title: The free-nipple breast-reduction technique performed with transfer of the nipple-areola complex over the superior or superomedial pedicles.
abstract: BACKGROUND
  Although the free-nipple breast-reduction technique is essentially an amputation, achieving aesthetic results still is important. The authors present their technique for free nipple-areola complex (NAC) transfer over the superomedial or superior pedicle full-thickness flaps in patients for whom a free-nipple technique is inevitable due to certain risk factors.
  
  
  METHODS
  The study included 25 patients who underwent surgery with the aforementioned method for addressing severe gigantomastia. The patients had a mean age of 43 years (range 34-59 years) and a mean body mass index (BMI) of 35.8 kg/m(2) (range 28-42 kg/m(2)). During the operation, the NAC was elevated as a full-thickness skin graft, then transposed to the superior or superomedial pedicles, which had been planned previously. The subsequent stages of the operation thus became a Wise-pattern breast reduction.
  
  
  RESULTS
  The mean resection per breast was 1,815 g (range 1,620-2,410 g). Breast projection, shape, and areolar pigmentation were assessed during the follow-up visit. One patient experienced a partial loss of the NAC graft, which healed secondarily, and three patients experienced a patchy hypopigmentation of the NAC. Breast projection and conical structure were observed to be preserved during the follow-up period.
  
  
  CONCLUSIONS
  The modified free-nipple technique aimed to convert the reduction procedure to a technique similar to pedicle methods, yielding successful results during the early phases. The full-thickness flap constructed in this way provides more fullness and a maximum contribution to projection in patients who will inevitably undergo breast reduction with the free-nipple method.
  
  
  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.affiliation: Department of Plastic and Reconstructive Surgery, Bagcilar Research and Training Hospital, Oztopuz cad. Camli konak, Ulus-Besiktas-Istanbul, Istanbul, Turkey, basarankaraca@gmail.com.
authors.forename: Karaca
authors.initials: K
authors.lastname: Basaran
authors.forename: Funda Akoz
authors.initials: FA
authors.lastname: Saydam
authors.forename: Idris
authors.initials: I
authors.lastname: Ersin
authors.forename: Memet
authors.initials: M
authors.lastname: Yazar
authors.forename: Ahmet Cemal
authors.initials: AC
authors.lastname: Aygit
mesh_terms: D000328:Adult; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D013524:Surgical Flaps