Plastic Surgery>>>>>Breast, trunk and perineum
Question 7#

Which of the following MUST be adhered to when undertaking a breast reduction?

A. The new nipple position should always be located at 20-22cm from the suprasternal notch
B. The nipple should be repositioned at the mid-humeral line
C. The nipple should be repositioned at 4-5cm from the IMF
D. The new nipple position is determined by the two-finger manoeuvre at the inframamamry fold (Pitanguy’s point) and straying from this position is likely to lead to poor results
E. None of these options is correct

Correct Answer is E

Comment:

None of these options is correct. Most aesthetic measurements of the breast are based on Penn’s publication which are only a guide. In a group of 20 women with aesthetically perfect breasts, he found the ideal position of the nipple is located at 21cm from the SSN. Mid-humeral measurement was popularised by Lassus. Locating the new nipple position at 4-5cm higher than the IMF is used in inverted-T mammaplasty and does not apply to all techniques. Pitanguy put the nipple where one index in the IMF touches the other index crossing the breast parenchyma. All these measurements can be used as a good starting point; however, more variations have been demonstrated by many other surgeons. Surgeons need to drop the nipple position at least 2cm from their usual design with the inverted-T approach. Vertical mammaplasty creates a significant breast projection and the nipple will have the illusion of being higher because of the increased slope of the upper portion of the breast. Therefore, the new nipple position needs to be lowered about 2cm below what one would use to mark in the inverted-T approach.

References:

  1. Penn J. Breast reduction. Br J Plast Surg 1955; 7: 357.
  2. Hall-Findlay EJ, A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 1999; 104(3): 748-59.