Evaluating the Performance of Different Pedicles in Reduction Mammaplasty: A Comparative Analysis
Year: 2025
Type: conference-abstract
Study design: Observational Study
Abstract: PURPOSE: Pedicle selection for reduction mammaplasty is dictated by the interplay of surgeon experience and patient characteristics. We review clinical patient characteristics that dictate pedicle selection and review outcomes associated with the interplay between patient characteristics and technique. METHODS: A retrospective chart review of 2500 patients having undergone reduction mammaplasty at five institutions from 2010-2019 was performed to record pedicle selection, patient demographics, comorbidities, body mass index, patient measurements to determine patient selection for different pedicle techniques and clinical outcomes associated with these techniques. RESULTS: 1186 patients had inferior pedicle technique, 65, superior pedicle technique, 816 superomedial pedicle technique, 148 with free nipple graft and the remainder were not specified.. 6.2% of inferior and 0.5% of superomedial reductions required conversion to free nipple grafts. 1899 reduction mammaplasties were closed with wise pattern skin closure and 189 were circum-vertical. Demographics were similar across groups except for higher age (p<0.001), BMI (p<0.001), and ASA score (p<0.001) in the free nipple graft cohort. Superomedial pedicle was used most frequently with lower sternal notch to nipple (SNN) distance while inferior pedicle was performed most frequently with higher SNN distance. Inferior pedicle was favored over other pedicle types for obesity classes I-III patients and free nipple graft was only employed for obese patients. On linear regression, superior pedicle reduction (Co-efficient = -195.2, p=0.001) was significantly associated with lower resection weights while free nipple grafting was associated with a higher resection weight (Co-efficient = 752.8, p<0.001). Inferior pedicle technique was associated with higher dehiscence, overall wound healing rates and overall complication rates than other techniques (p<0.001). Regression analysis demonstrated age, BMI and inferior pedicle technique as independent risk factors for overall complications and superomedial pedicle as protective against complications. BMI alone independently predicted nipple necrosis (p=0.002) and fat necrosis (p<0.001). CONCLUSIONS: Inferior pedicle reduction remains the most popular pedicle design followed by superomedial pedicle, with wise pattern closure the most common skin closure type. SNN distance was the most impactful design metric used to choose between pedicles. Inferior pedicle and free nipple graft were used most commonly for obese patients while superior reduction was associated with lower resection weights and BMI. Inferior pedicle technique reduction mammaplasty was independently associated with increased wound healing complications. Superomedial technique performed well across different BMI classifications. As previously reported, increasing BMI and smoking had a higher complication rate.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4411064355