Vertical Breast Reduction with Limited Horizontal Scar: A Broad-Based Superior Areolar Pedicle Approach Ensuring Neurovascular Safety and Emphasizing Shape Stability.

INTRODUCTION

Breast reduction surgery aims to alleviate physical symptoms and improve breast esthetics. Vertical techniques have evolved to reduce scarring and complications. This study describes a modified vertical breast reduction technique utilizing a broad-based superior areolar pedicle to enhance neurovascular safety and long-term contour.

METHODOLOGY: A multicenter retrospective review included 194 patients who underwent implant-free vertical breast reduction between 2020 and 2024. Exclusion criteria were prior implant surgery or <6 months of follow-up. Demographics, resected tissue volume, surgical time, nipple-areola complex (NAC) elevation, and complications were analyzed. Patients were stratified by risk factors including BMI >30 kg/m2, resection >1000 g, smoking, diabetes, and prior irradiation. Statistical significance was set at p<0.05.

RESULTS

The mean patient age was 42.2 years, and BMI was 25.4 kg/m2. The average total breast tissue resected was 570.7 g. Combined procedures were performed in 27.8% of cases. Complications occurred in 4.1% of patients, primarily minor issues such as unesthetic scars and wound dehiscence. No cases of areolar necrosis or infection were observed. Risk factor stratification and NAC elevation >8 cm did not significantly impact complication rates.

CONCLUSION

The proposed technique is safe, effective, and versatile for both moderate and large-volume reductions. It offers a low complication rate, preserves NAC vascularity and sensation, and enables intraoperative customization. This approach is a reliable alternative to traditional patterns, providing shorter scars and stable, long-term esthetic outcomes.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .