![]() MISSHAPEN AREOLA SKINIn this technique, popularized by Hester, 17 thick skin and subcutaneous flaps are dissected off around the nipple, leaving a central mound. 15 A major criticism of the inferior pedicle is the development of the “bottoming out” phenomenon. In a 2002 American Society for Aesthetic Plastic Surgery survey, 56% of surgeons reported using only the inferior pedicle and inverted T skin pattern. 14 It has been advocated for use in younger patients given its reliability in maintaining sensation, even in larger resections. 10 It has similar rates of postoperative lactation as the superior and medial pedicles, around 60% of women, regardless of pedicle choice. ![]() 12, 13 A 3:1 ratio for length:width of pedicle was recommended by Georgiade et al. 11 It is therefore a strong option for larger resections, having been described in resections as large as 3000 g with no increase in complications compared with smaller resections. Introduced in 1975 by Ribeiro, 7 and popularized by Robbins, 8 Courtiss and Goldwyn, 9 and Georgiade et al, 10 the inferior pedicle is very reliable in both viability and retention of sensation. Numbers as high as 70% of women have diminished sensation at the nipple-areolar complex 1 year postoperative with the superior pedicle, irrespective of the amount of tissue resected. 5 This is found to be independent of the amount of tissue resected and is thought to be due to the tissue resection at the base of the breast this pedicle requires. 4 A major disadvantage of the superior pedicle technique is the higher risk for sensory loss at the nipple-areolar complex postoperatively. It has been demonstrated to be a safe option in women with sternal notch to nipple distances >40 cm. 3 Although not ideal for larger resections, there is a role for the superior pedicle in severely ptotic breasts as it leaves upper-pole fullness and maintains breast projection. The superior pedicle was described by Weiner et al 2 in 1973 and has traditionally been associated with smaller resections, best used in resections of less than 1000 g, as it becomes difficult to inset with larger resections. Pedicle formation is balanced between being as wide as possible to maximize vascularity and being narrow enough to allow sufficient tissue reduction. 1 Orientation of the pedicle attempts to maximize both vascularity and sensation to the nipple while optimizing aesthetic outcome. Innervation of the nipple is by the anterior and lateral cutaneous branches of the third through fifth intercostal nerves, most frequently the fourth lateral cutaneous branch. ![]() The breast receives its vascular supply from the branches of the internal mammary artery, lateral thoracic artery, thoracodorsal artery, intercostal perforators, and thoracoacromial artery, with the largest suppliers being the former two.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |