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54. Augmentation-Mastopexy
Shervin Etemad, Salam Kassis, Jacob G. Unger
See Essentials of Aesthetic Surger y, pp. 763–768
STAGING
1. You are discussing the possibility of one-stage augmentation-mastopexy for a patient with grade II ptosis who
desires increased breast fullness. What is the reoperation rate you share for simultaneous augmentation and
mastopexy can be?
A. Approximately 2%.
B. Approximately 3–8%.
C. Approximately 10–20%.
D. Approximately 20 –30%.
E. Greater than 30%.
INDICATIONS AND CONTRAINDICATIONS
2. You are evaluating a 55-year-old woman as a potential candidate for augmentation-mastopexy. She has a his-
tory of periareolar mastopexy 10 years ago for grade I ptosis complicated by periareolar scar widening which
was surgically revised. She is also a former smoker, who quit 6 months ago after 35 pack-years. Past medical
history includes history of asthma and mild hypertension controlled on medication. She last had a mammogram 3 years ago. There is no family history of high-risk breast cancer, and no personal history of breast cancer. Which of the following aspects of her history is a contraindication to augmentation-mastopexy?
A. Periareolar mastopexy.
B. Complications following mastopexy.
C. Smoking within the past year.
D. Last mammography 3 years ago.
E. Hypertension.
STAGING
3. Which of following measurements is the most important component to determine staging the procedure in
augmentation-mastopexy?
A. Pinch thickness.
B. Skin stretch.
C. Nipple-to-inframammary fold distance.
D. Vertical excess.
E. Base diameter.
SKIN INCISIONS
4. You have planned single-stage augmentation-mastopexy for a 47-year-old woman. Her nipples sit 3 cm below
the inframammary fold, vertical excess is 4 cm, and additional measurements indicate significant skin excess
in both the horizonal and vertical dimensions. Which of the following mastopexy incisions is most
appropriate?
A. Periareolar.
B. Vertical.
C. Wise pattern.
D. No mastopexy required.
E. Stage the procedure as the patient is high risk.
Chapter 54&Augmentation-Mastopexy 409
PERIAREOLAR MASTOPEXY
5. A 40-year-old patient asks about the possibility for a periareolar mastopexy with augmentation to minimize
visible scarring. In which of the following scenarios would periareolar augmentation-mastopexy be most
appropriate?
A. Nipple-areola complex (NAC) at the lower contour of the breast, pointing inferiorly.
B. Nipple 1 cm below the level of inframammary fold (IMF).
C. Nipple 3 cm below the level of the IMF.
D. Nipple at the level of the IMF with the majority of parenchyma below the IMF.
E. Nipple 5 cm below the level of the IMF.
SURGICAL APPROACHES
6. A 35-year-old woman presents for evaluation of hypomastia and post-pregnancy breast changes. Light traction
on the nipples produces approximately 2 cm of nipple excursion, with nipple-to-inframammary fold (N-IMF)
distances of approximately 5 cm. Which of the following surgical approaches is most appropriate for this
patient?
A. Staged augmentation followed by mastopexy.
B. Staged mastopexy followed by augmentation.
C. One-stage augmentation-mastopexy.
D. Augmentation alone.
E. Mastopexy alone.
SURGICAL APPROACHES
7. You plan a single-stage augmentation-mastopexy for a 35-year-old woman. On evaluation, you note skin
stretch of 5 cm with a nipple-to-inframammary fold distance of 12 cm. She has approximately 3 cm of vertical
excess. Which of the following surgical approaches is most appropriate for this patient?
A. Breast augmentation only.
B. One-stage augmentation-mastopexy.
C. Augmentation followed by staged mastopexy.
D. Mastopexy followed by staged augmentation.
E. Mastopexy alone.
SURGICAL APPROACHES
8. Which of the following is true regarding one-stage augmentation-mastopexy?
A. It is recommended to place the implant prior to mastopexy.
B. It is recommended to perform mastopexy prior to implant placement.
C. There is a very low likelihood for needing revision surgery.
D. There is a high likelihood for implant malposition.
E. There is a high likelihood for capsular contracture compared to two-stage augmentation-mastopexy.
410 Part VIII&Breast Surgery
Answers
STAGING
1. You are discussing the possibility of one-stage augmentation-mastopexy for a patient with grade II ptosis who
desires increased breast fullness. What is the reoperation rate you share for simultaneous augmentation and
mastopexy can be?
