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What is an inferior pedicle technique?

What is an inferior pedicle technique?

 Breast Reduction Inferior Pedicle TechniqueThe inferior pedicle technique is a surgical technique performed for breast reduction (reduction mammoplasty).

The inferior pedicle technique is a surgical technique performed for breast reduction (reduction mammoplasty). “Pedicle method” means the surgeon leaves an attached tissue graft (pedicle) with nerves and blood vessels that supply the breast.

A pedicle can be superior, lateral, medial, inferior, or central. With the inferior pedicle technique, the blood supply to the nipple and areola remains generous. As a result, the inferior pedicle has proven sufficient to sustain the nipple-areola complex (NAC) with good circulation, good sensation, and breastfeeding ability.

Patients who undergo reduction mammoplasty tend to be the most satisfied patients treated by plastic surgeons. It can be performed at any age following puberty. Patients tend to experience immediate relief of their neck and shoulder pains, including older patients.

In general, the scars that result from this procedure heal very well. Occasionally, some redundancy may be present which may require liposuction.

Why is an inferior pedicle breast reduction done?

This procedure may prove useful for:

  • Large breasts, disproportionate to the body frame
  • Large, heavy breasts causing significant neck, back and shoulder pain
  • Grooves in the shoulders from the weight of bra straps
  • Difficulty in wearing and fitting in clothes
  • Breasts that interfere with sports and exercise
  • Skin irritation beneath the breasts
  • Asymmetrical breasts
  • Self-consciousness or aesthetic concerns

Who should not get an inferior pedicle breast reduction?

Some people are medically unable to undergo the surgery when other systemic diseases are present.

Smokers should quit smoking prior to the procedure as it increases risk of complications.

Breast reduction and age

  • Patients may seek reduction mammoplasty starting at puberty. If reduction mammoplasty is performed at an early age, such as 14 years, patients may require an additional procedure.
  • If breasts are significantly large, surgery can be performed in the teenage years.
  • The patient should undergo a preoperative mammogram if she is older than 35 years.

How is an inferior pedicle breast reduction procedure performed?

During the procedure

  • The surgery is performed under general anesthesia.
  • Breast reduction reduces the skin envelope and volume of breast tissue while the nipple is repositioned.
  • The breasts are not reduced to a standard size but to one that is compatible with the patient's body. This may range from a B to a D cup or even bigger in larger women.
  • Breast tissue is carefully preserved, marked, and protected so that each specimen from each breast can be evaluated by a pathologist to detect malignancy in the breasts.
  • The wounds are closed with buried sutures and then either a subcuticular suture or Dermabond (skin glue) on the skin, which heals with minimal scarring in most people..
  • Some surgeons opt for drain placement to reduce risk of blood clots (hematomas) or fluid accumulation (seroma).

After the procedure

  • Painkillers and antibiotics may be administered.
  • The patient may be advised to wear a surgical bra to provide support and help healing.
  • The patient should rest upright with their back elevated.
  • The patient can be discharged 24 to 48 hours after surgery.
  • Swelling and bruising resolve in one or two weeks.
  • Assistance with routine activities like bathing, dressing may be required in the first week.
  • The surgeon may advise certain exercises and massage techniques for the first two to three weeks.
  • Light activities can be resumed after two weeks.
  • Avoid rigorous exercises, sports, lifting heavy objects for the first eight to 12 weeks.
  • After four to six weeks, patients can switch from surgical bras to bras of their choice.
  • Patients can resume work depending on nature and requirement of job, their own comfort level and the surgeon’s approval.
  • The scars generally heal well and are barely visible with time.
  • Regular follow-up with the surgeon is required to monitor healing.

What are the complications of an inferior pedicle breast reduction?

  • The most devastating potential complication is total loss of the nipple-areolar complex (NAC)
    • This is extremely rare
    • In patients with extremely large breasts, consider the possibility of a free nipple graft to avoid loss of NAC 
  • Blood Clot (hematoma) formation (common)
  • Bleeding
  • Infection
  • Possible asymmetry
  • Loss of sensation around incision
  • Problems with breastfeeding
  • Scarring (keloid formation)
  • Lack of fullness and poor projection
  • Poor reaction to anesthesia

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