In this woman, we did a superior pedicle, to give you an idea about this picture. As you are looking at it, on the left side is the head of the patient. The nipple where my arm is, is towards the belly button. The part that I’m holding with my right hand is where the blood supply comes from to the nipple. I like the superior pedicle as it preserves volume in the upper part of the breast. If you look at the before photo you can see that even though she has large breasts, there is very little volume in the upper part of her breasts. My aim is always to give you smaller breasts but still perky and a nice shape.
Now, it all depends on how far the nipple-areolar complex needs to travel. If you have a really, really low set breast, very hangy, very saggy, I usually do a medial-pedicle because that can swing the nipple-areolar way up. If you only have a little bit of distance to go, then a superior pedicle is really good because it preserves the upper fullness. The inferior pedicle is an old fashion pedicle that’s been down for many, many years, 30 years plus, and is associated with a wise pattern excision, which I’ll explain in a moment.
The inferior pedicle, the problem with that one is that all the tissue is on the bottom, so over time you actually get more sagginess. I prefer using the superior or the medial-pedicle. However, at times if you’re having a revision and you had the previous inferior-pedicle, we would go with this one for your revision surgery.
It is all tailored made to your breasts. The excision pattern is very different from the pedicle. The first thing you decide is, how long does the nipple-areolar need to travel? Then, you do your blood supply, where does it comes from, and then you decide on how to do the excision pattern. The excision pattern just means basically how much skin you cut out and how you do it. If you get a tiny bit of skin then you really only need around the nipple straight down, if you had a lot of excess skin, then you need to cut a horizontal excess out as well.
If you have a lot of skin down the side of your breasts, then you will need an extended cut down the side. Again, it’s all tailored, custom made, it’s not cookie cutter solutions. I do this on each and every breast, it’s slightly different because everyone is different and unique. I will tailor it so that you get the best possible result and for each and every person. Sometimes, each and every person is different too, so you can have a breast that has less sagginess and more sagginess on the other side, and you do different techniques to even them out.