INTRODUCTION: The central mound breast reduction technique was first described by Balch in 1981 and verified by Hester et al in 1985. This technique was originally designed to reduce the post-op ptosis and superior nipple areola tilt. In this technique, the nipple areola complex depends on the parenchymal circulation and not any dermal pedicle. This allows reduction and reshaping of the breast by resection in all directions. However, as with all other breast reduction technique, the reduced breasts often lack superior and medial fullness. We modified the central mound technique by adding an internal mastopexy to add upper pole fullness and to eliminate tension on the skin closure inferiorly.
METHODS: All patients who had breast reduction with internal mastopexy from 02/2014 to 02/2016 were included in the study. Demographic data including BMI and post-operative outcomes (including all complications) were retrospectively assessed. In our technique, the primary components of the procedure can be summarized as follows:
1. Wide skin underming via Wise pattern skin design exposing the entire breast on the breast ‘capsule’ itself.
2. Circumferential resection of the large and ptotic breast in a dome shaped fashion.
3. Creation of a superior / upper pole glandular ridge.
4. Internal mastopexy by securing the cut superior edge of the newly shaped breast mound to the upper pole glandular ridge with absorbably sutures.
5. Tension free closure of the mammoplasty skin flaps.
RESULTS: Twenty patients underwent breast reductions for macromastia or for symmetry. A total of 32 breasts were reduced. Average weight of reduction was 424 g (range from 129 to 748). Average BMI was 27.16 (range 20.7 to 36.86). Average follow up was 162 days (range 6–619). There were no major complications. Minor complications included 3 minor wound breakdowns at the trifurcation point managed conservatively and one hematoma. There were no nipple losses in this series.
CONCLUSION: The maximally vascular central mound breast reduction technique is safe. This technique allows surgeons to perform an internal mastopexy which takes most of the tension off of the skin closure and optimimally augments upper pole fullness.