McKissock's Reduction Mammaplasty Revisited: A Case Series Study with 12-months Follow-up.

Background: Reduction mammaplasty is 1 of the highly challenging yet demanded plastic surgeries worldwide. Different techniques have been described, and their modifications are always evolving to achieve better aesthetic results. The objective of the current study was to explore the efficiency and safety of bipedicled McKissock's technique with 3 newly added modifications as a reliable procedure for reduction mammaplasty.

Methods: The study was conducted in Royal Hospital, Cairo, Egypt, during the period from January 2015 to October 2016. It included 25 female patients undergoing reduction mammaplasty. All patients were evaluated by detailed history, careful physical examination, and photographed pre- and postoperatively. The new modifications included surgical undermining and thinning of the bipedicle for volume reduction and contour enhancement. The second modification was a dermal suspension of the lower pole for parenchymal support and longer breast shape stability. The third change was an S-shaped folding of the upper pole of the pedicle during nipple-areolar complex (NAC) transposition. After the operation, all subjects were followed up for 12 months to assess the outcomes of the procedure.

Results: Twenty-five female patients were included in the analysis of this study. The age of the patients ranged from 22 to 49 years with a mean age of 36.2 (7.3) years. The mean body mass index was 30.5 ± 4.3 kg/m2 with a minimum of 24 and a maximum of 38. The average time of operation was 4 hours. The resected tissue was 630-980 g. The optimal aesthetic appearance of the breasts was achieved at 6-9 months postoperatively and marinated to 12 months. The maintenance of improvement was measured by the distance between the mid-clavicular point and 12 O'clock point of the NAC (12'NAC). It varied between 28 and 43 cm preoperatively (mean ± SD, 34.12 ± 4.19 cm), and between 19 and 22 cm postoperatively (mean ± SD, 20.70 ± 1.03 cm; P < 0.001). The average percentage reduction in mid-clavicular point-NAC distance was 38.7% ± 6.2% with a minimum reduction of 27.6% and a maximum 48.8%. Moreover, the nipple to inframammary crease distance varied between 16 and 20 cm preoperatively (mean ± SD, 16.08 ± 1.66 cm), and between 8 and 10 cm postoperatively (mean ± SD, 8.04 ± 0.79 cm; P < 0.001). The patients were very satisfied in most of the cases (20 cases), satisfied in 3 cases, and 2 cases were unsatisfied as they wanted slightly smaller breasts. No complications detected in 18 cases (72%), superficial wound dehiscence at the T-junction in 3 (12%), and seroma in 1 (4%). Two cases (8%) demanded smaller breasts and 1 case (4%) needed a surgical revision of widened scars after 11 months. The major drawbacks were NAC sensitivity alteration and the inability to lactate.

Conclusion: We can conclude that our modifications for the McKissock's technique with its maintained aesthetic shape in those patients are a reliable option that can be considered, as it is a simple, efficient, and satisfactory method that can improve the results of reduction mammaplasty operations.