l

BREAST

The Central Mound Pedicle: A Safe and Effective

Technique for Reduction Mammaplasty
Michael R. DeLong, M.D.
Irene Chang, B.A.
Matt Farajzadeh, B.S.
Edward H. Nahabet, M.D.
Jason Roostaeian, M.D.
Jaco Festekjian, M.D.
James Rough, M.D.
Andrew L. Da Lio, M.D.
Downloaded from http://journals.lww.com/plasreconsurg by BhDMf5ePHKbH4TTImqenVLDYB5WEYn0wbcpOCa/BExbhWSIP5MFhDjaesTfsLAFPb9ufepQzYCU= on 09/24/2020
Background: The central mound technique offers a relatively less common
approach for breast reduction. This study evaluated the expected safety and
efficacy outcomes using this technique in a large patient series.
Methods: A retrospective review of all patients undergoing central mound
breast reduction at the authors’ institution between June of 1999 and Novem-
ber of 2018 was performed. Both bilateral macromastia and unilateral sym-
metrizing reduction patients were included but evaluated separately for some
outcomes. Patient demographics and comorbidities, operative details, postop-

Los Angeles, Calif.; and Tucson, Ariz.
erative adverse events, and BREAST-Q scores were recorded. Associations be-
tween preoperative variables and outcomes were assessed with chi-square tests,
Wilcoxon tests, and Kendall tau-b correlations.
Results: A total of 325 patients were identified for inclusion (227 bilateral
and 98 unilateral; 552 breasts). The average patient age was 46 years, and the
average body mass index was 27.4 kg/m2. Among the bilateral macromastia
patients, the average operative time was 3 hours 34 minutes, and average
breast tissue removed was 533 g (right breast) and 560 g (left breast). Among
all patients, average follow-up was 169 days. On a per-breast basis for all pa-
tients, the following complication rates were observed: seroma, 0.2 percent;
hematoma, 1.1 percent; dehiscence, 2.9 percent; infection, 1.5 percent; hy-
pertrophic scar, 4.6 percent; nipple necrosis, 0.4 percent; fat necrosis, 0.9
percent; and skin flap necrosis, 1.7 percent. Using the BREAST-Q Reduc-
tion/Mastopexy questions on a Likert scale ranging from 1 to 5, restricted
to the bilateral macromastia patient population, all scores improved with
statistical significance.
Conclusion: The central mound pedicle is a safe and effective approach for
reduction mammaplasty for both bilateral macromastia patients and unilateral
symmetrizing operations. (Plast. Reconstr. Surg. 146: 725, 2020.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

