Design-enhanced breast reduction: an approach for very large, very ptotic breasts without a vertical incision.

Breast reduction and mastopexy have been performed with a number of techniques. Due to problems encountered with prior procedures (such as fat necrosis, skin and nipple necrosis, decreased nipple sensitivity, shaping difficulties, and bleeding), we have changed our approach to breast reduction and mastopexy. Eleven initial patients have been operated with a design-enhanced procedure that emphasizes (1) a wide-based, glandular deepithelialized pedicle; (2) an attempt to preserve the fourth intercostal nerve; (3) adequate vertical-dimension skin excision leaving no vertical scar; (4) mesial advancement of thick, superior skin flaps; and (5) administration of dilute lidocaine/epinephrine solution. We have been pleased with our results and recommended this technique as our procedure of choice for patients with very large, very ptotic breasts.