In pursuit of effective volume reduction and enhanced aesthetics for treatment of gigantomastia using superior dermoglandular pedicle
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Gigantomastia is defined as extreme hypertrophy of the female breast. It is a disabling condition that presents unique challenges to plastic surgeons. Initial breast volume is an important factor affecting the success of the reduction. Usually, it is difficult to achieve small-sized breasts, and long-term results are often unsatisfactory, resulting in complications such as "bottoming-out" deformities. This paper presents a case series involving 40 patients (mean age 44.2 +/- 12.5) with gigantomastia. Reductions were performed by superior nipple-areola complex pedicle with or without liposuction. Total resection weight ranged from 2050 to 5398 g (mean 3066 +/- 944.2). Generally, the literature emphasizes the unreliability of the long superior pedicle when used to reduce the size of very large breasts. The technical steps for this procedure have been clearly described, and ways in which to overcome technical difficulties and attain effective volume reduction with minimal complications were presented. The technique described here is applicable to all gigantomastia cases; even very large, pendulous breasts could be effectively reduced. Physical symptoms rapidly improved during the early postoperative period, patients' aesthetic satisfaction scores were high (4.6/5), and none of the patients complained of flat breasts. The rate of partial areola necrosis was 5%, and the rate of complete areola necrosis was 2.5%. These rates are comparable to those in the literature. Using the technique described above, superior pedicle can be applied to all gigantomastia cases and enhanced aesthetic results can be obtained with minimal complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.