Breast reduction in gigantomastia using the posterosuperior pedicle: An alternative technique, based on preservation of the anterior intercostal artery perforators

Background: The purpose of this study was to describe and evaluate the outcomes of breast reduction in cases of gigantomastia using a posterosuperior pedicle. Methods: Four hundred thirty-one breast reductions were performed between 2004 and 2007. Fifty patients of 431 (11.6 percent) responded to the inclusion criteria (>1000 g of tissue removed per breast (100 breasts). The mean age was 33.2 years (range, 17 to 58 years). The average notch-to-nipple distance was 37.9 cm (range, 35 to 46 cm). The mean body mass index was 27 (range, 22 to 35 cm). The technique of the posterosuperior pedicle was used, in which the perforators from fourth anterior intercostal arteries are preserved (posterior pedicle). Results were evaluated by means of self-evaluation at 1 year postoperatively. Results: The average weight resected was 1231 g (range, 1000 to 2500 g). The length of hospital stay was 2.3 days (range 2 to 4 days). Thirty seven patients evaluated their results as "very good" (74 percent), nine as "good" (18 percent), and four as "acceptable" (8 percent). There were no "poor" results. The chief complaint was insufficient breast reduction (four patients), despite the considerable improvement in their daily life (8 percent). Back pain totally resolved in 46 percent and partially (with significant improvement) in 54 percent of cases. One major and seven minor complications were recorded. Conclusions: The posterosuperior pedicle for breast reduction is a reproducible and versatile technique. The preservation of the anterior intercostal artery perforators enhances the reliability of the vascular supply to the superior pedicle.