Modified Superomedial Pedicle Breast Reduction or Mastopexy for Patients With Medially Positioned Nipple Areola Complex.

Background: Medially positioned nipple areola complex (NAC) is an anatomic configuration common in women who have undergone significant weight loss. The superomedial pedicle (SMP) technique is thought to have excellent long-term outcomes but is considered unsafe in patients with a medially positioned NAC. In a patient with a medially positioned NAC, the SMP technique can be challenging to achieve sufficient arc of rotation of the NAC.

Methods: Medial canting of both vertical limbs of the Wise pattern as well as broadening the base of the pedicle are 2 key modifications to the standard SMP technique that create sufficient arc of rotation of the NAC. Demographics (age, body mass index), operative details (weight of tissue excised from each breast), and outcomes (perioperative complications, incidence of partial or total NAC loss, and aesthetics) were recorded for each patient. A modified superomedial pedicle breast procedure was performed on 8 women with medially positioned NAC (16 breasts); 6 underwent breast reduction, and 2 underwent mastopexy. Mean age was 38.0 years (range 21-50), mean BMI was 28.1 (range 23-35). The mean weight of tissue removed was 509 grams (range 245-889 grams) in patients undergoing a reduction and 105 grams (range 83-131 grams) in patients undergoing mastopexies.

Results: There was 1 perioperative complication (hematoma) and no instances of partial or complete NAC loss. All patients had satisfactory breast shape and NAC position.

Conclusions: Modifications to the standard SMP design that include medial canting of the vertical limbs and lateral extension of the base of the pedicle allow SMP breast reduction or mastopexy to be safely and successfully performed in women with medially positioned NAC.