title: ''The dermal internal brassiere flap,'' a new modification of inferior pedicle breast reduction technic.
abstract: BACKGROUND
  The inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation.
  
  
  METHODS
  A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests.
  
  
  RESULTS
  The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p < 0.0001). The preoperative mean nipple pressure threshold value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p < 0.0001) There were no patients determined as having bottoming-out deformity. No breast asymmetry was encountered at the late follow-up period. All patients, except the scarred ones, were satisfied with the results.
  
  
  CONCLUSIONS
  In this study, we achieved an internal fascial reconstruction using a pair of triangular and quadrangular dermal flaps suspended to the rib periosteum. We believe that our modifications will contribute to decreasing the disadvantages of the inferior pedicle breast reduction technique.
  
  
  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, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey, prsdrmetintemel@gmail.com.
authors.forename: Metin
authors.initials: M
authors.lastname: Temel
authors.forename: Ali O
authors.initials: AO
authors.lastname: Karakaş
authors.forename: Recep
authors.initials: R
authors.lastname: Dokuyucu
authors.forename: Arif
authors.initials: A
authors.lastname: Türkmen
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology