title: Superior-medial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction: technical aspects and outcome.
abstract: BACKGROUND
  Reduction mammaplasty procedures and especially the superior-medial dermoglandular pedicle (SMDP) technique are frequently used for esthetic objectives; however, few reports have been available regarding its application following conservative breast surgery reconstruction. The purpose of this study is to analyze the feasibility of the technique and describe the surgical planning and its outcome following oncologic surgery.
  
  
  METHODS
  Thirty-nine patients underwent immediate bilateral SMDP breast reconstructions. Mean time of follow-up was 20 months. SMDP was indicated to reconstruct inferior breast defects in patients with enough remaining breast tissue. Reconstructed (RB) and opposite (OB) breast complications were evaluated and information on esthetic result and patient satisfaction was collected.
  
  
  RESULTS
  Tumors (51.2%) measured 2 cm or less (T1) and 66.6% were located in the lower outer quadrants. Mean change in nipple position was 12.5 cm. Immediate RB complications occurred in 8 patients (20.5%), with skin necrosis in 3 (7.6%), infection in 2 (5.1%), dehiscence in 2 (5.1%), and partial areola necrosis in 1 (2.5%) patient. Late complications were observed in 7.6%. All late complications were observed after adjuvant radiotherapy. The cosmetic result was considered to be good or very good in 84.6%, and the majority of patients were either very satisfied or satisfied. All complications were treated by conservative approach.
  
  
  CONCLUSIONS
  SMDP is a reliable technique and should be given primary consideration in cases of lower quadrant reconstruction. The success of the procedure depends on patient selection, coordinated planning, and careful intraoperative management.
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.forename: Eduardo Gustavo
authors.initials: EG
authors.lastname: Arruda
authors.forename: Claudia
authors.initials: C
authors.lastname: Aldrighi
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Aldrighi
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D042361:Mammary Glands, Human / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012867:Skin / Q000473:pathology