Modified McKissock Technique for Secondary Breast Reduction: A Prospective Study on Safety and Surgical and Aesthetic Outcomes.

Abstract

Summary: Secondary breast reductions are increasingly being performed, but they are potentially associated with higher complication rates than primary mammaplasty. Necrosis of the nipple-areola complex (NAC) is a devastating complication that can occur after repeated NAC transposition, particularly when the initially used pedicle is unknown. Thus, the authors established a modification of the McKissock technique for secondary breast reductions including 3 pedicle components to ensure safe vascular supply of the NAC. The presented technique incorporates a superior and inferior dermoglandular pedicle, according to the McKissock technique, and an additional central pedicle. The technique was applied for secondary breast reduction in a series of 25 breasts (14 patients: 11 bilateral, 3 unilateral). Complication rates, preoperative and postoperative BREAST-Q scores, and aesthetic outcomes were evaluated. Mean resection weight was 299 g (range, 40 to 646 g), and the NAC was transposed by 4.2 cm on average (range, 1 to 10 cm). No case of NAC necrosis was observed, and comparison of preoperative and postoperative BREAST-Q values indicated substantial improvement in all domains. After surgery, 84.6% of patients reported excellent satisfaction with breast appearance. According to these results, the modified McKissock technique is safe for patients requiring secondary breast reduction, even if the primarily used pedicle is unknown. The established technique is associated with improved postoperative patient-reported outcomes and yields aesthetically favorable results.

Clinical question/level of evidence: Therapeutic, IV.