Introduction

Women with macromastia can have multiple symptoms ranging from intertrigo to chronic back, neck, and shoulder pain, which may hinder their physical function. Common conservative management includes tailored brassieres, weight reduction, and physical therapy. However, these measures are not always effective in alleviating the symptoms and improving patient satisfaction.

When medical management fails, surgical options such as reduction mammoplasty (surgical resection of the breast parenchyma) are considered.

Reduction mammoplasty involves an anchor or vertical pattern incision with either a superiorly or inferiorly based parenchymal vascular pedicle. The nipple–areolar complex (NAC) is maintained on the pedicle, but this procedure can prove difficult in larger, ptotic breasts because the pedicle viability may become compromised due to excess length. Furthermore, if the pedicle is folded or improperly rotated, it can disrupt the underlying vasculature, which can lead to nipple necrosis. In addition, in rare instances with large reductions using a pedicle, NAC necrosis can happen bilaterally.

To combat the complications of large pedicled reductions, surgeons utilize a free nipple graft with a vertical and inframammary incision on patients with macromastia. This procedure allows for a more aesthetic breast shape and nipple placement, as well as a decreased risk of vascular disruption. However, the tissue at the T-junction receives a diminished vascular supply, leading to slower tissue healing and an increased risk of wound dehiscence.

A benefit to the free nipple graft procedure with no vertical incision is that, in patients with large breasts undergoing lumpectomy for a centrally located breast cancer, the free nipple graft technique allows for aggressive lumpectomy while preserving breast contour. The same procedure can then be performed on the opposite breast for reduction and symmetry.

The aim of this study was to perform a retrospective chart analysis of healing outcomes of breast reductions using free nipple grafts without a vertical incision. This study is focused on presenting a more aesthetic surgical technique for reduction mammoplasties, which warrants further study.