A superior vertical dermal pedicle for the nipple-areola: an alternative for severe breast hypertrophy and ptosis.

[BACKGROUND] Nipple-areola nourishment and sensation have been the main concern in reduction mammaplasty for severe breast hypertrophy and ptosis. Free grafting for the nipple-areola can cause flatness and loss of sensation. These complications can be improved by pedicle techniques for the nipple-areola, no matter the pedicle orientation. The aesthetic outcomes and complications are similar for the inferior and superior pedicle techniques. The pedicle length has been crucial to nipple-areola viability and sensation.

[METHODS] Using a keyhole pattern, a vertical flap with a superior pedicle was outlined for nipple-areola transposition. The mammary tissue under the flap was removed, creating a vertical dermal flap 7-14 cm long, and the superior pedicle was located on the new site of the areola marked by the pattern. Sensation was evaluated monthly by subjective contact testing of the four quadrants of the nipple-areola.

[RESULTS] The Pearson product-moment correlation coefficient was used to correlate the return of sensation with the length of the dermal flap and the amount of breast tissue removed. Sensation was achieved for the four quadrants 6 months after the breast reduction for all the patients of this series. Recovery of sensation was significantly greater for the superior quadrants than for the inferior quadrants in the first 3 months.

[CONCLUSIONS] The vertical dermal flap with the superior pedicle preserves nipple-areola nourishment and sensation. It is an alternative option for pedicle techniques in surgical correction of severe breast hypertrophy and ptosis.