ABSTRACT
Scenario B This is the more common scenario in which standard techniques must be modified to satisfactorily fill the defect. The two basic modifications are either an extension to the nipple-areolar pedicle, which is then rotated into the defect, or alternatively creation of a secondary pedicle. Many possibilities exist in terms of the exact orientation of these pedicles. The principles governing choice of pedicle include the following:
l Quality of breast tissue l Viability of pedicle l Ease with which the pedicle is going to fill the defect l Degree of rotation of pedicle
Though the value of mammoplasty techniques centers on their adaptability, in practice the range of potential techniques is usually confined to a limited number of procedures as follows:
l For defects in the lower half of the breast (i.e., below a horizontal line drawn through the proposed nipple position) an extended nipple-areola pedicle is often used. The latter can be based either superomedially or superolaterally (Fig. 4).
