The most common complication of a bilateral reduction myeloplasty in general that we speak to patients about are possible loss of lactation postoperatively, which I tell my patients is probably only about 1 in 30, and possible loss of nipple sensation. What I've observed in my patients actually is that many of them didn't have good sensation preoperatively and actually get better sensation postoperatively, probably from a lack of stretch on the nerves. The most common thing we often see is a little bit of breakdown at that T of the incision. They tend to heal fine with a little bass tracing and dressing changes, and that probably happens in under 10% of patients. Next I'll come laterally to determine the lateral extent. I purposely don't go down to the chest wall or see the pec muscle or fascia. Then I get my fingers under laterally so I can cut right down on my fingers to continue to delineate the pedicle. Cutting straight down on the tips of my fingers. Continue to come all the way around the pedicle. She's rather fibrous, so a little more effort. Continue to try to get our bleeders as we go. I purposely don't inject the breasts because most of my breast reductions take me close to about 45 minutes, and if I inject them, it tends to be a flash rebound from the epinephrine in the recovery room. We can end up with a hematoma or bleeding. And for that reason, I don't inject them intraoperatively. Continuing to delineate the resection now superiorly. Pouring out from the center of the Y's pattern. Now delineating the base of the pedicle and coming around the corner in the same plane, making sure not to create two planes. Now basically have the pedicle isolated with no undermining. Now laterally, I'm going to get my fingers under lateral and define the lateral breast to define the superior breast flap. And getting my fingers under and cutting directly on my fingers, coming into the groove to get out the rest of the resection. Now my pedicle is completely defined, so I'm ready to take out my resection. I'm going to get my fingers under again, so I know exactly where I am for my final reception laterally, making sure that my breast flap is not too thin. One last piece laterally. That's basically the resection now. You can see the flaps define, the pedicle define, and everything will just sort of fit into place. This is still bigger than she wants to be, so we're going to take a little more resection. I'm going to take a little more around the pedicle, again taking care to cut straight down on my fingers, and not undermine the pedicle whatsoever. End of the pedicle bleeds nicely, which is our goal. So the breast we took out weighs 537 grams. Like we saw with her standing up, she was pretty even. Got a little pouching here, a distal pedicle, I'm going to take off that to even things out. That will probably be my last piece of resection. And we'll just see how things look. Looks pretty good. Looks like it wants to sit like that. So we'll start by setting the meridian where it sort of naturally wants to fall, and I'll set up a trifurcation suture. Getting the inferior borders of the vertical limbs to line up. We'll rotate the nipple areal complex in place, and we'll close it like that. In order to avoid any dog ears, I'll put a tool back immediately and laterally to get rid of the dog ear. If there is one, there isn't much of one on this breast. But I'll still put in the vagalis to line things up laterally and medially. I'll start by cat-tagging the nipple areal complex in place with deep dermals. And then I'll continue to inset the nipple areola complex. The recovery period for bilateral reduction mammoplasty using this technique is actually extremely short. I have a hard time telling patients that preoperatively because I've never gone through the procedure myself. But 98% of the patients come back and tell me it was significantly less pain than what they thought was going to happen preoperatively. In addition, many call me three or four days after the surgery asking if they can go back to work. One of the keys to this technique is not using any drains. I've not found them to be important in terms of postoperative complications and that drain is sort of an impetus to prevent people from going back to work. So without the drains, there's really a lot of incentive for them to go back to work early and to recuperate much more quickly. I think she looks like the bee cup she wanted to be, reasonably symmetric, inframarow fold In reviewing this WISE pattern medial pedicle reduction mammoplasty, I think the key takeaway is the ease of the technique and the ability to get an excellent result for the long term. Maintaining superior pull fullness and an excellent result long term is the key to the success of this operation.

bilateral reduction mammoplasty

surgical technique

patient recovery

aesthetic result

complications