American Association of Plastic Surgeons

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Dual Perfusion Superomedial Pedicle In Reduction Mammaplasty - A Prospective Intraoperative Radiographic Study
Jake Moscarelli, BS1, Martin J. Carney, MD1, K. Lynn Zhao, MD1, Brogan Evans, MD1, Elizabeth B. Card, MD2, Vikram G. Mookerjee, MD1, David P. Alper, MD1, Paris D. Butler, MD, MPH, FACS1.
1Yale School of Medicine, New Haven, CT, USA, 2Perelman School of Medicine, Philadelphia, PA, USA.

Purpose: Superomedial pedicle (SMP) reduction mammaplasty yields excellent outcomes at greater resection weights. The primary vascular supply is attributed to internal mammary artery (IMA) perforators, but success in severe ptosis/macromastia has led to suggestion of intercostal artery (ICA) perforators’ involvement. This study utilizes intraoperative ultrasound to assess contributions from both IMA and ICA perforators in the SMP.
Methods: This prospective study enrolled patients undergoing SMP reduction mammaplasty (n=14 patients, 28 breasts). After resection, sound-only Doppler and color-Doppler ultrasound were used to identify ICA perforators on the central undersurface of the breast mound and IMA perforators percutaneously at the pedicle's superomedial base. Clinical outcomes were recorded and surveys assessed symptom improvement and aesthetics.
Results: Ultrasound identified contributions to the SMP from both IMA and ICA perforators in all 28 breasts. Eleven patients (78.6%) had Grade 3 ptosis, mean sternal notch-to-nipple distance was 32.0 ± 3.9 cm, mean inframammary fold-to-nipple distance was 13.7 ± 3.0 cm, and mean resection weight was 730.7 ± 319.0 g. There were no major complications. All patients reported improvement of their macromastia symptoms and satisfaction with their aesthetic results.
Conclusions: The SMP can possess a dual blood supply from IMA and ICA perforators if pedicle dissection is deliberate and avoids undermining off the chest wall. Dual blood supply may improve the safety of the SMP in patients with extremely large and/or ptotic breasts.

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