C. Approximately 10–20%.
The reoperation rate for single-stage augmentation-mastopexy can range from about 8% to as high as 20%
(C), contributing to it being one of the most common causes for malpractice claims in plastic surgery.
Augmentation and mastopexy subject the breast to opposing forces of skin and parenchymal expansion
and reduction resulting in outcomes that are less predictable than those following each procedure alone.
A review of 23 studies on single-stage augmentation-mastopexy found an overall complication rate of
13.1% with a revision rate of 10.7%.
sis followed by poor scar formation, capsular contracture, and tissue-related asymmetry. It is therefore
important to set an expectation that there is a high revision rate for combined augmentation-mastopexy
and critically evaluate the possible need for a two-stage procedure.
3
In this review, the most common complications were recurrent pto-
REFERENCES
1. Calobrace MB, Herdt DR, Cothron KJ. Simultaneous augmentation/mastopexy: a retrospective 5-year review of
332 consecutive cases. Plast Reconstr Surg 2013;131:145
2. Gorney M. Ten years’ experience in aesthetic surgery malpractice claims. Aesthet Surg J 2001;21:569
3. Khavanin N, JordanSW, Rambachan A, Kim JY. A systematicreviewof single-stage augmentation-mastopexy.Plast
Reconstr Surg 2014;134:922–931
1,2
INDICATIONS AND CONTRAINDICATIONS
2. You are evaluating a 55-year-old woman as a potential candidate for augmentation-mastopexy. She has a his-
tory of periareolar mastopexy 10 years ago for grade I ptosis complicated by periareolar scar widening which
was surgically revised. She is also a former smoker, who quit 6 months ago after 35 pack-years. Past medical
history includes history of asthma and mild hypertension controlled on medication. She last had a mammogram 3 years ago. There is no family history of high-risk breast cancer, and no personal history of breast cancer. Which of the following aspects of her history is a contraindication to augmentation-mastopexy?
D. Last mammography 3 years ago.
The fact that this patient's last mammogram was 3 years ago is a contraindication to augmentation-mastopexy
(D). According to AMA and ACOG guidelines, a mammogram within the last year is required for the following
patients: age over 40 years, or age over 35 years with high risk for breast cancer, or a personal history of breast
1
cancer.
eolar mastopexy with complications (A, B) is not a contraindication. This patient should, however, be
counseled regarding the possibility that she may need revision—especially in the case of a single-stage
procedure.
gery since she quit 6 months ago.Hypertension that is controlled is not a contraindication to surgery.
She should have a mammogram prior to moving forward with the operation. A history of periar-
2
This patient is not a current smoker, and therefore option C is not a contraindication to sur-
REFERENCES
1. American College of Obstetricians-Gynecologists. Practice bulletin no. 122: breast cancer screening. Obstet
Gynecol 2011;118(2 Pt 1):372
2. Doshier LJ, Eagan SL, Shock LA et al. The subtleties of success in simultaneous augmentation-mastopexy. Plast
Reconstr Surg 2016;138(3):585–592
STAGING
3. Which of following measurements is the most important component to determine staging the procedure in
augmentation-mastopexy?
D. Vertical excess.
All of the above are important considerations of tissue-based planning in augmentation-mastopexy;
however, vertical excess of >6 cm is indication for staging procedure. Upper pole pinch thickness (A) may
Chapter 54&Augmentation-Mastopexy 411
inform pocket plane and implant selection as it provides insight into soft tissue coverage. Skin stretch (B)
provides valuable information regarding anteroposterior laxity, while nipple-to-inframammary fold
distance (C) provides information regarding laxity in the vertical dimension. Vertical excess (D) is an
important measurement as it provides information on the amount of skin/parenchyma to be resected
and may inform a consideration of one-stage versus two-stage augmentation-mastopexy.
1,2
REFERENCES
1. Lee MR, Unger JG, Adams WP Jr. The tissue-based triad: a process approach to augmentation mastopexy. Plast
Reconstr Surg 2014;245:215
2. Sanniec K, Adams WP. The tissue-based triad in augmentation mastopexy: single-stage technical refinements
[published online ahead of print January 9, 2019]. Aesthet Surg J doi: 10.1093/asj/sjz006
SKIN INCISIONS
4. You have planned single-stage augmentation-mastopexy for a 47-year-old woman. Her nipples sit 3 cm below
the inframammary fold, vertical excess is 4 cm, and additional measurements indicate significant skin excess in
both the horizonal and vertical dimensions. Which of the following mastopexy incisions is most appropriate?
