title: Mammaplasty: the "super flap" or the superior pedicle extra long flap for massive breasts with marked ptosis or gigantomastia.
abstract: BACKGROUND
  Very large breasts associated with ptosis frequently present a challenge to the plastic surgeon in choosing the ideal procedure to obtain a satisfactory result. A free nipple graft, which for many represents the best option in these conditions, has many disadvantages.
  
  
  METHODS
  The author's method of a superior pedicle flap allows for very long flaps, in some cases over 40 cm, and breast ptosis with the nipple at more than 55 cm from the suprasterna notch with preservation of the circulation to the nipple-areola complex. This procedure has been developed and modified from the French oblique method of Dufourmentel and Mouly converted to an inverted T, while the glandular resection is performed in a keel fashion behind the areola to house and give room for these very long flaps without undue compression on them and endangering the blood supply to the areola-nipple complex.
  
  
  RESULTS
  The method is described in detail, the early and late results presented, and advantages and disadvantages discussed. It has stood the test of time as it has been used regularly for more than 20 years and has become our standard method.
  
  
  CONCLUSIONS
  The method presented is especially suitable for very large breasts with ptosis; however, excellent results are also achieved for all other degrees of ptosis, with very little modification in the procedure needed to suit different breast sizes and shapes. Most of the time we obtain a pleasing and attractive breast. This method rarely resulted in complications and never required a blood transfusion.
authors.affiliation: Department of Plastic Surgery, Faculty of Medicine, Cairo University, 12 Hassan Sabry Street, Zamalek, Cairo, Egypt. Gheita@link.net
authors.forename: Alaa
authors.initials: A
authors.lastname: Gheita