The Infero-Central Mound Reduction Mammoplasty: A Single Surgeon, 20-Year Experience

Dear Sir, We have read with great interest the paper entitled “The Infero-Central Mound Reduction Mammoplasty: A Single Surgeon, 20-year Experience” by Kaplan HY et al. [1]. The authors describe how their reduction mammoplasty technique, employing the infero-central pedicle, can be applied to breast reduction of most breast sizes, emphasizing the safety of the method due to the vascular support that reduces complications rates. We congratulate with the authors for the large number of patients enrolled in the study, for the excellent results reporting a very low rate of major complications such as nipple areola necrosis, but we have some elements to discuss. We completely agree with the authors regarding the safety and versatility of their technique. Moreover, the possibility of plication of the pedicle due to its vascular support can improve the projections of the reduced mammary cone, but although in breast reduction the decrement of volume remains the main goal of the procedure, in the restoration of a suitable mammary cone, the long lasting fullness preservation of the upper pole remains the weakest point. Did the Authors investigate this issue? Patients that required breast reduction usually suffer from severe degree of ptosis with emptiness upper pole. In the presence of satisfactory amount of breast tissue, parenchyma recontouring should be addressed through the setting up of adipo-glandular flaps by volume displacement to recontour a suitable profile of the upper breast pole in association with breast reduction. Lower breast quadrants mostly offer extra parenchyma to be transposed. In our experience, superior pedicle while ensuring a satisfactory safety during breast reduction procedure allows a wide range of maneuvers to permit at the same time volume displacement rebalancing suitable proportion respecting the golden ratio between the appearance of the upper and lower breast profile. These structural parenchyma modifications could guarantee more long lasting stability to the final pleasant result and therefore should be considered. Basing on our experience, superior NAC pedicle allows extra parenchyma harvesting from the lower ptotic tissue to be inset, in the presence of lack of volume, in the upper pole, correcting at the same time the caudal breast bulk and the gigantomastia [2, 3]. Breast asymmetry can be often observed in patients suffering from gigantomastia. Since breast tissue consists of fat and gland acting in very dissimilar way in response to physiological input, the recurrence of asymmetry could be observed, especially in the long lasting period. Breast reduction procedure should balance these two difference components to guarantee more stable result. Did the authors consider this aspect? Since scar represents one on the most popular claims, especially in the intermammary space, subcutaneous mastectomy of the two triangle of parenchyma inferiorly to the bottom edges of the medial and lateral pillars preserving skin should be considered to reduce horizontal scarring length. Did the authors consider this aspec