as confirmed by the survey of Mojallal and colleagues, the blood supply of the fibrous septum is further enhanced by the addition of the superior pedicle. This vascular safety can be seen in our practice in the extremely low rate of complications in over 150 patients treated. However, we believe that it is appropriate to comment on the location of tissue to be resected. The diagram used in the article by Mojallal and colleagues shows that the excess tissue in gigantomastia is almost completely caudal to the fibrous septum, but in our experience the portion of breast tissue caudal to the central pedicle is always very limited (Fig. 1). Major resections are performed medially and laterally to the pedicle, and mostly beneath the handle formed by the superior and central pedicles (Fig. 2).Fig. 1.: Diagram showing the location of the breast tissue to be removed; in our experience, the portion of tissue caudal to the central pedicle is always limited. A major resection is carried out beneath the handle composed of central and superior pedicles.Fig. 2.: Skeletonizing the fibrous septum enables remarkable reductions and a very high mobility of the remnant tissue with a consequent greater ease of breast shaping.The authors reported that the most frequent patient complaint was the insufficient volume reduction; we think that this can be overcome because of the removal of that deep tissue. Skeletonizing the fibrous septum enables truly remarkable reductions without jeopardizing the blood supply to the nipple-areola complex. Another significant advantage of the handle is the very high mobility of the remnant tissue, with a consequent greater ease of breast shaping. Another observation concerns the treatment of the skin cover. The authors used an inverted-T scar and claimed to have delayed healing in 12 percent of cases. We always use markings involving a vertical scar; we believe this enables a better adaptation of the skin to the remaining glandular tissue and, in our experience, it gives a very low rate of wound-healing problems. Finally, the authors in their study did not analyze the sensitivity of the nipple-areola complex in the early postoperative period. It would be very useful for us to compare their data with ours to understand whether skeletonizing the pedicle may somehow affect nipple-areola innervation. In conclusion, we congratulate the authors for their work and hope that the central-superior pedicle breast reduction (selective breast reduction2) is even more popular and that more surgeons publish work regarding this procedure, which seems really safe from the vascular and nervous points of view, even in cases of severe gigantomastia. We realize that confidence in a technique of this sort is reached slowly, especially because of the difficulty of dissection of the central pedicle, but we believe that the advantages in terms of safety and quality of the results justify a long learning curve. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Giacomo Datta, M.D. Department of Plastic Surgery University of Torino Salvatore Carlucci, M.D. Department of Plastic Surgery San Giovanni Bosco Hospital Torino, Italy" @default.
• W2076134328 created "2016-06-24" @default.
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• W2076134328 date "2010-10-01" @default.
• W2076134328 modified "2023-09-27" @default.
• W2076134328 title "Details on the Central-Superior Pedicle for Breast Reduction" @default.
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• W2076134328 doi "https://doi.org/10.1097/prs.0b013e3181ea9154" @default.
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