Modified McKissock Technique for Secondary Breast Reduction – A Prospective Study on Safety, Surgical and Aesthetic Outcomes

Summary: Numbers of secondary breast reductions are increasing but those are potentially associated with higher complication rates than primary mammaplasty. Necrosis of the Nipple-Areola-Complex (NAC) is a devastating complication that can occur after repeated NAC transposition, particularly when the initially used pedicle is unknown. Thus, the authors established a modification of McKissock’s technique for secondary breast reductions including three pedicle components to ensure safe vascular supply of the NAC. The presented technique incorporates a superior and inferior dermoglandular pedicle according to McKissock and an additional central pedicle. The technique was applied for secondary breast reduction in a series of 25 breasts (14 patients: 11 bilateral, 3 unilateral). Complication rates, pre- and postoperative BREAST-Q scores, and aesthetic outcomes were evaluated. Mean resection weight was 299 g (range, 40-646), and the NAC was transposed by 4.2 cm on average (range, 1-10). No case of NAC-necrosis was observed, and comparison of pre- and postoperative BREAST-Q values indicated substantial improvement in all domains. Postoperatively, 84.6% of patients reported excellent satisfaction with breast appearance. According to those results, the modified McKissock-technique is a safe technique for patients requiring secondary breast reduction, even if the primarily used pedicle is unknown. Additionally, the established technique is associated with improved postoperative patient-reported outcomes and yields aesthetically favorable results.