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Background: Free-nipple-graft reduction mammoplasty (RM) is the procedure of choice in patients with major hypertrophy and ptosis. The limitations of most free-nipple-graft reduction techniques include insufficient breast projection and various complications. The authors have designed a method of free-nipple-graft RM with the mammary tissue folded upward to provide a conical breast with adequate projection.
Methods: Based on the principle of breast reduction, preoperative markings were made. After the planned tissue was excised, breast remodeling was done, followed by folding the mammary tissue upward to be sutured to the pectoral fascia. The entire nipple-areola complex (NAC) was removed to a new position as a graft. The evaluation included the amount of resection, complications, and postoperative breast shape.
Results: Two patients underwent free-nipple-graft reduction with the modified technique. The inclusion criteria specified major breast hypertrophy and ptosis larger than 1500-cc volume per side, and nipple-areola transposition greater than 15 cm. An average tissue of 1,498 g for one person and 1,313 g for the other per breast was excised. There were no complications and the patients were both satisfied with the relief of symptoms as well as with the shape and projection of their breasts.
Conclusion: The up-folded mammary gland yields a conical breast with adequate projection, leaving no complications. Parenchyma sutures to the pectoral fascia provide favorable projection. The inverted T creates a dog-ear, which greatly enhances nipple projection. This operative method is a simple and effective technique for patients with major hypertrophy and ptosis, especially whose nipple-areola transposition is greater than 15 cm.
