INFERIOR PEDICLE TECHNIQUE (WISE-PATTERN)
There are multiple procedures that can be performed through the years, which will reduce the breasts. Dr. Linder favors the inferior pedicle technique (Wise-Pattern). This technique has allowed us to preform enormous reductions without loss of the nipple areolar complex and maintain excellent blood supply to the nipple areola. This is my favorite approach and I use this every week. The operative goals on a breast reduction are always to reduce tissue, reduce the functional pain and weight of the breast upon the back and to aesthetically lift the breast without devascularization of the nipple areolar complex. Inferior pedicle Wise-pattern technique is Dr. Linder’s favorite choice. The scar is an anchor scar, the incision around the nipple, down the middle of the breast and along the inframammary fold. Sometimes a bi-pedicle will be maintained, allowing the superior portion of the pedicle to maintain blood supply to the tissue or the fascia overlying the upper chest wall and this may increase blood supply, especially with long flaps. Importantly, patients should realize that the blood supply is the most key issue when performing a breast reduction and the plastic surgeon needs to be Board Certified in order to have the judgment experience to perform this operation safely and make sure the flaps are not too thin or that the pedicle is not less than in our hand 8 cm wide, which could lead to blood supply problems and necrosis or death of skin or the nipple areolar complex.
BENELLI TECHNIQUE OR PERIAREOLAR (ROUND BLOCK) TECHNIQUE.
Other techniques that have been used through the years include the Benelli or periareolar mastopexy, also referred to as the round block technique. Dr. Linder does not like this technique. He believes that scarring is often poor with stretching around the areolar complex and that there is a better result when the scar is brought down vertically at least through a vertical mastopexy. Distributing tension around the areolar only is often associated with poor scarring. The periareolar mastopexy which is basically useless in this operation in that it does not reduce the breast enough and the scarring is often poor.
VERTICAL SCAR TECHNIQUE
The next technique is the vertical scar breast reduction with or without undermining. Beautiful results have been found with this. Dr. Lassus and Dr. Lejour are world renown for this technique. Vertical reduction mammoplasty is more useful for smaller breast reductions, at least in Dr. Linder’s opinion, in not always able to remove the inframammary fold skin on the long reductions which can lead to elongated shaped breasts. In my opinion, the shape of the breast should never be sacrificed for scarring. In other words, an inframammary scar if necessary will greatly improve the rounding shape of the breast.
CENTRAL MOUND, L-SHORT SCAR MAMMOPLASTY, BREAST AMPUTATION WITH FREE NIPPLE AREOLAR COMPLEX GRAFTING TECHNIQUE
Other techniques include the central mound technique, the L-short scar mammoplasty and the breast amputation with free nipple areolar complex grafting. This is done for enormous breast reductions where thousands of grams of tissue are removed per breast or the pedicle length is extraordinarily long. It has been stated that free nipple breast reduction is ideal for patients who have enormous breasts or gigantomastia where more than 1000 grams of tissue will be removed per breast and free nipple grafts can then be placed, realizing that there will be complete loss of sensitivity as well as obviously no lactation whatsoever.
It is absolutely vital that all pathological specimens must be sent to the Department of Pathology to determine any cancer or premalignancy within breast tissue specimen. We personally use UCLA Medical Center or Cedars Sinai Medical Center if surgeries are performed there. Path reports are very important and copies should be maintained by the patient as well for their future, including future mammograms.
In our practice all patients undergo mammography if they are going to undergo a breast reduction surgery if they have not had one already. It is vital to have a mammogram and/or an ultrasound so that a map preoperatively will be determined of the breast and this can be reviewed by the radiologist in the future if something new should occur postoperatively, realizing that with the reduction surgery, flaps of issue are going to be rotated, which could lead to difficulty in determining a calcification versus a premalignancy in the future.