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Superomedial Pedicle Breast Reduction in Patients with Sternal Notch-to-Nipple Distances Greater than 40 cm
Christian X. Lava
*, Nicole Episalla, Rachel Rohrich, Kenneth Fan, Samer Jabbour
Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington,
Background: The superomedial pedicle (SMP) is favored for preserving nipple-areolar complex (NAC) vascularity and superior pole fullness. However, its use in breast reductions (BR) with sternal notch-to-nipple (SN-N) distances ≥40 cm is debated. This study evaluates the safety and efficacy of SMP in such cases.
Methods: A retrospective review of BR patients from March 2022 to February 2025 was conducted. Patients were included if they: 1) were at least 18 years of age, 2) underwent a SMP-based BR for macromastia, 3) had a SN-N distance of ≥40 cm, and 4) had a follow-up duration of at least one month.
Results: A total of 54 breasts (29 patients) were included. The median weight of breast tissue resected was 1,237.5 g (range: 750-2,600 g). The median SN-N distance was 42.0 cm (range: 40.0-48.0 cm). A total of five (9.3%) breasts experienced at least one complication, including hematoma (n=1, 1.9%), minor dehiscence (n=1, 1.9%), fat necrosis (n=1, 1.9%), and small skin necrosis (<2 cm; n=3, 5.6%). There were zero (0.0%) cases of reoperation. Breasts were stratified by resection weight using a cutoff of 1,240 g to ensure an even distribution. Patients in the >1,240 g group had a significantly higher BMI compared to those in the ≤1,240 g group (40.7±5.4 vs. 37.6±5.3; p=0.041). In a multivariable logistic regression, adjusted for body mass index (BMI), nipple-to-inframammary fold (IMF), SN-N, and resection weight, there were no statistically significant associations with complications (all p≥0.05). In a propensity score matching analysis, which included BMI, N-IMF, and SN-N as matching variables, incidence of any complications was comparable between >1,240 g (n=27 breasts) and ≤1,240 g (n=12 breasts) groups (average treatment effect on the treated (ATT)=0.111; p=0.829).
Conclusion: SMP is safe in patients with SN-N ≥40 cm and large resection weights. These findings challenge the notion that SMP is contraindicated for SN-N >35 cm and suggest that, with technique modifications, it can be safely used in longer SN-N distances without increased complications.
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