R
eduction mammaplasty is a common pro-
cedure used by plastic surgeons to improve
quality of life in patients with symptomatic
macromastia, or to restore symmetry in patients
with congenital discrepancies or after unilateral
reconstruction.1–3 Although this is a common
procedure, adherence to fundamental plastic
surgery principles is required to remove the
excess skin and breast parenchyma and to repo-
sition the nipple while maintaining adequate
perfusion to all tissues.4 Improper technique or
overly aggressive resection can result in necrosis
From the Division of Plastic and Reconstructive Surgery,
Department of Surgery, University of California, Los Angeles;
and Plastic Surgery Specialists.
Received for publication August 8, 2019; accepted March 31,
2020.
Copyright © 2020 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000007173
of the nipple, skin, or fat, and can lead to a poor
cosmetic result.5,6 In addition, the extent of skin
excision must be balanced with the ultimate scar
burden on the breast mound and inframam-
mary fold.7
Disclosure: The authors report no financial con-
flicts of interest. This study was not funded.
Related digital media are available in the full-text
version of the article on www.PRSJournal.com.
Read classic pairings, listen to the podcast, and
join a live Q&A to round out your Journal Club
Discussion. Click on the Journal Club icon on
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 Plastic and Reconstructive Surgery • October 2020
These considerations have resulted in the
development and description of numerous tech-
niques for performing reduction mammaplasty,
categorized by differing skin pattern reductions
and pedicle designs.8–12 The most commonly used
technique is the inferior pedicle with a Wise inci-
sion pattern, preferred by an estimated 70 percent
of surgeons.13 The inferior/Wise approach offers
the safe excision of large tissue volumes with pre-
dictability and reproducibility.14,15 However, some
surgeons have criticized this approach for per-
ceived shortcomings, including squaring of the
breast borders and late pseudoptosis.16
Many critics of the inferior/Wise approach have
adopted the superomedial pedicle reduction, using
either a Wise or vertical incision pattern. Advocates
of this technique believe that the superiorly based
pedicle affords longevity to the final breast mound
shape and position by primarily resecting tissue
inferiorly. In addition, limiting the skin incision
to only a vertical ellipse can reduce the eventual
scar burden for patients. However, although stud-
ies have suggested that the superomedial pedicle
can be used safely for larger reductions, some sur-
geons are hesitant to use the superomedial tech-
nique in gigantomastia patients with ptosis because
of the reliance on a superiorly based blood supply
and potential for nipple ischemia.17,18 The supero-
medial and inferior pedicle techniques also may be
of limited utility in re-reduction patients where the
original pedicle is unknown.19
The central mound pedicle technique, intro-
duced by Balch in 1981,20 offers many advantages.
The central mound relies on a highly vascular glan-
dular pedicle directly from the chest wall and can be
safely used in re-reductions regardless of the pedicle
design used in the prior reduction. In addition, the
central mound technique allows the surgeon to pre-
cisely predict and modify the base width of the breast
mound by shaping the underlying coned pedicle
and draping the skin over the final desired shape.
By centering the pedicle under the nipple and point
of maximal projection, an aesthetic and anatomical
breast contour can be constructed. The preserva-
tion of the directly underlying tissue also may limit
the likelihood of damage to the sensory cutaneous
nerves destined for the nipple-areola complex.
Multiple senior surgeons at our institution
exclusively perform their reduction mammaplasty
procedures with the central mound technique.
We evaluate multiple decades of patients hav-
ing undergone this relatively less common tech-
nique to report on our experience with respect
to expected safety and efficacy outcomes for the
central mound procedure.
726
Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
PATIENTS AND METHODS
Operative Technique
The central mound pedicle reduction mam-
maplasty is a highly reproducible technique
(Figs. 1 and 2). [See Video (online), which dem-
onstrates the steps of the central mound breast
reduction technique, including excision patterns
and internal mastopexy sutures.] Preoperative
markings are made with the patient in the sitting
position, with a typical Wise-pattern skin reduc-
tion design drawn on the patient. The expected
new nipple-areola complex position is marked
at or just slightly above the Pitanguy point. The
limbs of the Wise pattern are then marked based
on surgeon preference estimating the final breast
size and extent of expected resection.
Once in the operating room, an areolar tem-
plate is used to mark the new preferred size of the
areola. Incisions are made through skin based on
the preoperative Wise-pattern markings. The skin
around the areola and the inferior pole is com-
pletely removed down to the breast capsule. Supe-
riorly, medial and lateral skin flaps are created at
the junction between the subcutaneous fat and
the breast capsule. This plane will vary based on
the patient’s body habitus and body fat percent-
age. Dissecting in this plane maintains the entire
subcutaneous layer on the skin flap and is usually
adequate to maintain adequate vascular perfusion
to the skin flaps. In extremely thin patients, if the
surgeon feels that insufficient subcutaneous tissue
is present, or if the capsule is not clearly defined,
a rim of breast tissue measuring a few millimeters
can be included on the skin flaps in a more con-
servative elevation. The desired base width for
the patient’s body habitus is determined and the
breast parenchyma is marked with a circle of this
diameter centered on the nipple. Parenchymal
reduction is conducted circumferentially to cre-
ate a cone-shaped breast central mound pedicle,
with the apex and resulting point of maximal
projection being the nipple-areola complex. The
amount of tissue to resect can be reliably deter-
mined without needing anatomical landmarks by
using a circular template based on the final antici-
pated base width and resecting tissue outside
of this construct as demonstrated (See Video).
The usual diameter of the neo–breast mound
will vary, again depending on the patient’s body
habitus, breast shape, and desired final breast vol-
ume; however,, in general, as with implant-based
breast reconstructions, this diameter will range
anywhere from 11 to 15 cm as a rough estimate.
For surgeons less familiar with the central mound
 Volume 146, Number 4 • Central Mound Reduction Mammaplasty

