In this Surgery Spotlight video, Scot Bradley Glasberg, MD demonstrates a breast reduction with medial pedicle Wise pattern on a patient who presents symptomatic hypertrophy.  Watch Dr. Glasberg in the OR, as he effectively eliminates pedicle-related complications through careful planning and pre-operative markings.  The medial pedicle technique was given primary consideration in this case in an attempt to reduce postoperative bottoming-out and loss of upper pole fullness to the shape of the breast.  An advantage of this technique is that the medial pedicle contains the primary blood supply to the breast and is usually shorter than the inferior pedicle. Thus, using this approach should address these long-term postoperative issues.  This approach can also optimize perfusion of the nipple-areolar complex and improve the percentage of patients who maintain nipple sensitivity post-operatively.  Based on recent studies reported in the literature, the use of drains neither increases nor decreases postoperative complications, causes greater patient discomfort, and possibly increases the length of hospital stay.  Consequently, Dr. Glasberg recommends avoiding the use of drains in reduction mammaplasty and suggests that this can improve patient comfort and satisfaction with the procedure.

Learning Objectives

Upon completion of the online course, the participant should be able to:

1. Know the ideal candidate for a medial pedicle Wise pattern bilateral breast reduction, and plan the appropriate breast reduction technique.
2. Master your preoperative markings for a medial pedicle Wise pattern breast reduction surgery to ensure a successful operation. 
3. Implement intraoperative and postoperative management strategies to prevent complications such as nipple-areola necrosis, wound dehiscence, infections, seromas, and hematomas.