Simplifying Free Nipple Graft Mammoplasty in Postmenopausal Obese Patients using Inferior Dermaglandular Flap

Abstract

Breast hypertrophy causes medical problems ranging from back and neck pain to dermatitis creating a demand for breast reduction surgery along with aesthetic and psychological reasons. Free-nipple-graft breast reduction surgery is a safeguard procedure for patients who are at risk for nipple necrosis with pedicled techniques but has a disadvantage of resultant flat breasts with poor projection. Study included twenty-three postmenopausal women who underwent breast reduction with inferior pedicled dermaglandular flap and free-nipple-grafting, between September 2015 and January 2020. A rectangular 8 x 10 cm inferior-pedicled dermaglandular flap was dissected and anchored to the thoracic wall for better projection and upper pole fullness. All patients had at least one comorbidity. Visual analog scale was evaluated at 1-3 months. Mean age of the patients was 54.08 SD 4.65 years, and mean body mass index (BMI) was 33.56 SD 2.53. Mean follow-up period was 10.56 SD 5.6 months. Mean SN-N distance was 37.45 SD 3.77 and 38.86 SD 3.91 cm for right and left breasts, respectively. Mean resection weight was 1373 SD 440 g. Wound dehiscence was seen in 3 patients (13.0%) and treated medically. No other complications, including total nipple areolar complex (NAC) loss, were seen. Mean visual analog scale score for patient satisfaction was 7.7. All patients were satisfied with their final breast shapes. Utilizing inferior dermaglandular pedicled flap technique with free-nipple-graft breast reduction mammaplasty provides better nipple projection and a more aesthetically pleasing breast shape and contour. It helps achieve an effortless preoperative planning and a straightforward procedure with high patient satisfaction in postmenopausal obese women.