Date of Award
Medical Doctor (MD)
Stephanie L. Kwei
A COMPARISON OF SUPEROMEDIAL VERSUS INFERIOR PEDICLE REDUCTION MAMMOPLASTY USING THREE-DIMENSIONAL ANALYSIS.
Victor Z. Zhu, Ajul Shah, Rachel Lentz, Tracy Sturrock, Alexander F. Au, Stephanie L. Kwei.
Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT.
Reduction mammoplasty using the inferior pedicle (IP) technique continues to be more commonly performed than the superomedial pedicle (SMP). This study uses three-dimensional (3D) imaging to compare postoperative linear and volumetric changes in SMP and IP breast reductions.
Reduction mammoplasty was performed using either a SMP or IP, with a Wise-pattern skin incision. Patients in each cohort were matched based on total postoperative breast size, BMI, and age. Postoperative 3D photographs were taken at 1-3 months and 6-12 months. Measurements included: sternal notch to nipple distance, areola surface area, total breast volume, breast projection, proportion superior pole volume, proportion medial pole volume, and tissue shifting over time.
There were 13 SMP patients (26 breasts) and 14 IP patients (28 breasts). There were significant differences at 1-3 months between the cohorts in sternal notch to nipple distance (21.6+0.4cm SMP vs. 24.1+0.3cm IP, p<0.01), and proportion superior pole volume (53.9+1.2% SMP vs. 57.3+1.1% IP, p=0.04). The sternal notch to nipple distance (21.6+0.4cm SMP vs. 24.6+0.4cm IP, p<0.01) remained different between the two cohorts at 6-12 months; however, there was no difference in superior pole fullness at this time point. There was a significant difference in proportion medial pole volume (38.1+2.0% SMP vs. 45.8+1.4% IP, p<0.01). There were changes in volumetric distribution over time in both cohorts, with decreased proportion medial pole volume in the SMP cohort, and increased proportion medial pole volume in the IP cohort (p<0.01) over time. Areola surface area increased significantly more over time in the IP cohort than the SMP cohort (2.87+0.77cm2 IP vs. 0.01+0.57cm2 SMP, p<0.01).
There is no difference between the SMP and IP technique in proportion superior pole volume or breast projection within the 12-month postoperative period; however, the IP technique demonstrated greater proportion medial pole volume and increased areolar surface area over time.
Zhu, Victor Zhang, "A Comparison Of Superomedial Versus Inferior Pedicle Reduction Mammoplasty Using Three-Dimensional Analysis" (2016). Yale Medicine Thesis Digital Library. 2101.