Abstract

Objectives: To avoid nipple areolar graft in extreme ptosis thanks to an enlarged and thin superior dermal pedicle, as a safe alternative to the classical treatment. Introduction: Graft of the nipple areola complex is the classical treatment for ptosis and gigantomasties because of the risk of areolar necrosis. To avoid nipple areolar graft in extreme ptosis thanks to an enlarged and thin superior dermal pedicle, is a safe alternative to the classical treatment. Materials / method: between January 2003 and January 2024, 142 patients with a sternal notch-to-nipple distance ≥ 40 cm underwent surgery using this superior pedicle technique with a wider base for the nipple-bearing flap harboring, partially or totally, the two (internal and external) vertical branches. Results: Mean jugular notch to nipple distance was 43.7 cm [40-52], mean breast ptosis was 14 cm [11-22], and mean brassiere size was 42DD [40D-48DD+]. Mean weight reduction was 1395 g/breast. Areolar necrosis never occurred, 15 patients presented early minor scar disunion with prolonged healing time and 8 patients experienced postoperative inflammation with lymphorrhea. The result was considered highly or very highly satisfactory by 94 percent of the patients. Conclusion: Mammaplasty with Superobilateral Enlarged Dermal Pedicle is an efficient and safe technique, which avoids free nipple graft technique in gigantomastia with extreme ptosis.