C. Wise pattern.
In cases where the nipple is >2 cm below the level of the inframammary fold (IMF) and there is skin
excess in both vertical and horizontal dimensions, a Wise pattern mastopexy (C) incision is most
appropriate. Periareolar incision (A) would be appropriate in cases of minimal ptosis and a nipple-areola
complex at or above the breast border.
where the nipple is >2 cm below the IMF with horizontal skin excess but minimal vertical skin excess.
Staging the procedure (E) is something to consider once the vertical excess is >6 cm.
1,2
Vertical pattern (B) would provide acceptable results in cases
REFERENCES
1. Davison SP, Spear SL. Simultaneous breast augmentation with periareolar mastopexy. Semin Plast Surg
2004;18:189
2. Kirwan L. A classification and algorithm for treatment of breast ptosis. Aesthet Surg J 2002;22:355
PERIAREOLAR MASTOPEXY
5. A 40-year-old patient asks about the possibility for a periareolar mastopexy with augmentation to minimize
visible scarring. In which of the following scenarios would periareolar augmentation-mastopexy be most
appropriate?
B. Nipple 1 cm below the level of inframammary fold (IMF).
Periareolar augmentation-mastopexy would be most appropriate in the following cases: less than 3 to 4 cm
of breast ptosis, NAC at or above the breast border and not pointing inferiorly , and nipple no more than 2 cm
below the IMF (B).
and low nipple position relative to the IMF (C) are not appropriate cases for periareolar mastopexy as
they indicate increased degrees of ptosis which may warrant vertical or Wise-pattern approaches. Choice
D describes a case of pseudoptosis, and inferior wedge resection would be indicated in this situation.
1,2
The presence of an NAC pointing inferiorly at the inferior contour of the breast (A)
REFERENCES
1. Kirwan L. Augmentation of the ptotic breast: simultaneous periareolar mastopexy/breast augmentation. Aesthet
Surg J 1999;19:34
2. Stoff-Khalili MA, Schoze R, Morgan WR, et al. Subfascial periareolar augmentation mammaplasty. Plast Reconstr
Surg 2003;114:1280–1288
SURGICAL APPROACHES
6. A 35-year-old woman presents for evaluation of hypomastia and post-pregnancy breast changes. Light traction
on the nipples produces approximately 2 cm of nipple excursion, with nipple-to-inframammary fold (N-IMF) distances of approximately 5 cm. Which of the following surgical approaches is most appropriate for this patient?
D. Augmentation alone.
Breast augmentation alone (D) is most appropriate for this patient. Tissue-based planning should take into
consideration superior pole pinch thickness, skin stretch (SS), nipple-to-inframammary fold (N-IMF)
412 Part VIII&Breast Surgery
distance, vertical excess (VE), and base diameter (BD).1In a patient with combined hypomastia and ptosis,
tissue-based planning approaches can help the surgeon identify the most appropriate operative approach
to maximize patient satisfaction and minimize probability for reoperation.2This patient's SS of 2 cm and
N-IMF distance of 5 cm suggest minimal anteroposterior and vertical laxity, respectively. Her lack of significant ptosis and minimal skin laxity indicate that she is unlikely to benefit from mastopexy (A, B, C, E).
REFERENCES
1. Lee MR, Unger JG, Adams WP Jr. The tissue-based triad: a process approach to augmentation mastopexy. Plast
Reconstr Surg 2014;245:215
2. Sarosiek K, MaxwellPG, UngerJG. Getting the most out of augmentation-mastopexy. Plast Reconstr Surg 2018;142
(5):742e–759e
SURGICAL APPROACHES
7. You plan a single-stage augmentation-mastopexy for a 35-year-old woman. On evaluation, you note skin
stretch of 5 cm with a nipple-to-inframammary fold distance of 12 cm. She has approximately 3 cm of vertical
excess. Which of the following surgical approaches is most appropriate for this patient?
