Perspective Chapter: Breast Reduction with Central Pedicle and Autologous Mesh Dermis – Surgical Tecnique

*Armin Rudolph Geisse, Klaus Rudolph Oppliger and Thomas Rudolph Oppliger*

### **Abstract**

Looking to improve the esthetic and functional results of the central pedicle technique, we add the dermis mesh shaping and support forming a "central cone" to manage the mammary tissue. The periareolar skin agglomeration searches for a reduction in horizontal submammary scars' size. The purpose of this chapter is to describe this surgical technique (combination of techniques).

**Keywords:** reduction mammoplasty (RM), central pedicle (CP), dermis mesh (DM), periareolar, nipple-areolar complex (NAC)

#### **1. Introduction**

There are multiple techniques of Breast Reduction (BR) [1–3] that look to, alongside reducing the size, achieve a symmetric pleasant looking shape, stable through time with minimal ptosis, minimal scarring, and frequency of complications.

Techniques based on structural support from skin and suture usually end up with ptosis and ample scars, because of the weight of the mammary tissue and the expansion of the skin and scars. Besides that, the mammary cone loses firmness and projection.

The BR technique based on the Central Pedicle (CP) was initially described by Balch in 1981 [4] and popularized by Hester in 1985 [5]. It is a trusted technique since the CP has good irrigation and innervation from the perforating branches of the fourth and fifth intercostal spaces [6], and if a wide base is kept, it will also receive irrigation from the perforating branches of the internal mammarian artery and branches from the lateral thoracic artery [5], allowing to reduce great volumes, achieve better mastopexies, and preserve lactation [7–9].

In this chapter, we will show the combination of two techniques: CP + Mesh of Dermis that produces a stable and well-projected central cone, described by Sampaio Goes in 1996 [10, 11] and Circumferential Periareolar Suture described by Benelli in 1990 [12], which allows reducing the submammary scar. Both of these techniques have been proposed in the literature and used separately. By combining them,

we pretend to obtain better long-term results in shape, reducing ptosis, and achieving minimal submamarian scarring.

This association of techniques has been applied in patients with mamarian hypertrophy and great ptosis, looking to reach the ever-increasing expectations of the patients [13].

We present here a description of this systematized **surgical technique**, complemented with a series of images.

This technique, as well as all the images shown here, and the results of a series of 300 patients who were intervened with this technique, followed and analyzed before, during, and after the procedure; were first published in the "Cirugía Plástica Ibero Latinoamericana" magazine in March 2021, volume 47, N 1, pages 35–48. Used with permission of the editor.
