90 consecutive patients who had a modified Passot (no vertical scar) breast reduction technique are presented. At least three authors have reported variations on this technique in recent times. Additional modifications for ease of dissection and breast shaping are outlined. All cases presented were done by the reporting surgeon.

Study population: All patients had symptomatic breast hypertrophy. No smokers were identified within the patient population. Age ranged from 17 to 65 years. Follow-up ranged from one to five years.

Study design: a retrospective review of all patients charts and medical record was carried out. Data including age, height, weight, comorbid conditions, brassiere size, sternal notch to nipple distance and inframammary fold to nipple distance were tabulated. Weight of breast tissue resected was recorded in the operating room and later correlated with pathology reports. No free nipple grafts were performed.

Results: Patient's weight averaged 195 pounds with a range of 121 to 310 pounds. Average sternal notch to nipple distance was 38.5 centimeters with a range of 29 to 56 cm. Amount resected from a single breast averaged 1575 g with a range of 420 to 4899 g. Drains were kept for an average of 6 days. Fixation to the chest wall was performed with number 1 PDS sutures and coning of the internal brassiere was done utilizing 2-0 Prolene. Excellent maintenance of breast shape and projection was seen in all cases with minimal or no bottoming out up to five years.

Major complications: one patient (1%) had partial areola loss with retraction of the remaining nipple areola complex. Five (5%) patients had tissue loss in the region of the inframammary fold. Of these five patients, three had moist dressings and two were returned to the operating room in the perioperative period for debridement and closure, converting them to a vertical scar technique. One (1%) patient was returned to the operating room for hematoma evacuation with closure. As a subset, 32 patients (36%) had sternal notch to nipple distance in excess of 40 cm. Three of the7 major complications outlined in this section belonged to this group.

Minor complications: liquefied fat necrosis or seroma requiring aspiration or replacement of drains (7%); superficial de-epithelialization or minor wound separation treated with moist dressing or Band-Aids(10%); hypertrophic scarring requiring depot steroid injections(3%); calcific steatonecrosis requiring excision or liposuction under local anesthesia(2%) ; and palpable subcutaneous suture (2%).

Conclusion: a technique for breast reduction is described which utilizes a wide-based pedicle, coning with sutures, and chest wall fixation to predictably determine breast shape and prevent "bottoming out". The procedure is particularly suitable for those with moderate to severe breast ptosis and can be applied to breast reduction as well as mastopexy. Elimination of the vertical scar provides an additional benefit, particularly in those prone to hypertrophic scarring. Although the technique can be modified to incorporate free nipple graft, the use of this technique significantly reduces the need to resort to free nipple graft even in cases of severe breast hypertrophy.