Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
PURPOSE:The evolution of procedures for reduction of breast volume and improvement of breast shape has been ongoing, based on the rich blood supply that has allowed a plethora of pedicle types. With particular consideration of the primary pattern of sensory innervation to the nipple-areola complex previously described in the literature, the authors have utilized the superolateral dermoparenchymal pedicle as a basis for surgery on a variety of presenting breast shapes. This has been proven to be a versatile and effective technique for a wide array of breast morphologies and with differing patterns of skin excision
METHODS:The operative technique involves a superior rotation of a superolaterally-based dermoparenchymal pedicle, resulting in a “periwinkle” effect that provides desirable superior pole fullness and increased projection to the breast. An algorithm is described for the use of the various procedures utilizing the superolateral dermoparenchymal pedicle.
RESULTS:Over 1500 breast procedures have been performed by the senior author during the past 15 years using the superolateral pedicle. Experience has demonstrated that the operation is safe, with total nipple-areola loss observed in only four cases with loss of six nipples (0.2%). Nipple-areola sensibility was evaluated as normal or slightly reduced at a 1-year follow-up in 96% of patients. Long-term follow-up to 15 years has shown that the results are maintained well with time.
CONCLUSION:The superolateral dermoparenchymal pedicle has fulfilled the goals of successful breast surgery. It is a safe and effective technique that has provided long-lasting results for patients. The design of the procedure can be adapted to a variety of skin excision patterns and breast morphologies.