Şeyda GÜRAY, Cihan GENÇTÜRK
Turkish Journal of Plastic Surgery - 2026;34(3):87-92
Introduction: Postoperative pseudoptosis ("bottoming-out") and upward nipple-areola complex rotation remain important late esthetic problems after reduction mammaplasty. Dermal flap suspension to the pectoralis major fascia provides internal support, but maintaining a stable breast cone requires parenchymal reshaping. This study compared dermal flap suspension with a novel anatomic resuturing technique designed to reconstruct internal breast architecture without external fixation. Materials and Methods: A retrospective comparative analysis included 39 women undergoing Wise-pattern reduction mammaplasty with a superomedial pedicle. Group 1 underwent dermal flap suspension to the pectoralis major fascia (n = 21); Group 2 underwent anatomic resuturing with pedicle rotation and pillar-based parenchymal reapproximation (n = 18). Outcomes included body mass index, resection weight, pre- and postoperative nipple-jugulum distances, and 12-month BREAST-Q Reduction/Mastopexy scores. Independent-samples t-tests were performed, and analysis of covariance (ANCOVA) adjusted for baseline nipple-jugulum distance. Results: Baseline body mass index, preoperative nipple-jugulum distance, and resection weight were comparable. Postoperative nipple-jugulum distance differed between techniques (21.16 +/- 0.39 cm vs. 22.26 +/- 1.49 cm; P = 0.007), and technique remained an independent predictor after adjustment (ANCOVA P = 0.003). Despite this difference, the anatomic resuturing group reported higher BREAST-Q scores across domains, particularly satisfaction with outcome (81.3 +/- 14.5 vs. 68.5 +/- 12.0; P = 0.002) and sexual well-being (72.9 +/- 10.1 vs. 64.4 +/- 7.9; P < 0.001). Conclusions: In Wise-pattern, superomedial-pedicle reduction mammaplasty, anatomic resuturing with pedicle rotation and pillar-based parenchymal reapproximation produced better 12-month patient-reported outcomes than dermal flap suspension to the pectoralis major fascia.
