The great majority of plastic surgery teaching programs in the United States still continue to favor the inferior pedicle techniques of reduction mammaplasty which is in contrast to their European, South American and Asian counterparts where the short scar or vertical mammaplasty techniques are far more common. The reasons for this could be that the vertical scar procedures are felt to be more intuitive and therefore harder to teach to residents and also there may be a certain reluctance to leave the operating room without the final result since it may be many weeks to months before the breasts settle into their final form. This article describes in detail each step of a vertical mammaplasty technique with a supero medial pedicle and a short inframammary scar. It also outlines modifications to existing vertical mammaplasty techniques such as that described by Hall-Findlay. All of these components create a technique that is easy to teach and fast (average operating time 1 hour 45 min). The final result can also be appreciated immediately on the table producing breasts with excellent shape and projection and minimal inframammary scars. From January 2001 to December 2004, 100 consecutive patients (195 breasts) had reduction mammaplasties using this technique. The average amount of breast tissue removed per breast was 650 g (range 350 to 1900 g). Complications were minimal; there was one hematoma which was evacuated without adverse effects to the nipple areola complex (NAC) or to the final result. There were no cases of necrosis of the NAC, either partial or complete. Six (6%) patients had to be revised for excess fullness of the lower pole and excess length of the vertical limb from NAC to inframammary fold. These 6 patients were in the first group of 20 patients, since then no patients have required revisions. This technique can be applied to any size breast and any skin type with minimal complications and scarring and predictable results.

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