A Simplified Approach to Breast Reduction Using the Medial Pedicle

Background Breast reduction is a common procedure for plastic surgery. We have adopted a modified technique using the medial pedicle, with markings using a 15-9-9 framework and a methodical step wise approach. Objectives This study introduces the 15-9-9 framework as a design for medial pedicle breast reductions that is easy to perform and teach, with favourable outcomes. Methods Markings using the 15-9-9 framework was used, describing the mosque dome and medial pedicle length and width. The technique was performed in day surgery under general anesthesia. Patients were followed up to 1 year, with photographs taken at each visit and complications recorded. A retrospective review of 80 patients between November 2013 and July 2019 was completed in a single surgeon’s practice. Results Patients were an average of 49 years (18-72 years) with a BMI of 28 (23-32). The average postoperative sternal notch to areola distance was 22 cm (19-26 cm) and sternal notch to nipple distance was 24 cm (21-28). The average duration of the surgical procedure was 3.4 hours. An average of 464 g (90-1210 g) was removed from each breast. Complication rates were low with minor fat necrosis (14%), T junction breakdown (10%), hematoma (3.8%), dog ear formation (3.8%), junctional necrosis (2.5%), and partial nipple loss (1.3%). One patient had a cerebrovascular accident in the late postoperative period. Aesthetically pleasing results were achieved postoperatively. Conclusions This technique using the 15-9-9 framework is simple to learn, perform and teach with overall aesthetically pleasing outcomes.