Modifying the inferior pedicle technique of breast reduction results in outcomes that are at least comparable to, and perhaps better than, those previously reported, researchers say.
A 6-year retrospective review of 241 patients who underwent bilateral inferior pedicle breast reduction for macromastia showed that modifications to the technique, including methylene blue tattooing, preoperative hydrodissection, and inframammary darting resulted in reduced wound dehiscence, blood loss, and surgical revision.
The modifications, which also included the preservation of superomedial volume and dermatome blade-guided tissue resection, also resulted in a high rate of patient satisfaction.
Linear regression analysis revealed a significant reduction in estimated intraoperative blood loss in patients who underwent preoperative hydrodissection before incision, one of the surgical modifications. Indeed, the average estimated blood loss in patients who did not undergo this technique was approximately 226 mL over the operative period, compared with 112 mL in those who did not receive this modification.
"This represents an average reduction in intraoperative blood loss by a factor of approximately 2," say Seth Thaller (University of Miami, Florida, USA) and colleagues in the American Journal of Surgery.
There was also a significant reduction in mean operative time associated with using the dermatome blade during breast tissue resection. In cases where electrocautery was used as the sole resection device, operative length was approximately 203 minutes on average, compared with 131 minutes in cases where the dermatome blade was used.
Univariate analysis revealed that inframammary darting along the inframammary line reduced the risk for postoperative dehiscence by a significant factor of 5.8 compared with traditional breast reduction.
Surgical revision was performed in 24 (5%) cases including operative evacuation of three hematomas, four (17%) cases of operative scar revision secondary to hypertrophic scarring, removal of fat necrosis in three (13%) cases, and reoperation for asymmetry in two (8%) other cases. The remaining 12 (50%) revisions were performed for the correction of residual axillary fullness not directly related to the initial procedure.
Moreover, 96% of the 241 patients included in the study expressed overall satisfaction with their postoperative results, including a reduction of resolution of preoperative symptomatology including neck pain, back pain, and perception of self-image.
"The inferior pedicle technique is a highly effective approach to the management of breast hypertrophy with demonstrated effects on both the physical and physiologic wellbeing of patients," write the authors in the American Journal of Surgery.
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