B. One-stage augmentation-mastopexy.
This patient is an appropriate candidate for single-stage augmentation-mastopexy (B). In patients with combined hypomastia and ptosis, skin stretch (SS), nipple-to-inframammary fold (N-IMF) distance, and vertical
excess (VE) provide the basis for a tissue-based triad approach to staging, as developed by Lee et al.
and N-IMF distance indicate excess skin laxity and that she would benefit from mastopexy in addition to
augmentation (A) for hypomastia. The amount of VE should inform whether or not one should stage the
procedures. Vertical excess of <6 cm suggests one-stage augmentation-mastopexy would be effective,
thereby avoiding a staged operation (C, D). Contraindications to a single-stage combined approach
include: constricted breast or skin deficiency, lack of necessity of either procedure, significant asymmetry
requiring asymmetrical mastopexy, and significant vertical skin excess requiring large skin resection.
1
Her SS
2
REFERENCES
1. Lee MR, Unger JG, Adams WP Jr. The tissue-based triad: a process approach to augmentation mastopexy. Plast
Reconstr Surg 2014;245:215
2. Stevens WG, Macias LH, Spring M, et al. One-stage augmentation mastopexy: a review of 1192 simultaneous
breast augmentation and mastopexy procedures in 615 consecutive patients. Aesthet Surg J 2014;34:723–732
SURGICAL APPROACHES
8. Which of the following is true regarding one-stage augmentation-mastopexy?
A. It is recommended to place the implant prior to mastopexy.
In single-stage procedures, the implant should be placed prior to mastopexy (A). This allows an
evaluation for whether augmentation alone may provide effective ptosis correction and helps avoid the
consequence of being skin-short as a result of the mastopexy. The reoperation rate (C) for one-stage
procedures can be as high as 20%, and a discussion of this possibility is an important component of the
informed consent process.
included reoperation (14.6%), implant rupture (3.7%), unattractive scarring (2.5%), recurrent ptosis or bottoming out (2.2%), nipple malposition or asymmetry (2.2%), and <2% rates of capsular contraction, breast
asymmetry, infection, loss of nipple sensation, nipple loss or depigmentation, implant malposition, and
hematoma.
2
1
In a review of 321 cases of one-stage augmentation-mastopexy, complications
REFERENCES
1. Calobrace MB, Herdt DR, Cothron KJ. Simultaneous augmentation/mastopexy: a retrospective 5-year review of
332 consecutive cases. Plast Reconstr Surg 2013;131:145
2. Stevens WG, Freeman ME, Stoker DA, et al. One-stage mastopexy with breast augmentation: a review of 321
patients. Plast Reconstr Surg 2007;120:1674
55. Breast Reduction
Juan L. Rendon, Anmol Chattha
See Essentials of Aesthetic Surger y, pp. 769–785
BREAST PHYSIOLOGY
1. Breast hypertrophy is associated with which of the following?
A. Increased estrogen receptors.
B. Increased circulating estrogens.
C. Increase estrogen sensitivity.
D. Increase estrogen sensitivity and excess adiposity.
E. Excess adiposity.
BREAST PHYSIOLOGY
2. Disadvantages to suction lipectomy of the breast include which of the following?
A. Disruption of the vascular supply to the nipple-areolar complex.
B. Inability for precise pathologic examination of evacuated breast tissue.
C. Disruption to nipple-areolar complex sensation.
D. Contraindication in elderly patients.
E. Must be performed under general anesthesia.
SURGICAL TECHNIQUE
3. The inferior pedicle resection is associated with which of the following?
A. Variable neurovascular supply and high complication rate.
B. Impaired lactation and high rate of bottoming out.
C. Ideal only for small reductions.
D. Boxy breast appearance and high rate of bottoming out.
E. Large learning curve compared to other breast reduction techniques.
SURGICAL TECHNIQUE
4. The superior and superomedial pedicle resections are associated with which of the following?
A. Variable neurovascular supply and high complication rate.
B. Impaired lactation and high rate of bottoming out.
C. Upper pole fullness and limited bottoming out.
D. Boxy breast appearance and high rate of bottoming out.
E. Easier inset comparted to inferior pedicle.
SURGICAL TECHNIQUE
5. Lactation is best preserved with which of the following reduction techniques?
A. Superior pedicle.
B. Central pedicle.
C. Superomedial pedicle.
D. Inferior pedicle.
E. Lateral pedicle.
414 Part VIII&Breast Surgery
SURGICAL TECHNIQUE
6. In an inferior pedicle breast reduction, what should be the typical measure of the vertical limbs?
A. 5–6 cm.
B. 7–8 cm.
C. 9–10 cm.
D. 11–12 cm.
E. 12–15 cm.
SURGICAL TECHNIQUE
7. In a superomedial pedicle breast reduction, what should be the width of the pedicle?
A. 2–4 cm.
B. 4–6 cm.
C. 6–10 cm.
D. 10–12 cm.
E. 12–15 cm.
SURGICAL JUDGMENT
8. Which of the following statements regarding the breast meridian and Pitanguy's point is correct?
A. The breast meridian determines the new vertical nipple posit ion while Pitanguy's point determines the new
horizontal nipple position.
