A simple method to choose a pedicle
for reduction mammoplasty
Hosam Mohammed Aboelatta
Yasser Abdallah Aboelatta
Received: 12 August 2013 /Accepted: 22 October 2013 / Published online: 21 November 2013
Springer-Verlag Berlin Heidelberg 2013
Background Breast reduction procedures can be based on
different pedicles according to each case and preference of
the surgeon himself. This paper presents a new method for
simple preoperative markings that facilitate choosing the ap-
propriate pedicle for reduction mammoplasty procedure.
Methods The method depends on the relationship of the
breast meridian in relation to the site of the nipple–areola
complex (NAC). If NAC complex is medial to the meridian,
superiomedial pedicle is used and vice versa for lateral pedi-
cle. If the NAC is traversed by the meridian, superior pedicle
is then used.
Results This method has been used in 112 (224 breasts) pa-
tients who underwent breast reduction surgery. According to
our markings, superiomedial pedicle was used in 53 patients,
superior pedicle in 48 patients, and superiolateral pedicle in 11
patients. Partial nipple areola necrosis occurred in two patients
and the aesthetic outcome was satisfactory in all patients.
Conclusions This paper presents a new, safe, simple, and easy
method for choosing a pedicle for breast reduction operations
in different breast sizes. This method is considered as a guide-
line and not as a strict rule. Preoperative ultrasonograpic
determination of perforators for different pedicles can be
added to this clinical method when needed.
Level of Evidence: Level IV, therapeutic study.
Keywords Breast reduction
Nipple areola necrosis
Breast reduction is one of the most common operations per-
formed on the female breast . Breast reduction surgery
continues to evolve and is being refined constantly. Many vari-
ations of pedicle design have been conceived. Pedicles can be
based superiorly, superiomedially, superiolaterally, and inferiorly.
All these pedicles aim to maintain adequate vascularity to the
nipple–areola complex (NAC) .
Weiner et al.  first described reduction mammoplasty and
nipple transposition on a superiorly based dermal flap in 1973.
Many refinements in the superior-pedicle technique have been
published since then [4–9]. Skoog  described nipple–are-
ola transposition on a lateral dermal pedicle that was later
modified by Nicolle . In 2000 Nahabedian et al. 
reported their experience with medial-pedicle breast reduction.
In 1964, Claude Lassus began using a vertical mammaplasty
without an inframammary-fold scar .The Lejour vertical
mammaplasty is actually a modification of Lassus’stechnique
. More recently, Hall-Findlay  simplified vertical re-
duction mammaplasty that gained worldwide popularity.
The choice of a pedicle usually depends on surgeon expe-
rience and his familiarity with a certain surgical technique.
However, for less experienced surgeons and junior staff mem-
bers, choosing an appropriate pedicle may be confusing which
can lead to major complications. This paper presents a new
method for simple preoperative markings that facilitate choos-
ing appropriate pedicle for reduction mammoplasty proce-
dure. These markings depend on the relationship of the breast
meridian in relation to the site of the NAC.
Patients and methods
This study included 112 female patients (224 breasts)
complaining of enlarged ptosed breasts and underwent
H. M. Aboelatta
Y. A. Aboelatta (*)
Department of Plastic and Reconstructive Surgery,
Faculty of Medicine, Ain-Shams University, Abassia, Cairo, Egypt
Eur J Plast Surg (2014) 37:153–158