Breast Reduction, Medial Pedicle And Mastopexy

Mastopexy is a compound word derived from the Greek mastos (breast) and pexy (to fix or secure). It refers to the correction of ptotic and pendulous breasts. The term mammaplasty refers to shaping of the breast, as the Greek derivative plasty means to mold.

The principles and techniques used to correct pendulous ptotic breasts are similar to those used to perform a breast reduction. In all techniques used, the most critical consideration is the viability of the nipple-areola complex (NAC). This article focuses on the medial pedicle as the one that provides blood supply to the NAC. The medial pedicle technique can be used to safely perform a large breast reduction, a mastopexy, or a mastopexy with simultaneous augmentation. For information on other techniques for breast reduction, augmentation, and reconstruction, see the Breast section of eMedicine's Plastic Surgery journal.

The history and evolution of breast reduction spans many centuries. Paul from the Greek island of Aegina was the first to describe details of reduction mammoplasty in the 6th century AD.1 Multiple techniques of breast reduction and mastopexy have been described over the past century. In the last 3 decades, the main evolution and progress in the field of reduction mammaplasty and mastopexy has been in better molding of the breast parenchyma (limiting the resultant scars) and not relying on the skin envelope for long-term parenchymal support and breast shape.

The true etiology of breast hypertrophy is not clearly understood. The breasts are hormonally sensitive organs that change with hormonal and, especially, estrogen variations. Breast enlargement usually begins with changes associated with puberty and pregnancy. In some women, estrogen receptors that are hypersensitive to estrogen may be a cause of mammary hyperplasia.2,3,4,5

The problem of breast ptosis is also not clearly understood. The ideal youthful-looking breast should have a natural tear drop shape, adequate projection (perkiness), and no ptosis. The entire breast parenchyma should be above the inframammary fold (IMF), and the NAC should be centered at the breast or be slightly lower than the center.