Which technique for which breast? A prospective study of different techniques of reduction mammaplasty.

This study was designed to analyse the outcome of three different techniques of reduction mammaplasty with long-term follow-up. We developed a prospective protocol to record patient satisfaction and complaints as well as to objectively quantify the final result. The techniques used were the B-technique of Regnault, the Eren technique and the Frey technique. The technique was chosen according to a preoperatively applied protocol. Eighty-one women, all of whom exhibited physical symptoms of macromastia, were followed up postoperatively for 12 months to 5.4 years (mean 31.8 months). The relief of chronic back pain, improvement of mastodynia and overall satisfaction were rated by the patients subjectively and were reduced with all three techniques. Long-term stability of the postoperative result, especially of the vertical inframammary distance, was achieved in the techniques using a central pedicle and dermis suspension, namely the Eren and the Frey techniques. In smaller and medium-size reductions a medial submammary scar can be avoided using the Frey techniques. Complications, secondary scar and dog-ear revisions were significantly less frequent in the techniques with B-shaped skin incisions. For reductions with nipple transpositions up to 10 cm we prefer the Frey technique. In reduction mammaplasties with nipple transpositions more than 10 cm the Eren technique should be performed. The free nipple-areola graft is the procedure of choice in the treatment of gigantomastia.