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Morphometric analysis of two breast reduction techniques: The Yin-Yang and the Inferior Pole Pedicle techniques
Francesco Gargano, M.D. Phd1, Suma Sangisetty, M.D.1, Noah Prince, B.S.2, Jack Bevivino, M.D.1, Lawrence Bowen, M.D.1, Lee Edstrom, M.D., , FACS1, Paul Liu, M.D., FACS1.
1Brown University, Providence, RI, USA, 2Tufts University School of Medicine, Boston, MA, USA.

PURPOSE:
Breast reduction techniques should aim to achieve “ideal breast shape”. To our knowledge no studies have well defined, with accurate measurements, the morphometric changes occurring during reduction mammaplasties. The goal of our study is to compare two techniques of breast reduction currently used at Rhode Island Hospital and to evaluate which best achieves the “ideal breast shape”. The two techniques studied are:
1) The inverted T inferior pedicle technique using an inferior pedicle to nourish the NAC with inverted T skin closure.
2) The Yin-Yang technique using the principles of gland remodeling characterized by the following: A) superomedial pedicle for the nipple, B) glandular resection pattern with an S-shape on the right breast and opposite mirrored S-shape on the left breast, C) laterally based inferior pole dermoglandular flap. The movement and interdigitation of the two flaps allows narrowing of the mammary base, a stable lower pole and enhanced nipple projection. D) Tension at the T junction is minimized by resecting skin excess via the tailor-tacking method. This also reduces scar length.
METHODS:
A total of 1175 inverted T techniques and 89 Yin-Yang have been performed in the last 5 years by five Authors. All Yin-Yang cases have been performed by a single surgeon, measured and retrospectively reviewed. The study prospectively analyzes 30 patients divided in two groups: 1) 15 patients who underwent the Yin-Yang technique and 2) 15 patients with the inferior pedicle inverted T technique. Patients were stratified for weight, height, BMI, grade of hypertrophy and breast size. Patients requiring mastopexy were not included in the study. Morphometric analysis was performed collecting the following data: nipple projection, mammary base width, position of the new NAC and IMF, nipple-IMF distance. The stability of the breast shape and the lower pole were assessed over time. Photographic documentation with overlapping images was taken before and after surgery. Patient follow up consisted of postoperative visits at 10-14 days and again at 3 months, 6 months, and 1 year.
RESULTS:
 The Yin-Yang technique allows significant breast base narrowing, axillary roll/tail improvement and good nipple projection while decreasing scar length and tension. Similar complication rates and nipple sensation findings were detected between the two analyzed techniques.
 Analysis of the morphometric changes showed statistical significance for base width (p value<0.05) and a trend toward significance for projection (p=0.16)

CONCLUSION: The Yin-Yang technique best achieves breast base narrowing and nipple projection. The statistical significance in mammary base width (p<0.05) shows the Yin-Yang technique, using gland remodeling, is most effective in achieving the "ideal breast shape".



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