International Journal of Clinical Research

Objective One of the fundamental goals of breast reduction plasty is to create fullness in the upper pole of the breast. The procedure aims to resect as much excess skin and glandular tissue as possible while ensuring the blood supply to the nipple-areola complex (NAC), and to achieve an aesthetically pleasing breast shape postoperatively. The superior-pedicle (S-P) technique can provide additional tissue for the upper pole; however, folding of an excessively long pedicle may compromise the blood supply to the NAC. The medial-superior pedicle (SM-P) technique avoids the need to fold the breast pedicle, but its limitation lies in its inability to increase the amount of tissue in the upper pole. By integrating the advantages of the S-P and SM-P techniques, we designed a new surgical method to enhance the fullness of the upper pole of the breast after reduction mammoplasty for macromastia. Methods From March 2022 to March 2025, the Department of Plastic Surgery at People's Hospital of Xinjiang Uygur Autonomous Region enrolled 40 patients with macromastia. Among them, 20 patients underwent breast reduction and uplift correction using the traditional medial-superior pedicle technique with a vertical incision (control group), and the other 20 patients were treated with the modified SM-P/S-P technique (experimental group). Two plastic surgeons who were unaware of the specific surgical methods performed a blinded evaluation of the success rate of upper pole fullness based on pre- and postoperative photographs of all patients. The success rate was scored on a 1-10 scale, determined by the degree of difference in upper pole fullness between pre- and postoperative periods: a score of <5 indicated no difference (failure), 5-7 indicated a moderate difference (average), and 8-10 indicated a significant difference (success). Photographs of the patients were taken from five angles: anterior view, left and right oblique views, and left and right lateral views. Results Among all patients, the average score in the experimental group was 8.2 ± 1.2, while that in the control group was 7.1 ± 1.8. No major complications were observed in any patient, including glandular necrosis, NAC necrosis, or sensory disturbance. Conclusion The modified vertical incision with the medial-superior pedicle technique for correcting hypertrophic and ptotic breasts ensures the safety of pedicle blood supply, allows personalized operation, and enables sufficient resection of redundant tissue. Postoperative scars are inconspicuous, and the breast shape is full and symmetrical. For patients with mild (partial cases), moderate (all cases), and severe (most cases) macromastia complicated with ptosis, this technique can significantly improve the fullness of the upper pole of the breast. Currently, there are still aspects of the reduced and reshaped breasts that are not satisfactory postoperatively, and many details need further improvement. Integrating this technique into the Enhanced Recovery After Surgery (ERAS) protocol for breast reduction plasty, to provide patients with a safe, aesthetically pleasing, and comfortable experience, is our ultimate goal.

Macromastia; Breast reduction plasty; Medial-superior pedicle technique