B. The breast meridian determines the new horizontal nipple position while Pitanguy's point determines the
new vertical nipple position.
C. The breast meridian and Pitanguy's point both determine the new horizontal nipple position.
D. The breast meridian and Pitanguy's point both determine the new vertical nipple position.
E. Pitanguy's point overestimates nipple vertical height.
SURGICAL JUDGMENT
9. Which is the following is the recommended surgical approach for the treatment of recurrent hypermastia in
patients requiring large resections (>500 g) with unknown primar y pedicle?
A. Liposuction alone.
B. Inferior wedge resection.
C. Inferior pedicle reduction.
D. Superomedial pedicle reduction.
E. Free-nipple graft technique.
SURGICAL JUDGMENT
10. A key principle to maintaining vascularity to the nipple-areolar complex during re-reduction includes which
of the following?
A. Developing a new pedicle.
B. Deepithelializing only around the nipple-areolar complex.
C. Excising excess breast tissue under the nipple-areolar complex.
D. Excising excess skin below the inframammary fold.
E. Dissect down through the subdermal plexus around the nipple-areolar complex.
SURGICAL TECHNIQUE
11. Wetting solution in breast reduction surgery should be infiltrated into which of the following areas?
A. Retroglandular space and peri-incisional.
B. Retroglandular space only.
C. Peri-incisional only.
D. Circumferentially around the breast footprint taking care not to infiltrate the retroglandular space.
E. Around the pedicle of choice.
Chapter 55&Breast Reduction 415
SURGICAL JUDGMENT
12. Strategies for reducing the tension in the T region of an inverted-T skin excision breast reduction include
which of the following?
A. Marking a 90-degree superior keyhole angle.
B. Marking 6 cm vertical limbs.
C. Leaving a small wedge of skin at the T region closure site.
D. Placement of closed suction drains.
E. Leaving some permanent sutures in place.
SURGICAL TECHNIQUE
13. The use of closed suction drains in breast reductions is associated with which of the following?
A. Decreased rates of hematomas.
B. Decreased rates of nipple loss.
C. Decreased rates of wound complications.
D. No difference in complications or hematomas.
E. Increased infection rates.
SURGICAL JUDGMENT
14. When is pathological examination of excised breast tissue warranted?
A. All specimens should undergo pathological examination.
B. In patients >50 years old.
C. In patients with family history of breast malignancy.
D. In patients with BMI >30 kg/m
E. In patients <50 years old.
2
.
416 Part VIII&Breast Surgery
Answers
BREAST PHYSIOLOGY
1. Breast hypertrophy is associated with which of the following?
D. Increase estrogen sensitivity and excess adiposity.
Normal number of estrogen receptors and normal levels of circulating estrogens have been found in
women with hypermastia. Thus, an increased sensitivity to the hormone is thought to be responsible for
breast hypertrophy. Additionally, with the increasing obesity epidemic, breast hypertrophy is often from
excess adipose tissue rather than just glandular hyperplasia.
REFERENCES
1. Pang S. Premature thelarche and premature adrenarche. Pediatr Ann 1981;10:29
2. Root AW, Shulman DI. Isosexual precocity: current concepts and recent advances. Fertil Steril 1986;45:749
3. Jabs AD, Frantz AG, Smith-Vaniz A, et al. Mammary hypertrophy is not associated with increased estrogen receptors. Plast Reconstr Surg 1990;86:64
BREAST PHYSIOLOGY
2. Disadvantages to suction lipectomy of the breast include which of the following?
B. Inability for precise pathologic examination of evacuated breast tissue.
Disadvantages to suction lipectomy of the beast include the inability to address breast ptosis, prolonged
postoperative edema and induration, and inability to effectivel y send specimens for pathologic evaluation.
Advantage s include smaller scar, not disrupting vascular supply to nipple-areolar complex, can be
performed under local or intravenous sedation easily, and not contraindicated in elderly patients.