Fig. 1. Schematic depicting the central mound reduction technique. (Above, left) A standard Wise-pattern incision is marked on
the patient. (Above, center) The superior skin flaps are elevated in the plane between the breast capsule and subcutaneous tis-
sue. (Above, right) The desired base width is marked, and the breast parenchyma is resected to preserve the central mound cone.
(Below, left and below, center) The central mound pedicle is secured to the upper parenchymal ridge as an internal mastopexy.
(Below, right) Closure.

technique, a more conservative resection can be A ridge of breast parenchyma is intention-

used with the knowledge that additional tissue
can be resected after a tailor-tacking assessment,
as discussed below.
In large ptotic breasts, the surgeon will find
that, in the supine position, the notch-to-nipple
distance will not be as lengthy as in the sitting
position. The central breast mound can easily be
performed on these cases simply because the ves-
sels will still be present from the central mound
originating off of the chest wall. Alternatively, in
extremely severe cases, or if the breast is overpro-
jecting in the supine position, the central mound
can be trimmed appropriately, removing the
nipple-areola complex, in addition to the circum-
ferential resection. The nipple-areola complex is
then grafted in these cases.
ally left at the superior portion of the dissection
cavity in the intrinsic breast mound. This ridge is
approximately 2 to 3 cm in width, spanning the
entire width of the upper quadrants. At this time,
absorbable sutures are placed, securing the newly
shaped and reduced central breast mound to this
superior parenchymal ridge, creating an internal
mastopexy of the entire neo–breast mound. With
this maneuver, the breast mound is supported
not only by the skin envelope, but by the internal
parenchymal mastopexy.
The skin flaps are then redraped and tailor-
tacked with staples. The patient’s back is then
elevated on the operating room table to assess sym-
metry, shape, and nipple position. Adjustments
can be made as necessary. If the initial resection

727
Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
 Plastic and Reconstructive Surgery • October 2020

Fig. 2. Central mound surgical technique. (Above, left) Skin incision with desired pattern. (Above, second from left) Skin flaps raised
in plane between breast parenchyma and subcutaneous fat. (Above, second from right) Full-thickness skin excision on tissue inside
the Wise pattern. (Above, right) Circular template used to mark central mound pedicle with desired base width. (Center, left) Paren-
chyma resection leaving the previously marked conical central mound. (Center, second from left) Marking the superior wedge of
the central mound and (center, second from right) excision of this superior wedge. (Center, right) Internal mastopexy performed by
elevating central mound pedicle where wedge was excised and (below, left) Sutured into place. CM, central mound. (Below, center)
Demonstration of internal mastopexy sutures. (Below, right) Closure.

based on the desired base width template is felt to
be insufficient, more tissue can be resected from
the central mound pedicle in the areas that still
appear inappropriately full or convex. This step
can be repeated with tailor-tacking to ensure that
the final appearance of the breast is the desired
size and shape and that satisfactory symmetry is
achieved. Once the result appears acceptable, the
patient is returned to the supine position and the
incisions are closed after hemostasis is ensured.
A closed-suction drain may be used if desired.
Finally, a new areolar defect is created at a desired
distance from the inframammary fold and the
underlying nipple-areola complex is delivered
and the skin is closed with absorbable sutures.
Study Design
Institutional review board approval for the
study was granted through the University of Cali-
fornia, Los Angeles (no. 18-001222). All patients
undergoing reduction mammaplasty between
June of 1999 and November of 2018 were iden-
tified by using CPT code 19318. This period was
selected because it represents all available years
in our facility’s archives. We further restricted the
study population to only patients of surgeons at
our institution who solely use the central mound
reduction technique. The remaining surgeons at
our institution do not use the central mound tech-
nique, so none of their patients were included.
Both macromastia patients and patients undergo-
ing unilateral symmetrizing reduction for asym-
metry or after reconstruction were included but
were evaluated separately for some outcomes.
Patient demographics, medical comorbidities,
smoking status, operative details, follow-up, and
postoperative adverse events were extracted by
chart review. Patients who had undergone bilateral
reduction mammaplasty for symptoms were then
contacted by phone and were asked to complete
the BREAST-Q reduction module questions on a
Likert scale ranging from 1 to 5 for both their pre-
operative and their postoperative scores. Although
a baseline response before surgery would have
been preferable to eliminate recall biases, this
information is not routinely obtained at our insti-
tution and so the preoperative scores had to be
obtained postoperatively. The use of the individual

