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For decades, the most popular procedure in breast reduction (or breast lift) surgery has been the inferior pedicle technique. For women with excessively large breasts, it has been reliable in providing:

  • more attractive breasts

  • the ability to exercise

  • the ability to fit clothes normally

  • relief from back pain

However, the Interior pedicle technique has had is weaknesses, the main one being the extent or scarring it produces.

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Its constellation of three scars resembles a boat anchor: a circular scar surrounds the nipple-areola complex, a second scar runs from the circular one down to the fold underneath the breast, and a long, third scar runs along this fold. The third scar is the most problematic of all, as it is the most visible one and the one most likely to grow wide and thick and even keloid (raised, reddish scar tissue).

"Fall-out" is another problem that can develop after this type of breast reduction. This is due to the very design of the inferior pedicle technique. During this technique. the plastic surgeon raises skin flaps and removes excess fat, breast tissue and skin. The nipple and areola remain attached to the mound of breast tissue the surgeon leaves in place, and these three structures together comprise the "pedicle"."After the plastic surgeon contours the pedicle, he wraps the skin flaps tightly around it. He stitches the skin edges together under a considerable amount of tension. The skin serves as the "brassiere that maintains the shape and location of the breast. For several months every patient enjoys her new, perky breasts. For this short duration, her breasts remain high on the chest wall and possess upper fullness. Unfortunately, this excitement does not last forever.

Within six months, the perkiness disappears in a large percentage of women. Gravity and tension cause the skin to stretch, and this allows the breast mound to fall down ward. Eventually, the once perky breasts end up lower on the chest. Superior fullness seems to melt away. We call this "fall out". The nipples do not descend with the breast mounds so, relative to the breast mounds; they end up too high on the chest. In the worst-case scenario, the nipples point upward (toward the stars). We have a name for this too: "star gazing". "Fallout" and "star gazing" would not develop if the shape and location of the breast did not depend primarily on support from the skin brassiere. But with the interior pedicle technique, they do.

Over the last ten years or so, plastic surgeons all over the world have been looking for answers to these two shortcomings of the inferior pedicle technique. We believe the answer is at hand - The Vertical Breast Reduction. Following a Vertical Breast Reduction, there is less scarring and a lower incidence of fallout when compared to the inferior pedicle technique.


In the great majority of cases, the Vertical Breast Reduction technique doesn't require that third scar running along he fold underneath the breast. The scars following Vertical breast reduction, therefore, usually resemble a lollipop rather than an anchor.

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During Vertical Breast Reduction, we remove a single central wedge of tissue from the inferior part of each breast. The pedicle arises from the upper part of each breast. We rotate the pedicle until it occupies its new home. We then close the resultant defect vertically, by sewing both sides of the breast together. The final form of the breast results from the molding and sewing together of breast tissue, rather than dependence on a skin brassiere. Since there is little tension across the skin, the skin is less likely to stretch. Thus, the breast mound is less likely to fall.

The Vertical Breast Reduction technique is gaining popularity across the nation. It may even eventually replace the inferior pedicle technique as the standard procedure for breast reduction surgery. There are two reasons for this. First, the great majority of patients who undergo vertical breast reduction can avoid that long scar that runs along the inferior mammary fold. Second, patients who undergo Vertical Breast Reduction can expect a lower incidence of fall-out and stargazing.


Like any procedure, the vertical breast reduction does have a weakness. Occasionally, a patient is left with a small lump of extra skin where the lower end of the lollipop scar approaches the inferior mammary fold. Fortunately, this can easily be corrected in the office setting with local anesthetic alone, and the horizontal scar that results is only a few centimeters long, a vast improvement over the horizontal scar that results from the inferior pedicle technique.

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