1,2,3
1,2
REFERENCES
1. Brown MH, Weinberg M, Chong N, et al. A cohort study of breast cancer risk in breast reduction patients. Plast
Reconstr Surg 1999;103:1674
2. Colwell AS, Kukreja J, Breuing KH. Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg 2004;113:1984
SURGICAL TECHNIQUE
3. The inferior pedicle resection is associated with which of the following?
D. Boxy breast appearance and high rate of bottoming out.
The inferior pedicle breast reduction provides a reliable neurovascular supply and is easily teachable. Yet,
it depends on passive creation of breast shape from tailoring skin around the remaining breast
parenchyma, and often creates a boxy breast and is associated with a high rate of bottoming out. The
learning curve is less when compared to the superomedial or superior pedicles.
1
REFERENCE
1. Nahai FR, Nahai F. MOCPSSM CME article: breast reduction. Plast Reconstr Surg 2008;121(1 Suppl):1
SURGICAL TECHNIQUE
4. The superior and superomedial pedicle resections are associated with which of the following?
C. Upper pole fullness and limited bottoming out.
Advantages to superior and superomedial pedicle breast reduction include the ability for large
parenchymal resections with excision of the ptotic tissue and ability for the creation of inferior pillar
support to limit bottoming out as well as superior fullness created by a superior pedicle location. Inset is
more challenging with the super ior or superomedial pedicle when compared to the inferior pedicle.
1
REFERENCE
1. Nahai FR, Nahai F. MOCPSSM CME article: breast reduction. Plast Reconstr Surg 2008;121(1 Suppl):1
Chapter 55&Breast Reduction 417
SURGICAL TECHNIQUE
5. Lactation is best preserved with which of the following reduction techniques?
B. Central pedicle.
Of the techniques listed, the central is ideal for lactation preservation due to the preservation of a majority of
the ducts required for lactation.
1,2,3
REFERENCES
1. Harris L, Morris SF, Freiberg A. Is breast feeding possible after reduction mammaplasty? Plast Reconstr Surg
1992;89:836
2. Brzozowski D, Niessen M, Evan HB, et al. Breast-feeding after inferior pedicle reduction mammaplasty. Plast
Reconstr Surg 2000;105:530
3. Cruz-Korchin N, Korchin L. Breast-feeding after vertical mammaplasty with medial pedicle. Plast Reconstr Surg
2004;114:890
SURGICAL TECHNIQUE
6. In an inferior pedicle breast reduction, what should be the typical measure of the vertical limbs?
B. 7–8 cm.
In an inferior pedicle breast reduction, the vertical limbs should typically measure approximately 7 to 8 cm
under tension. Long limbs can always be shortened on the operating table. Short limbs may result in closure
under tension, which may compromise both shape and skin viability.
1
REFERENCE
1. Hammond DC, Loffredo M. Breast reduction. Plast Reconstr Surg 2012;129:829e
SURGICAL TECHNIQUE
7. In a superomedial pedicle breast reduction, what should be the width of the pedicle?
C. 6–10 cm.
In a superomedial breast reduction a pedicle 6 to 10 cm in width will provide adequate perfusion to the
nipple-areolar complex and allow sufficient rotation into the new nipple position. The other answer
choices are either too short or too long.
1
REFERENCE
1. Hammond DC, Loffredo M. Breast reduction. Plast Reconstr Surg 2012;129:829e
SURGICAL JUDGMENT
8. Which of the following statements regarding the breast meridian and Pitanguy's point is correct?
B. The breast meridian determines the new horizontal nipple position while Pitanguy's point determines
the new vertical nipple position.
In marking for a breast reduction, the breast meridian determines the new horizontal nipple position.
Transposition of the inframammary fold (Pitanguy's point) determines the new vertical nipple position.
REFERENCE
1. Hammond DC, Loffredo M. Breast reduction. Plast Reconstr Surg 2012;129:829e
SURGICAL JUDGMENT
9. Which is the following is the recommended surgical approach for the treatment of recurrent hypermastia in
patients requiring large resections (>500 g) with unknown primar y pedicle?
E. Free-nipple graft technique.
According to the recommended algorithm for workup and treatment of recurrent mammary hypermastia
(Fig. 55.1), a free nipple graft should be performed in a patient requiring a very large resection with an
unknown primary pedicle.
1
1