SUBJECT: The vertical reduction mammaplasty is an evolving technique. While the original procedure resulted in significantly decreased scarring, better breast shape, and longer lasting results, the learning curve was steep and cosmetic outcomes were inconsistent. This led many plastic surgeons to attempt a vertical mammaplasty a few times before returning to the more familiar methods with which they were trained—usually some variation of the T-shaped inferior-pedicle technique. Recent modifications by Hall-Findley shortened the learning curve. We have further developed this approach to dramatically simplify preoperative markings, facilitate easy learning and correct cosmetic deficiencies for more reliable aesthetic results. TECHNICAL DETAILS: With the patient standing, three pre-operative marks are made: 1) the inframammary fold; 2) the breast axis; and 3) the apex of the new nipple-areola complex (NAC). The medial pedicle is developed and the breast parenchyma resected. The lateral skin flap is redraped inferomedially and anchored to the chest wall. The inferior aspect of the incision is aggressively debulked and a gathering subcuticular stitch started 2 cm below the NAC. Finally, the apex is temporarily closed while a 38-42 mm NAC marker is used to create a circular defect 0.5 cm medial to the vertical axis. At our institution, 43 patients were treated with a median follow-up of 15 months. Average reduction was 683 gm/breast, with 14 reductions >1000 gm/breast. There were no major complications. PRACTICAL VALUE: Using our modified vertical reduction mammaplasty, we have found the following: 1) chest wall anchoring improves shape; 2) aggressive debulking avoids the persistent inferior bulge; and 3) starting the subcuticular gathering suture 2 cm below the nadir of the NAC prior to insetting eliminates the teardrop deformity. These innovations dramatically soften the learning curve and improve aesthetic outcome by simplifying pre-operative markings and eliminating the NAC teardrop deformity, the lateral NAC deviation, and the inferior dog-ear. Our modified vertical reduction mammaplasty is a simple, easy-to-learn technique with aesthetically superior and enduring results.

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