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Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
 Volume 146, Number 4 • Central Mound Reduction Mammaplasty

Table 1. Patient Demographics time was 3 hours 34 minutes, and average breast
tissue removed was 533 g from the right and 560 g
Characteristic Value (%)
from the left. Among all patients, average follow-
Mean patient age ± SD, yr 46 ± 15.1 up was 169 days. Complete demographics data are
Mean BMI ± SD, kg/m2 27.3 ± 4.5
Bilateral 227 (69.8) listed in Table 1.
Ethnicity On a per-breast basis for all patients, the
Asian 7 (2.2) following complication rates were observed:
Black 35 (10.8)
Hispanic 19 (5.8) seroma, 0.2 percent; hematoma, 1.1 percent;
Indian 1 (0.3) dehiscence, 2.9 percent; infection, 1.5 percent;
White 220 (67.7) hypertrophic scar, 4.6 percent; nipple necro-
Other 12 (3.7)
Unknown 31 (9.5) sis, 0.4 percent; fat necrosis, 0.9 percent; and
Diabetes 6 (1.8) skin flap necrosis, 1.7 percent. Unsurprisingly,
Hypertension 29 (8.9) nipple necrosis was associated with diabetes
Smoking status
Current 13 (4) (p < 0.001), amount of tissue removed (p = 0.04),
Former 54 (16.6) and hypertension (p = 0.01), and dehiscence was
Never 258 (79.4) also associated with amount of tissue removed
Mean follow-up ± SD, days 169 ± 293
Mean operation time ± SD, min 183.3 ± 62.4 (p = 0.03).
Mean amount of tissue removed ± SD, g Ninety-six bilateral macromastia patients (42.3
 Right 532 ± 331 percent) completed the BREAST-Q Reduction/
 Left 560 ± 351
Mastopexy questions on a Likert scale ranging
from 1 to 5 (Figs. 3 and 4). The following changes
in average symptom frequency were observed
questions on a Likert scale was performed to iso- postoperatively: shoulder pain, 3.40 to 1.41 (of 5)
late the different satisfaction endpoints. Associa- (p < 0.001); neck pain, 2.94 to 1.63 (p < 0.001);
tions between preoperative variables and outcomes painful shoulder grooving, 3.78 to 1.57 (p < 0.001);
were assessed with chi-square tests, Wilcoxon tests, rashes under breasts, 2.08 to 1.09 (p < 0.001); and
and Kendall tau-b correlations. back pain, 3.27 to 1.64 (p < 0.001). Nipple sensa-
tion was also reduced from 3.53 to 3.05 (p < 0.001).
Patients were also satisfied with breast appearance
RESULTS in clothes, 1.48 to 3.70 (of 4) (p < 0.001); breast
A total of 325 patients were identified for size match to their body habitus, 1.46 to 3.70
inclusion (227 bilateral and 98 unilateral; 552 (p < 0.001); breast size, 1.39 to 3.61; (p < 0.001);
breasts). The average patient age was 46 years, breast shape in a bra, 1.91 to 3.64 (p < 0.001);
and the average body mass index was 27.4 kg/m2. comfort of bra fit, 1.53 to 3.59; (p < 0.001); how
Thirteen patients reported actively smoking, and breasts hang, 1.38 to 3.70 (p < 0.001); and how
54 patients were former smokers. Among the bilat- normal breasts appeared postoperatively, 1.57 to
eral macromastia patients, the average operative 3.60 (p < 0.001).

Fig. 3. BREAST-Q symptom results among bilateral macromastia patients.

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Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
 Plastic and Reconstructive Surgery • October 2020

Fig. 4. BREAST-Q satisfaction results among bilateral macromastia patients.

