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Page 2 of 11 Nicholson et al. Plast Aesthet Res 2018;5:34 I http://dx.doi.org/10.20517/2347-9264.2018.30

INTRODUCTION
[1]
Breast reduction has been described and modified by over 30 authors over more than 100 years , and most
techniques share the common pitfalls of pseudoptosis (bottoming out), difficulty ensuring an aesthetically
pleasing shape, and failure to maintain aesthetic results in the long-term.

Central mound breast reduction, in which the gland with the nipple at its apex contains the pedicle of blood
[2]
supply to the nipple, is reported to maintain nipple sensation well . In addition it maintains a reliable blood
supply and allows good visualisation of the whole gland for shaping and removal of tissue.

We describe a series of refinements to the technique of central mound breast reduction, designed to optimise
the aesthetic outcome and maintain longevity of results. This technique can be applied to reductions of large
or small breast volumes, or of simple mastopexy without reduction.

Principles of this technique are as follows
A smooth conical breast shape is obtained by carefully contouring the gland during the reduction,
suspending and wrapping the gland from below using a dermal sling, before re-draping the widely
undermined skin envelope.

A wider breast base is created by elevating the gland beyond the normal superior limit.

To reduce pseudoptosis the gland is plicated inferiorly using part of the dermal sling, which acts to shorten
the distance between the areola and the inframammary fold (IMF), such that the skin envelope is not relied
upon for support of the gland.

The gland is maintained in its new elevated position on the chest wall by a series of anchor points between
the inferior dermal sling, an additional superior dermal strip, and the rib periosteum.

The IMF is secured to the chest wall in order to maintain lower pole definition, further reduce tension on
the skin envelope, and further reduce the effects of gravity on recurrent ptosis.

The latter three points ensure no additional tension on the skin envelope, beyond that necessary for closure,
when the patient is upright. The effect of gravity on the skin is therefore diminished.

In large heavy breasts the footprint or base of the breast is narrow, so it is necessary to elevate the skin
envelope beyond the normal superior limit of existing breast base & extend it close to the clavicle. This
creates a reduced breast with a wider base which “takes off” more superiorly than the usual point where a
ptotic breast starts.

In breast ptosis, the IMF can “slide” down the chest wall along with the rest of the base of the breast,
independently of any increase in IMF to nipple-areola-complex (NAC) distance. An incision parallel and 2-3
mm superior to the IMF line bevelled in a superior direction aims to preserve and protect the IMF ligament.
If this ligament is secure already, it should be kept intact. If it has become attenuated and the IMF separates
from the chest wall, as is the case in patients who lose large volumes of weight, it is often readily noticeable
and should be identified and addressed during the procedure.

METHODS
All patients undergoing bilateral breast reduction by the senior author (M.R.) in both public and private
practices over a 7-year period were included. Data on patient demographics, tissue mass excised, and post-