title: Septum-Enhanced Mammaplasty in Inferocentral Pedicled Breast Reduction for Macromastia and Gigantomastia Patients.
abstract: BACKGROUND
  Inferior pedicle and free nipple grafting are commonly used as breast reduction techniques for patients with breast hypertrophy and gigantomastia. Limitations of these techniques are, respectively, possible vascular compromise and total/partial necrosis of the nipple-areola complex (NAC). The authors describe the innovative inferocentral pedicled reduction mammaplasty (ICPBR) enhanced by preservation of Würinger's septum for severe hypertrophic breasts.
  
  
  METHODS
  Among 287 breast reductions performed between January 2001 and 2015, 83 (28.9%) macromastia and gigantomastia patients met the inclusion criteria (breast volume resection ≥400 g-sternal notch-to-nipple distance ≥33 cm) and were included in the study. Patients were stratified according to pedicle type: Group A (51 patients) underwent ICPBR with Würinger's septum preservation; group B (32 patients) underwent IPBR. Groups were compared for NAC vascular complications, surgical revisions, wound-healing period and patient satisfaction at a minimum 6-month follow-up assessed by a five-category questionnaire (breast size, shape, symmetry, texture and scars appearance), with five Likert subscales (1 = poor to 5 = excellent). Descriptive statistics were reported, and comparisons of performance endpoints between groups were performed using Chi-squared, Fisher's exact and Mann-Whitney U tests, with p value <0.05 considered significant.
  
  
  RESULTS
  Group A and group B had, respectively, a mean age of 48.3 ± 12.4 and 50.1 ± 11.7 years, mean BMI of 23.8 and 24.6, mean weight resected of 560 ± 232 g and 590 ± 195 g, mean sternal notch-to-nipple distance of 35.1 and 34.3 cm, average nipple elevation of 9.7 and 9.5 cm. Among group A and group B, NAC complication rates were, respectively, 6.2 and 24.2% (p = 0.03), surgical revision rates were 33.3 and 60% (p = 1.00), healing time was 15.90 ± 3.2 and 19.03 ± 5.9 days (p = 0.002), and mean patient satisfaction scores were 19.9 ± 2.6 and 18.7 ± 3.4 (p = 0.07).
  
  
  CONCLUSIONS
  The ICPBR technique enhanced by Würinger's septum preservation was found to be a reproducible and effective procedure for hypertrophic breasted and gigantomastia patients, improving the reliability of the vascular supply to the inferior-central pedicle. The authors do believe this procedure should be regarded as an innovative and safe option giving optimal aesthetic outcomes in this demanding group of patients.
  
  
  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, University of Foggia, Foggia, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Portincasa
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Viale Pinto n1, 71122, Foggia, Italy. francescociancio01@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ciancio
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Viale Pinto n1, 71122, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cagiano
authors.affiliation: Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Innocenti
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Parisi
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*; D007558:Italy; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D061214:Patient Safety; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016683:Supine Position; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome
keywords: Breast hypertrophy; Breast reduction; Gigantomastia; Inferocentral pedicle; Reduction mammaplasty; Würinger’s septum