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Elizabeth J Hall-Findlay, Commentary on: Supero-Septum Pedicle Mammaplasty: A New Modification for Reduction Mammaplasty, Aesthetic Surgery Journal, Volume 40, Issue 10, October 2020, Pages 1096–1097, https://doi.org/10.1093/asj/sjaa042
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I appreciate the opportunity to discuss “Supero-Septum Pedicle Mammaplasty: A New Modification for Reduction Mammaplasty” by Hesamirostami et al.1 This paper shows that there are multiple ways to achieve a good breast reduction. The authors employed a combination of a superior pedicle and a septum-based pedicle in 60 patients, and they managed to have good follow-up with all patients.1 The authors included all patients with a variety of resection weights and comorbidities, which included diabetes and smokers. As expected, patient satisfaction was good to excellent in the majority of patients.
It is important to watch the videos to better understand their technique. They are able to preserve blood supply both with the superior pedicle and from the chest wall at the fourth interspace. The authors state that “it is essential to preserve the septum to maintain circulation and to improve NAC sensation.” I disagree that the septum is needed for blood supply.2,3 Ghieta4 has shown impressive results with very long, thinned superior pedicles. The descending artery from the second interspace does not travel through the parenchyma, but it instead can be found approximately 1 cm deep to the skin in the subcutaneous tissue.5 As the breast descends and becomes ptotic, the artery descends with it.
