title: Septum-Inferior-Medial (SIM)-Based Pedicle: A Safe Pedicle with Well-Preserved Nipple Sensation for Reduction in Gigantomastia.
abstract: BACKGROUND
  Reduction in breasts with well-preserved nipple sensation and a viable nipple-areola complex (NAC) is one of the basic core concepts of reduction mammoplasty. Many techniques have been described with enthusiasm advocating full achievement of the aforementioned goals. The goal of this study is to introduce a novel technique that provides an intact neurovascular source to the nipple-areola complex for reduction in gigantic breasts.
  
  
  METHODS
  Twenty-six patients operated on from December 2010 through April 2015 were included in the study. The reduction was performed by isolating Wuringer's septum and the inferior pedicle in continuity with the medial pedicle to save the neurovascular supply to the NAC and its accompanying breast parenchyma. This pedicle is called as septum-inferior-medial-based pedicle. Inclusion criteria, marking and planning with detailed description of the surgical procedure are presented.
  
  
  RESULTS
  The overall satisfaction rate was high. Eighty percent of the patients rated their results. The results were as follows: 81% rated as 'very satisfied'; 19% rated as 'somewhat satisfied.' NAC sensation was intact in all cases at all time intervals even immediately after surgery.
  
  
  CONCLUSIONS
  The united pedicle technique provides an intact neurovascular source to the nipple-areola complex. Reduction with this pedicle is a safe procedure. Remodeling the gigantic breast can be accomplished without any restriction because of the flexibility of this pedicle. The very early results are promising, but long-term results needed to be evaluated.
  
  
  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: Division of Plastic Surgery, Atasehir Memorial Hospital, Istanbul, Turkey. drercanka@yahoo.com.
authors.forename: Ercan
authors.initials: E
authors.lastname: Karacaoglu
authors.affiliation: Division of Plastic Surgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Zienowicz
mesh_terms: D000328:Adult; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000175:diagnosis / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D009558:Nipples / Q000294:innervation* / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012677:Sensation / Q000502:physiology*; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast; Gigantomastia; Nipple; Pedicle; Reduction; Sensitivity; Symmetry