Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Aesthetic Plastic Surgery
Published in: Aesthetic Plastic Surgery 6/2017

01-12-2017 | Original Article

Combination of Würinger’s Horizontal Septum and Inferior Pedicle Techniques to Increase Nipple-Areolar Complex Viability During Breast Reduction Surgery

Authors: Osman Kelahmetoglu, Remzi Firinciogullari, Caglayan Yagmur, Kemalettin Yildiz, Ethem Guneren

Published in: Aesthetic Plastic Surgery | Issue 6/2017

Login to get access

Abstract

Background

Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger’s horizontal septum and inferior pedicle techniques.

Methods

This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger’s horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm.

Results

The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g).

Conclusions

This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
Lacerna M, Spears J, Mitra A et al (2005) Avoiding free nipple grafts during reduction mammaplasty in patients with gigantomastia. Ann Plast Surg 55(1):21–24CrossRefPubMed
2.
Zic R, Vlajcic Z, Dewing D et al (2013) The “dermal cage”: a modification of the inferior pedicle breast reduction. Aesthetic Plast Surg 37:364–371CrossRefPubMed
3.
4.
Widgerow AD (2005) Breast reduction with inferior pedicle fascial suspension. Aesthetic Plast Surg 29:532–537CrossRefPubMed
5.
Pennington DG (2006) Improving the results of inferior pedicle breast reduction using pedicle suspension and plication. Aesthet Plast Surg 30:390–394CrossRef
6.
Echo A, Guerra G, Yuksel E (2011) The dermal suspension sling: shaping the inferior pedicle during breast reduction. Aesthet Plast Surg 35:608–616CrossRef
7.
Ding H, Wang B, Gu Y et al (2015) The combination of inferior pedicle method and dermal suspension sling technique: one new efficient method for breast reduction. Int J Clin Exp Med 8:6613–6620PubMedPubMedCentral
8.
Würinger E, Mader N, Posch E et al (1998) Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg 101:1486–1493CrossRefPubMed
9.
Anderson RC et al (2006) Validation of the Breast Evaluation Questionnaire for use with breast surgery patients. Plast Reconstr Surg 118:597–602CrossRefPubMed
10.
Sterodimas A, Pineda EF, Meirelles V et al (2008) Maximizing nipple graft survival after performing free nipple-areolar complex reduction mammaplasty. J Plast Reconstr Aesthet Surg 61:971–972CrossRefPubMed
11.
Koger KE, Sunde D, Press BH, Hoovey LR (1994) Reduction mammoplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation. Ann Plast Surg 33:561–564CrossRefPubMed
12.
Nahabedian MY, Mofid MM (2002) Viability and sensation of the nipple-areolar complex after reduction mammaplasty. Ann Plast Surg 49(1):24–31CrossRefPubMed
13.
Atterhem H, Holmner S, Janson PE (1998) Reduction mammaplasty: symptoms, complications, and late results. Scand J Plast Reconstr Surg Hand Surg 32:281–286CrossRefPubMed
14.
Blomqvist L (1996) Reduction mammaplasty: analysis of patient weight, resection weights, and late complications. Scand J Plast Reconstr Surg Hand Surg 30:207–210CrossRefPubMed
15.
Jackson IT, Bayramicli M, Gupta M, Yavuzer R (1999) Importance of the pedicle length measurement in reduction mammaplasty. Plast Reconstr Surg 104:398–400CrossRefPubMed
16.
Erdogan B, Ayhan M, Deren O, Tunsel A (2002) Importance of pedicle length in inferior pedicle technique and long-term outcome of areola-to-fold distance. Aesthet Plast Surg 26:436–443CrossRef
17.
18.
O’Dey DM, Baltes P, Bozkurt A, Pallua N (2011) Importance of the suprasternal notch to nipple distance (SSN:N) for vascular complications of the nipple areola complex (NAC) in the superior pedicle vertical mammaplasty: a retrospective analysis. J Plast Reconstr Aesthet Surg 64(10):1278–1283CrossRefPubMed
19.
Gerzenshtein J, Oswald T, McCluskey P, Caplan J, Angel MF (2005) Avoiding free nipple grafting with the inferior pedicle technique. Ann Plast Surg 55(3):245–249CrossRefPubMed
20.
Simsek T, Engin MS, Abdullayev A, Kucuker I, Demir A, Eroglu L (2016) Accordion-style pedicle suspension in inferocentral pedicled mammoplasty. J Plast Surg Hand Surg 50(5):307–314CrossRefPubMed
21.
Hamdi M, Van Landuyt KV, Tonnard P et al (2009) Septum-based mammaplasty: a surgical technique based on Würinger’s septum for breast reduction. Plast Reconstr Surg 123(2):443–454CrossRefPubMed
22.
Bayramicli M (2012) The central pillar technique: a new septum-based pedicle design for reduction mammaplasty. Aesthet Surg J 32(5):578–590CrossRefPubMed
23.
Ryssel H, Germann G, Reichenberger R (2010) Craniomedial pedicled mammaplasty based on Würinger’s horizontal septum. Aesthet Plast Surg 34(4):494–501CrossRef
24.
Portincasa A, Ciancio F, Cagiano L, Innocenti A, Parisi D (2017) Septum-enhanced mammaplasty in inferocentral pedicled breast reduction for macromastia and gigantomastia patients. Aesthet Plast Surg. doi:10.​1007/​s00266-017-0868-1
25.
Karacaoglu E, Zienowicz RJ (2017) Septum-inferior-medial (SIM)-Based pedicle: a safe pedicle with well-preserved nipple sensation for reduction in gigantomastia. Aesthet Plast Surg 41(1):1–9CrossRef
26.
Strong B, Hall-Findlay EJ (2015) How does volume of resection relate to symptom relief for reduction mammaplasty patients? Ann Plast Surg 75(4):376–382CrossRefPubMed
Metadata
Title
Combination of Würinger’s Horizontal Septum and Inferior Pedicle Techniques to Increase Nipple-Areolar Complex Viability During Breast Reduction Surgery
Authors
Osman Kelahmetoglu
Remzi Firinciogullari
Caglayan Yagmur
Kemalettin Yildiz
Ethem Guneren
Publication date
01-12-2017
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 6/2017
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-017-0933-9

Other articles of this Issue 6/2017

Aesthetic Plastic Surgery 6/2017 Go to the issue

Original Article

Optimal Positioning of the Nipple–Areola Complex in Men Using the Mohrenheim-Estimated-Tangential-Tracking-Line (METT-Line): An Intuitive Approach

Original Article

Experience of Immediate Ambulation and Early Discharge After Tumescent Anesthesia and Propofol Infusion in Cosmetic Breast Augmentation

Letter to the Editor

Comment to: “The Characteristics and Short-Term Surgical Outcomes of Adolescent Gynecomastia”

Editor's Invited Commentary

Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures

Original Article

Impact of Metabolic Syndrome on the Morbidity and Mortality of Patients Undergoing Panniculectomy

Original Article

Creation of an Aesthetic Male Nipple Areolar Complex in Female-to-Male Transgender Chest Reconstruction