title: The "Superior Ledge": a Modification of the Standard Superomedial Pedicle Reduction Mammoplasty to Accentuate Nipple-Areola Complex Projection.
abstract: BACKGROUND
  The superomedial pedicle parenchymal excision pattern for reduction mammaplasty has the benefits of a reproducible breast shape and improved superomedial fullness, but is limited by a susceptibility to nipple retraction. The senior author of this paper has formalized the "superior ledge" modification of the superomedial pedicle technique (SL-SMP) to address these limitations.
  
  
  OBJECTIVE
  To describe the technical details of the SL-SMP breast reduction technique and to analyze patient outcomes.
  
  
  METHODS
  The technique involves only partial-thickness parenchymal excision superolateral to the pedicle, thereby leaving a "superior ledge" of parenchyma on top of which the nipple-areola complex (NAC) rests in a tension-free manner. Postoperative photographs were recorded; and patient demographics, intraoperative details, complications, and outcomes were recorded and analyzed.
  
  
  RESULTS
  One hundred seven patients underwent SL-SMP reduction mammaplasty between 2007 and 2013. Complications included wound-healing complications (9.3 %), infection (2.8 %), seroma (1.9 %), and hematoma (1.9 %). Mean follow-up was 44.6 months (Range: 17-72), and during that period no incidence of clinically relevant NAC retraction was noted by either the patient or surgical team.
  
  
  CONCLUSIONS
  Maintenance of a distinct superior ledge underlying the final position of the NAC is an important modification to stress, to prevent nipple retraction. Importantly, the height of the ledge can be personalized for each patient. We feel it is a valuable addition to the plastic surgeon's armamentarium to optimize outcomes for patients seeking relief from excessive breast tissue.
  
  
  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: Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Room 5-506, New York, NY, 10032, USA.
authors: Peter W
authors: PW
authors: Henderson
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Room 5-506, New York, NY, 10032, USA.
authors: Michelle M
authors: MM
authors: Chang
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Room 5-506, New York, NY, 10032, USA.
authors: Erin M
authors: EM
authors: Taylor
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Room 5-506, New York, NY, 10032, USA.
authors: Ross
authors: R
authors: Weinreb
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Room 5-506, New York, NY, 10032, USA. chr2111@cumc.columbia.edu.
authors: Christine H
authors: CH
authors: Rohde
mesh_terms: D000328:Adult; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods* / Q000639:trends; D008875:Middle Aged; D009558:Nipples / Q000033:anatomy & histology / Q000601:surgery*; D009929:Organ Size / Q000502:physiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast reduction; Macromastia; Mastopexy; Superomedial pedicle