Maximizing breast projection with combined free nipple graft reduction mammaplasty and back-folded dermaglandular inferior pedicle

Standard technique for free nipple reduction mammoplasty was described by Thorek in 1922. In contrast to its effectiveness, late postoperative results included insufficient projection of the breast and the nipple-areola region. We describe a modification of this well recognized technique in order to increase central mound projection and improve nipple-areola projection by suturing the dermaglandular flap to the pectoralis major muscle by back-folding the pedicle. Twenty macromastia patients were subjected to free-nipple-graft reduction mammoplasty in combination with inferior pedicled dermaglandular reduction mammaplasty of a total of 40 breasts with this technique between years 2000 and 2004. Preoperative planning for inferior pedicled dermaglandular flap was made using the "Wise" pattern for large breasts. The variation of the technique comes from using the back-folded deepithelialized inferior pedicled dermaglandular flap for increasing the breast mound projection by fixating the demaglandular flap with absorbable sutures to the underlying pectoralis major muscle fascia and the costal cartilage pericondrium. By applying this technique, increased projection during the early preoperative and late postoperative periods are achieved, compared with patients who only underwent free-nipple- graft reduction mammoplasty.