Clinical Presentation
High-density clusters of perforators within 10 to 20 cm of the C7 reference point suggest reliable vascular supply for flap survival in reconstructive surgeries [PMID:25357058].
Management
In a retrospective review of 325 patients undergoing central mound breast reduction, the study reported low complication rates including seroma (0.2%), hematoma (1.1%), dehiscence (2.9%), infection (1.5%), hypertrophic scar (4.6%), nipple necrosis (0.4%), and fat necrosis (0.9%) [PMID:32590526].
The study identified a significant number of perforators in the thoracic region, including areas near the fifth thoracic vertebra, which can be utilized for pedicled flaps enabling reconstruction with minimal donor-site morbidity [PMID:25357058].
Through the creation of a strong, durable 'dermal cage' fixed to the chest wall, this technique narrows the breast, improves projection, and reduces tension on the inferior pedicle, minimizing postoperative wound dehiscence and long-term complications like 'bottoming out' [PMID:23358579].
Complications
Among the complications observed in the study, hypertrophic scarring occurred in 4.6% of cases, highlighting its significance as a potential adverse outcome [PMID:32590526].
Some lumbar perforators were found to cross the midline, connecting with contralateral perforators via linking vessels, which could pose challenges and increase complication risks in clinical applications [PMID:25357058].
By mitigating tension on the T junction through chest wall fixation, this method significantly lowers the risk of wound dehiscence in the early postoperative period [PMID:23358579].
Prognosis & Follow-up
The average follow-up period for patients in this study was 169 days, indicating a follow-up duration of roughly 6 months to assess outcomes and complications [PMID:32590526].
The technique effectively reduces tension on the nipple-areola complex, leading to better long-term support and reduced likelihood of breast tissue sagging over time [PMID:23358579].
References
1 DeLong MR, Chang I, Farajzadeh M, Nahabet EH, Roostaeian J, Festekjian J et al.. The Central Mound Pedicle: A Safe and Effective Technique for Reduction Mammaplasty. Plastic and reconstructive surgery 2020. link 2 Aho JM, Laungani AT, Herbig KS, Wong C, Kirchoff RW, Saint-Cyr M. Lumbar and thoracic perforators: vascular anatomy and clinical implications. Plastic and reconstructive surgery 2014. link 3 Zic R, Vlajcic Z, Dewing D, Zambelli M, Stanec Z. The "dermal cage": a modification of the inferior pedicle breast reduction. Aesthetic plastic surgery 2013. link