In addition, the revision rates from our series
were very low. Sixteen of 325 patients (4.9 per-
cent) underwent revision for dissatisfaction with
the appearance of their scar, and only three
patients (0.9 percent) requested re-reduction for
inadequate volume removal.
DISCUSSION
Reduction mammaplasty is an important and
common procedure available to breast plastic and
reconstructive surgeons.21 However, safe and effec-
tive implementation of this procedure requires
the maintenance of a robust blood supply to the
nipple while strategically removing excess tissues
to reduce and shape the final breast mound. The
breast parenchyma and skin receive blood sup-
ply from the thoracoacromial artery, internal
mammary perforators (second through fifth),
lateral thoracic artery, thoracodorsal artery, and
terminal branches of the intercostal perforators
(third through eighth), with roughly 60 percent
of the perfusion supplied by the internal mam-
mary perforators. Multiple surgical variations for
performing a reduction mammaplasty have been
reported and popularized among the plastic sur-
gery community, each relying on differing vascu-
lar pedicles.7,9,10,18
The most common technique is the inferior
pedicle with Wise-pattern skin incision.13 The
basic steps for an inferior/Wise reduction involve
the creation of a (usually) deepithelialized infe-
rior pedicle based on perforators from the fourth
through sixth intercostals.22 The superior and lat-
eral tissues are removed based on surgeon judg-
ment, and then the nipple is repositioned to the
apex of the skin incision. Although this technique
remains the most popular, critics have suggested
that the inferior/Wise approach may result in
boxy breast borders and a less appealing final cos-
metic result. In addition, some surgeons believe
that preferential removal of superior tissues with
preservation of inferior tissues can lead to late
pseudoptosis and bottoming-out of the breast
with time.
The second most popular option for reduc-
tion mammaplasty is the superomedial pedicle,
often combined with a limited vertical incision,

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Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
 Volume 146, Number 4 • Central Mound Reduction Mammaplasty
as popularized by Hall-Findlay. Perceived benefits
of this approach include preferential removal of
inferior tissues, reproducible and reliable pedicle,
and reduction in scar burden.7,16
Reports have presented evidence that a supe-
rior pedicle design may provide a longer lasting
lift and better cosmetic match to a prosthetic
reconstruction compared to inferior pedicle tech-
niques.23 Some comparisons between the supero-
medial and inferior/Wise techniques suggest that
complication rates are comparable between these
two techniques.24,25 However, in a literature review
and retrospective analysis of 938 procedures by
Bauermeister et al., the superomedial reduction
technique was associated with lower complication
rates than the inferior/Wise technique based on
comparisons to historical controls.26
The central breast mound reduction tech-
nique has the advantage of being supplied from
multiple sources. Because the base of the mound
is never violated, some have called this technique
the “maximally vascular central breast mound
reduction,” as perforators from the internal
mammary, intercostal, thoracoacromial, and
perhaps some branches from the lateral thoracic
arteries can contribute to the central mound
vascular supply. The maximally vascularized
pedicle enables the central mound technique
to be used for all appropriate breast reduction
candidates. There are no specific contraindica-
tions for this approach other than general con-
traindications for reduction mammaplasty.27
Conceptually, the central breast mound reduc-
tion technique has the following significant
advantages:
1. Wide skin undermining, which allows
redraping of the overlying skin envelope in
a much more controlled and tension-free
fashion.
2. Circumferential resection of the large and
ptotic breast parenchyma in a dome-shaped
fashion.
3. Creation of an internal parenchymal masto-
pexy by securing the upper pole of the new
breast mound to the upper glandular ridge
or pectoralis major fascia.
4. Tension-free closure of skin flaps. Because
the skin flaps do not bear the primary bur-
den of supporting the new breast mound,
the scars should in theory be less prone to
hypertrophic scar formation.
In our retrospective evaluation, we review
the largest number of breasts undergoing a
Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
central mound reduction that we are aware
of.28 Although a robust analysis is not possible
because of differences in patient populations,
resected tissue amounts, and follow-up duration,
we observed a lower complication rate in our
series than previously described in other stud-
ies that used inferior/Wise or superomedial pat-
terns.24–26,29 We also observed correlation between
the amount of tissue removed and complication
rates, which is consistent with prior studies.4,6
These data do not allow a definitive comparison,
but provide evidence that the central mound
technique offers a safe alternative for reduction
mammaplasty.
Regarding the effectiveness of the central
mound technique, we observed substantial and
statistically significant improvements in all symp-
tom and appearance questions from the BREAST-
Q Reduction/Mastopexy module, asked on a
Likert scale ranging from 1 to 5, among macro-
mastia patients. On average, patients reported
reduced or relieved symptoms along with an
enhanced and harmonized appearance. Unfor-
tunately, these data are limited by susceptibility
to recall bias because preoperative values were
acquired postoperatively during the retrospective
review. They are also not directly comparable to
other studies, which reported aggregate scores of
a total of 100. Again, these data provide a reas-
suring benchmark for the success of the central
mound technique. Patient satisfaction was simi-
larly reflected in the very low revision rates of 4.9
percent for scar revision and 0.9 percent for revi-
sion of the reduction itself, although we acknowl-
edge that these rates may be underestimates
because patients may undergo revisions at a dif-
ferent center if they are truly unhappy with their
results. Figures 5 and 6 demonstrate typical results
in a patient undergoing central mound reduction
for macromastia.
In addition, although we observed a statistical
reduction in nipple sensation in our cohort, the
degree was relatively minor based on the BREAST-
Q questionnaire, decreasing only from 3.53 to
3.05 (p < 0.05) and unlikely to be clinically mean-
ingful. Although there are not comparable data
on nipple sensation in relation to the BREAST-Q
from other studies, the decrease observed in our
series was likely relatively minimal. We believe
that the central mound technique may have par-
ticular utility in preserving sensation to the nipple
because of the centrally preserved tissues under-
lying the nipple-areola complex. For example,
superiorly based pedicles have been associated
with the greatest reduction in nipple sensation
731
 Plastic and Reconstructive Surgery • October 2020

Fig. 5. Frontal views of a patient who underwent bilateral reduction mammaplasty for macromastia with removal of 833 g from
the right and 814 g from the left shown (left) preoperatively, (center) 6 weeks postoperatively, and (right) 1 year postoperatively. Of
note, the patient lost weight between 6 weeks and 1 year postoperatively.

Fig. 6. Lateral views of the patient who underwent bilateral reduction mammaplasty for macromastia with removal of 833 g from
the right and 814 g from the left shown (left) preoperatively, (center) 6 weeks postoperatively, and (right) 1 year postoperatively. Of
note, the patient lost weight between 6 weeks and 1 year postoperatively.

because of resection of underlying tissues.30 Prior
sensitivity comparisons between the superomedial
and inferior/Wise techniques have concluded no
difference in postoperative nipple sensations.31,32
However, these studies used objective sensation
measurements, and the results cannot be com-
pared to the subjective results in our cohort based
on BREAST-Q questions.
The centralization of the pedicle under-
neath the final nipple position has additional
theoretical advantages that are more difficult to
measure. By minimally disrupting the underly-
ing breast parenchyma, lactation is likely to be
less impaired compared to other techniques.
The preservation of a cone of breast tissue
directly underneath the nipple also allows the
placement of the nipple-areola complex at the
point of maximal projection, which may be par-
tially responsible for the high satisfaction scores
observed in our patient population. The reliance
on a central, maximally vascularized pedicle also
allows the central mound technique to be used
safely in patients undergoing re-reduction with
unknown prior pedicle, or patients with a history
of radiation therapy.
Ultimately, our evaluation of the central
mound technique in 552 breasts demonstrates
reassuring safety and effectiveness outcomes.
Our data provide a benchmark in a large series
of patients to establish the expected complication
rates and efficacy results. Further rigorous evalu-
ation will be required to understand the relative
benefits or disadvantages compared to other
techniques.

732
Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
 Volume 146, Number 4 • Central Mound Reduction Mammaplasty
CONCLUSIONS
The central mound reduction mammaplasty
technique offers a relatively safe and effective
method for treating patients with symptomatic
macromastia or breast asymmetry. Theoretical ben-
efits for this technique include versatile reduction,
preservation of nipple sensation, reliable nipple
perfusion in re-reduction patients, and sustained
results with internal mastopexy. Further research is
needed to robustly assess the relative performance
compared to alternative reduction techniques.
Andrew Da Lio, M.D.
Division of Plastic Surgery
200 Medical Plaza Suite 460
Los Angeles, Calif. 90095
adalio@mednet.ucla.edu
@drdalio
@mikedelongmd
@doctor.eddie
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