Covid - 19 Protocols

A recent article in the journal Plastic and Reconstructive Surgery (DeLong, M.R., et. al., 146(4):725-733, October 2020) reported on a large series of patients from a single institution who underwent a central mound breast reduction.  This type of breast reduction technique is the one that I have employed for most of my time in practice.  The earliest breast reduction techniques employed a “free nipple graft”. This means that the nipple was removed and then replaced in the same manner as one would suture a skin graft. There were many issues with the free nipple graft the least of which was the final appearance.  The patients lost all sensation in their nipples as well as the ability to breast feed.  Subsequent techniques were developed which solved the problem of repositioning the nipple without removing it.  The blood supply was preserved by moving the nipple on a pedicle (basically a flap of skin and subcutaneous tissue where the epidermis has been removed).  Using this technique, the nipples look unchanged, or close to it, but the issues of sensation and lactation still remained.  In my experience the central mount technique solves these issues.

There were 325 patients in the series described above.  These authors looked at the results in their patients using multiple criteria.  Following surgery, the patients reported significant reductions in shoulder pain, neck pain, shoulder grooves, rashes under their breast and back pain. The patients were also happy with the size and shape of their breasts following the procedure.  As has been my experience, their patients retained nipple sensation.  They did not describe any patients who attempted to breast feed after the surgery; although, in my series, I have had 3 patients who were successfully able to do so.

Thus, as they concluded, the central mound technique for breast reduction is not only safe and effective, but also significantly reduces patient’s symptoms while leaving span aesthetically shaped and sensate breast.