Refinement of the central pedicle breast reduction by application of the ligamentous suspension.

In a previous article, the location of the neurovascular structures inside the breast were exactly determined using a suspension apparatus, and how to access these structures was described. The horizontal septum originates at the level of the fifth rib and curves upward into vertically oriented medial and lateral ligaments, thereby guiding the main vessels and nerves to the nipple and areola. This topographical definition is relevant to increase the precision of resection in breast reductions. In further anatomic dissections of 20 female breasts, it was found that the horizontal septum constantly divides the breast into regular sections and, consequently, it can be used as a guide to achieve symmetry in breast reductions with a central pedicle. Using it provides a more predictable and reliable method of maintaining sensation and viability within the nipple-areola complex and attaining symmetry in both breasts. Because no dermal pedicle is necessary, the size of the resulting scar can be reduced. The suspending function of the ligaments provides improved ability to shape the breast. Using this understanding of the ligamentous suspension of the breast, it has been possible to perform safe breast resections with a central pedicle, irrespective of the amount of resection and risk factors. This new approach has been used on 42 patients.