title: Meridian pedicle-based breast shaping in reduction mammaplasty: a technical modification.
abstract: BACKGROUND
  We present a technical modification of vertical reduction mammaplasty which provides a reliable pedicle that can be used in large and highly ptotic breasts with confidence when compared to vertical mammaplasty techniques without sacrificing conical breast shape and projection, in contrast to Wise pattern reduction techniques.
  
  
  METHODS
  Thirty-two patients under general anesthesia were operated on using this modification between 2008 and 2012. The surgical technique is as follows: after general anesthesia induction and local anesthetic infiltration, skin incisions are made according to preoperative drawings. The breast meridian is prepared by superior and inferior plication of the vertical pedicle, including two dermal and one central attachment to the chest wall. Lateral and medial tissue resections are performed, thus preparing medial and lateral pillars after skin undermining. The pillars are sutured to the meridian to reconstruct a projectile conical breast shape. Inverted-T scar (87.5%, n=28) and vertical scar (12.5%, n=4) were used for closure.
  
  
  RESULTS
  All patients were satisfied with the outcome regarding breast projection, shape, and size at 12 (n=30) and 24 months (n=15) after surgery except for 12 cases that needed reoperations: 2 cases for bottoming out and lower pole deformity, 2 cases needed more reduction by liposuction or re-excision, and 8 scar revisions.
  
  
  CONCLUSIONS
  Early and late results (up to 2 years) regarding breast shape and projection were found to be satisfactory while providing a reliable pedicle with less postoperative drainage.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors: Department of Plastic Reconstructive and Aesthetic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey. ilkeryazici@gmail.com
authors: Ilker
authors: I
authors: Yazici
authors: Unsal
authors: U
authors: Demir
authors: Sevin
authors: S
authors: Fariz
authors: Altughan Cahit
authors: AC
authors: Vural
authors: Esen Ibrahim
authors: EI
authors: Karakaya
authors: Tarik
authors: T
authors: Cavusoglu
authors: Ibrahim
authors: I
authors: Vargel
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology / Q000601:surgery*; D002921:Cicatrix / Q000517:prevention & control; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult