Lowering revision rates in medial pedicle breast reduction by the selective addition of "inverted-T" technique.

[BACKGROUND] The superomedial pedicle vertical-scar breast reduction is an effective technique, but high revision rates have been reported. The purpose of this study is to determine if revision rates can be lowered by the rational use of an inverted-T technique in a subset of patients who undergo superomedial pedicle reduction.

[METHODS] Records were reviewed of 127 breast reductions performed between 2002 and 2011. Group 1 (2002-2007) consisted of 51 patients who underwent a superomedial pedicle vertical-scar reduction. Four of these patients (8%) required a subsequent revision. Based on this, indications were adopted where vertical-scar reductions were performed in patients with proposed nipple position to inframammary fold (PNP-IMF) distances of less than 22 cm, with the remainder undergoing reduction with a superomedial pedicle and inverted-T skin resection pattern. In Group 2 (2008-2011), there were 41 vertical reductions and 35 "hybrid" reductions. Age, BMI, preoperative medical conditions, and reduction size did not differ significantly between the two groups.

[RESULTS] Nine patients in Group 1 (18%) experienced one or more minor complications, as did 12 patients in Group 2 (16%), (p=0.62). There were four revisions in Group 1 (8%) and none in Group 2 (p<0.001). Mean operative time was 177 min in Group 1 compared to 136 min in Group 2 (p<0.001).

[CONCLUSIONS] Breast reduction employing a superomedial pedicle can be used effectively in a wide range of patients. Revision rates can be reduced by employing an inverted-T skin resection in patients with a long PNP-IMF distance, while not significantly increasing complication rates or operative time.

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