Superolateral pedicle for breast surgery: an operation for all reasons

The evolution of procedures for reduction of breast volume and improvement of breast shape has been ongoing, based on the rich blood supply that has allowed a plethora of pedicle types. With particular consideration of the primary pattern of sensory innervation to the nipple-areola complex previously described, the authors have used the superolateral dermoparenchymal pedicle as a basis for surgery on a variety of presenting breast shapes. This has been proven to be a versatile and effective technique for a wide array of breast morphologies with differing patterns of skin excision. The operative technique involves superior rotation of a superolaterally based dermoparenchymal pedicle, resulting in a "periwinkle" effect that provides desirable superior pole fullness and increased projection to the breast. More than 1500 breast procedures have been performed by the senior author (Strauch) during the past 15 years using the superolateral pedicle. Experience has demonstrated that the operation is safe, with total nipple-areola complex loss observed in only four cases. Long-term follow-up to 15 years has shown that the results are maintained well with time. The superolateral dermoparenchymal pedicle has fulfilled the goals of successful breast surgery. It is a safe and effective technique that has provided long-lasting results for patients. The design of the procedure can be adapted to a variety of skin excision patterns and breast morphologies.